Symptoms of Trichotillomania
According to the American Psychiatric Association, the following symptoms must be present to be diagnosed with trichotillomania:
Recurrent pulling out or plucking of one’s hair, resulting in some loss of hair.
Repeated and failed attempts to stop or decrease hair pulling or plucking.
Clinically significant distress (such as sadness, shame, anxiety, etc.) or impairment in important areas of functioning such as occupational, academic, or social.
The hair pulling and/or hair loss is not due to a related medical condition, such as a skin condition. For instance, inflammation of the skin may result in hair pulling and hair loss. Similarly, individuals with alopecia, or naturally occurring hair loss, would not be appropriately diagnosed with trichotillomania.
The pulling or plucking of hair is not the result of another mental disorder, such as attempts at increasing cleanliness in Obsessive Compulsive Disorder. Additionally, trichotillomania should not be confused with hair removal common with obsessional rituals in Obsessive Compulsive Disorder, or other associated disorders. For example, individuals with body dysmorphic disorder may remove hair they find to be aesthetically displeasing. Similarly, individuals with developmental disorders, such as autism, may pull out hair as part of a stereotypic movement disorder.
There is a degree of hair pulling/ plucking which is normative, and does not warrant a diagnosis of trichotillomania. It is common to pluck hair for cosmetic reasons. Similarly, many people play with their hair, curling it around their fingers, etc., and do so without removing a significant amount of hair. In these instances the behavior does not cause significant distress, nor does it result in functional impairment. Thus it is not considered pathological.