According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the essential feature of trichotillomania is the recurrent pulling out of one's own hair that results in noticeable hair loss. Sites of hair pulling may include any region of the body in which hair may grow, with the most common sites being the scalp, eyebrows, and eyelashes. Hair pulling may occur in brief episodes scattered throughout the day or in less frequent but more sustained periods that continue for hours. Stressful circumstances frequently exacerbate hair pulling behavior, but increased hair pulling also occurs in states of relaxation and distraction (e.g., when reading a book or watching television). An increasing sense of tension is present immediately before pulling out the hair. The tension does not necessarily precede the act but is associated with attempts to resist the urge. There is gratification, pleasure, or a sense of relief when pulling out the hair. Trichotillomania may can cause significant distress or impairment in an individual's overall ability to function.

 Examining the hair root, twirling it off, pulling the strand between the teeth, or hair eating (trichophagia) may occur with trichotillomania. Hair pulling does not usually occur in the presense of other people and many social situations may be avoided. Individuals frequently deny their hair pulling behavior and attempt to conceal or camouflage the resulting hair loss. For more information regarding tichotillomania please visit the Trichotillomania Learning Center. Also see Compulsive Skin Picking.

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