Recurrent pulling out of one’s hair with noticeable hair loss.

Trichotillomania (TTM), also called hair-pulling disorder.

Repetitive hair pulling, leading to noticeable hair loss and functional impairment.

Approximately 4% of the population is affected by TTM.

It is seven times more prevalent in children as in adults.

Majority of cases occurring between ages 4 and 17 years.

Many individuals do not seek help.

88% to 94% are female.

Medical complications include:skin irritations at the hair-pulling site, infections, and repetitive-use hand injuries.

Some patients ingest hairs risking dental and serious gastrointestinal complications caused by trichobezoars.

Associated with significant distress and impairment in emotional and social int2242elationships.

Comorbidity is very common and includes anxiety disorders, mood disorders, substance use disorders, eating disorders, and personality disorders.

The scalp, eyebrows, and eyelashes are the most common areas for hair pulling.

Rarely patients pull hair from the legs, armpits, and pubic region.


Approximately 10% to 30% of patients ingest the hair.

Neuroimaging studies of patients suggest abnormalities in neural regions involved in cognition such as the frontal cortex, and affect regulation by alteration in the amygdala-hippocampal area, and habit learning with putamen changes.

May be associated with altered reward processing within the central nervous system.

In the DSM-5 it is categorized under obsessive-compulsive and related disorders.

Obsessive-compulsive disorder is commonly misdiagnosed for TTM, and often coexist and aggregate in the same family.

Hair pulling may be sporadic or sustained.

Stress may increase hair pulling but the process may occur during periods of relaxation.

Estimated that 2.5% of the population have engaged in such behavior.

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