A 25-year-old woman has severe hair-pulling episodes resulting in significant alopecia. She describes a mounting tension before pulling, satisfaction during the act, and guilt afterwards. She has tried to stop repeatedly but cannot. The DSM-5 diagnosis is:

• A Body dysmorphic disorder
• B OCD, grooming subtype
• C Trichotillomania (hair-pulling disorder) ✓
• D Excoriation (skin-picking) disorder

Explanation

Trichotillomania (hair-pulling disorder) is classified in DSM-5 within the OCD-related disorders chapter. It requires recurrent pulling out of hair with repeated attempts to stop, causing significant distress or functional impairment. The affective sequence (tension → gratification/relief → guilt) is characteristic. Habit Reversal Training (HRT) is the first-line psychotherapy. N-acetylcysteine has some evidence for pharmacotherapy. Body dysmorphic disorder involves preoccupation with perceived defects in appearance with checking behaviours. Excoriation disorder involves skin-picking rather than hair-pulling.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.