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Tests and diagnosis
By Mayo Clinic staffYour doctor will perform a thorough evaluation to determine if you have trichotillomania. He or she may need to take a biopsy of your hair or skin to try to pinpoint the problem. A biopsy that shows certain patterns of damage to your hair offers clues as to how the damage occurred. Your dermatologist or primary care doctor may also refer you to a mental health provider for further evaluation and treatment.
To be diagnosed with trichotillomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
DSM criteria for the diagnosis of trichotillomania include:
- Repeatedly pulling out your hair, resulting in noticeable hair loss
- An increasing sense of tension before pulling, or when you try to resist pulling
- Pleasure or relief when pulling
- Your hair loss isn't attributed to another medical or dermatologic condition
- Hair pulling causes you significant distress
There is some debate among mental health providers — and people with trichotillomania — about these criteria, and they may change in the future.
- Woods DW, et al. Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide. New York, N.Y.: Oxford University Press; 2008.
- Fact sheet: Trichotillomania. Mental Health America. http://www.nmha.org/index.cfm?objectid=C7DF9926-1372-4D20-C88C1DDD5A71D709. Accessed Dec. 1, 2008.
- About trichotillomania. Trichotillomania Learning Center. http://www.trich.org/about_trich. Accessed Dec. 1, 2008.
- Trichotillomania in childhood: Case series and review. Pediatrics. 2004;113:3494.
- Trichotillomania. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Dec. 1, 2008.
- Alternative treatments. Trichotillomania Learning Center. http://www.trich.org/treatment_resources/Alternative.asp. Accessed Dec. 1, 2008.
- Chamberlain SR, et al. Lifting the veil on trichotillomania. American Journal of Psychiatry. 2007;164:568.
- Walsh KH, et al. Trichotillomania. Presentation, etiology, diagnosis and therapy. American Journal of Clinical Dermatology. 2001;2:327.
- Zuchner S et al. SLITRK1 mutations in Tricholtillomania. Molecular Psychiatry. 2006;11:888. http://www.nature.com/mp/journal/v11/n10/full/4001865a.html. Accessed Dec. 29, 2008.
- Woods DW et al. Understanding and Treating Trichotillomania: What We Know and What We Don't Know. Psychiatric Clinics of North America. 2006;29:487. http://www.mdconsult.com/das/article/body/114970872-3/jorg=journal&source=MI&sp=16170821&sid=786898514/N/532552/1.html?issn=0193-953X. Accessed Dec. 29, 2008.
