Trichotillomania Differential Diagnoses

Updated: Aug 05, 2019
  • Author: Dirk M Elston, MD; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

In children, symptoms of trichotillomania must be assessed over a period of several months to confirm that the diagnosis is correct. Because children can acquire a short-term habit of hair pulling that closely resembles trichotillomania, establishing the diagnosis commonly requires several visits.

A record of hair pulling or the saving of plucked hairs may be required to confirm a diagnosis of trichotillomania. However, patient self-reporting or records from children should be regarded with a degree of caution; some children engage in trichophagia and consume pulled hairs or pluck hairs in privacy to hide the severity of the disorder.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Pili torti
  • Pressure alopecia due to headgear or helmet
  • Temporal triangular alopecia
  • Androgenetic alopecia
  • Telogen effluvium secondary to medical or nutritional causes (eg, infections, medications, febrile illnesses, crash diets)
  • Other psychological disorders
  • Systemic disease (eg, cancer, leukemia, Hodgkin disease, cirrhosis, hypothyroidism, tuberculosis)
  • Anxiety disorder (habit)
  • Factitious disorder with predominately physical signs and symptoms
  • Short-term habit in children


Differential Diagnoses