J Am Acad Child Adolesc Psychiatry 52 (3): 231 - 240, 2013. doi: 10.1016 / j. jaac.2012.12.020 Key Points In trichotillomania, hair pulling is not triggered by obsessions or concerns about appearance but may be preceded by a feeling of tension or anxiety that is relieved by the hair pulling, often followed by a feeling of gratification.