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Tests and diagnosis
By Mayo Clinic staffYour doctor will perform a thorough evaluation to determine if you have trichotillomania, which may include examining how much hair loss you have, having you fill out a questionnaire and eliminating other possible causes of hair pulling or hair loss. In some cases, your doctor may also take a biopsy of your hair or skin to try to pinpoint the problem.
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.
- Duke DC, et al. Trichotillomania: A current review. Clinical Psychology Review. 2010;30:181.
- 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 Oct. 12, 2010.
- Stein DJ, et al. Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety. 2010;27:611.
- Chamberlain SR, et al. Trichotillomania: Neurobiology and treatment. Neuroscience and Biobehavioral Reviews. 2009;33:831.
- Chamberlain SR, et al. Lifting the veil on trichotillomania. American Journal of Psychiatry. 2007;164:568.
- Tay YK, et al. Trichotillomania in childhood: Case series and review. Pediatrics. 2004;113:e494.
- Moritz S, et al. Movement decoupling: A self-help intervention for the treatment of trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry. In press. Accessed Oct. 12, 2010.
- Shenefelt PD. Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: Is it all in your mind? Dermatologic Therapy. 2003;16:114.
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