Functional Consequences of 
Trichotillomania (Hair-Pulling Disorder)
Trichotillomania is associated with distress as well as with social and occupational impair-
ment. There may be irreversible  damage to hair growth and hair quality. Infrequent med-
ical consequences of trichotillomania includ e digit purpura, muscul oskeletal injury (e.g.,
carpal tunnel syndrome; back, shoulder and neck pain), blepharitis, and dental damage
(e.g., worn or broken teeth due to hair biting). Swallowing of hair (trichophagia) may lead
to trichobezoars, with subs equent anemia, abdominal pain , hematemesis, nausea and
vomiting, bowel obstruction,  and even perforation. 
Differential Diagnosis
Normative hair re moval/manipulation. Trichotillomania should not be diagnosed when
hair removal is performed solely for cosmetic reasons (i.e., to improve one’s physical ap-
pearance). Many individuals twist and play with  their hair, but this behavior does not usu-
ally qualify for a diagnosis of trichotillomania . Some individuals may bite rather than pull
hair; again, this does not qualify for a diagnosis of trichotillomania.
Other obsessive-compulsive and related disorders. Individuals with OCD and sym-
metry concerns may pull out hairs as part of their symmetry rituals, and individuals with
body dysmorphic disorder may remove body ha ir that they perceive as ugly, asymmetri-
cal, or abnormal; in such cases a diagnosis of  trichotillomania is not given. The description
of body-focused repetitive behavior disorder  in other specified ob sessive-compulsive and
related disorder excludes individuals who meet  diagnostic criteria for trichotillomania.