iety disorder. The most common comorbid conditions are major depressive disorder (up
to 50% of cases), social anxi ety disorder (social phobia), an d generalized anxiety disorder.
Approximately 20% of individuals with hoardi ng disorder also have symptoms that meet
diagnostic criteria for OCD. These comorbidit ies may often be the main reason for consul-
tation, because individuals are unlikely to spontaneously report hoarding symptoms, and
these symptoms are often not asked ab out in routine clinical interviews.
Trichotillomania (Hair-Pulling Disorder)
Diagnostic Criteria 312.39 (F63.3)
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling. 
C. The hair pulling causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning. 
D. The hair pulling or hair loss is not attri butable to another medical condition (e.g., a der-
matological condition). 
E. The hair pulling is not better explained by the symptoms of another mental disorder
(e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic
disorder).
Diagnostic Features
The essential feature of trichotillomania (hai r-pulling disorder) is the recurrent pulling out
of one’s own hair (Criterion A). Hair pullin g may occur from any region of the body in
which hair grows; the most co mmon sites are the scalp, eyebrows, and eyelids, while less
common sites are axillary, facial, pubic, and peri-rectal regions. Hair-pulling sites may
vary over time. Hair pulling may occur in brief episodes sc attered throughout the day or