Diagnosis of Trichotillomania Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria Diagnostic criteria for trichotillomania typically include the following: Removing hair, resulting in hair loss Making repeated attempts to decrease or stop the hair pulling Experiencing significant distress or impairment in functioning from the activity While alopecia has a range of causes, individuals with trichotillomania typically volunteer that their alopecia is due to hair-pulling.