Background: Trichotillomania (TTM), also known as hair pulling disorder, is a chronic disorder that often leads to considerable emotional distress and functional impairment in affected individuals. Despite the strong underlying psychiatric component of TTM, the majority of individuals suffering from TTM initially may present to dermatologists because of their hair loss. This necessitates awareness and early recognition of TTM as well as familiarity with the unique considerations for its management. Summary: This study reviews the limited literature regarding quality of life in TTM, the methodologies employed to assess quality of life, and further explores the necessity of an interdisciplinary clinical approach to treatment. Several studies included in this review demonstrated the significant degree to which TTM reduces quality of life. Multiple treatment modalities for TTM have been successfully used in the literature that incorporate a comprehensive approach to management and ultimately address the underlying psychiatric component of TTM. Key Messages: TTM significantly reduces the quality of life in affected individuals. Successful management of TTM requires an interdisciplinary approach that bridges dermatology and psychiatry. Screening tools that assess the impact of TTM on quality of life are clinically useful and essential for early diagnosis and optimal management.

1.
American Psychiatric Association
.
Diagnostic and statistical manual of mental disorders
. 5th ed.
Arlington, VA
:
American Psychiatric Association
;
2013
.
2.
Alessandrini
A
,
Bruni
F
,
Piraccini
BM
,
Starace
M
.
Common causes of hair loss - clinical manifestations, trichoscopy and therapy
.
J Eur Acad Dermatol Venereol
.
2021
;
35
(
3
):
629
40
.
3.
Grant
JE
,
Chamberlain
SR
.
Trichotillomania
.
Am J Psychiatry
.
2016
;
173
(
9
):
868
74
.
4.
Thomson
HA
,
Farhat
LC
,
Olfson
E
,
Levine
JLS
,
Bloch
MH
.
Prevalence and gender distribution of trichotillomania: a systematic review and meta-analysis
.
J Psychiatr Res
.
2022
;
153
:
73
81
.
5.
Snorrason
I
,
Ricketts
EJ
,
Stein
AT
,
Thamrin
H
,
Lee
SJ
,
Goldberg
H
, et al
.
Sex differences in age at onset and presentation of trichotillomania and trichobezoar: a 120-year systematic review of cases
.
Child Psychiatry Hum Dev
.
2022
;
53
(
1
):
165
71
.
6.
Melo
DF
,
Lima
CDS
,
Piraccini
BM
,
Tosti
A
.
Trichotillomania: what do we know so far
.
Skin Appendage Disord
.
2022
;
8
(
1
):
1
7
.
7.
Pereyra
AD
,
Saadabadi
A
.
Trichotillomania
.
Treasure island (FL)
:
StatPearls Publishing
;
2023
.
8.
Grant
JE
,
Chamberlain
SR
.
Natural recovery in trichotillomania
.
Aust N Z J Psychiatry
.
2022
;
56
(
10
):
1357
62
.
9.
Lochner
C
,
Keuthen
NJ
,
Curley
EE
,
Tung
ES
,
Redden
SA
,
Ricketts
EJ
, et al
.
Comorbidity in trichotillomania (hair-pulling disorder): a cluster analytical approach
.
Brain Behav
.
2019
;
9
(
12
):
e01456
.
10.
Mubki
T
,
Rudnicka
L
,
Olszewska
M
,
Shapiro
J
.
Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination
.
J Am Acad Dermatol
.
2014
;
71
(
3
):
415.e1
15
.
11.
Waśkiel
A
,
Rakowska
A
,
Sikora
M
,
Olszewska
M
,
Rudnicka
L
.
Trichoscopy of alopecia areata: an update
.
J Dermatol
.
2018
;
45
(
6
):
692
700
.
12.
Weidt
S
,
Klaghofer
R
,
Kuenburg
A
,
Bruehl
AB
,
Delsignore
A
,
Moritz
S
, et al
.
Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation
.
Psychother Psychosom
.
2015
;
84
(
6
):
359
67
.
13.
Rogers
K
,
Banis
M
,
Falkenstein
MJ
,
Malloy
EJ
,
McDonough
L
,
Nelson
SO
, et al
.
Stepped care in the treatment of trichotillomania
.
J Consult Clin Psychol
.
2014
;
82
(
2
):
361
7
.
14.
Diener
E
,
Emmons
RA
,
Larsen
RJ
,
Griffin
S
.
The satisfaction with life scale
.
J Pers Assess
.
1985
;
49
(
1
):
71
5
.
15.
Heskeyahu
T
.
Quality of life in clinical and sub-clinical trichotillomania in females
.
Marywood University
;
2008
.
16.
Sheehan
KH
,
Sheehan
DV
.
Assessing treatment effects in clinical trials with the discan metric of the sheehan disability scale
.
Int Clin Psychopharmacol
.
2008
;
23
(
2
):
70
83
.
17.
Diefenbach
GJ
,
Tolin
DF
,
Hannan
S
,
Crocetto
J
,
Worhunsky
P
.
Trichotillomania: impact on psychosocial functioning and quality of life
.
Behav Res Ther
.
2005
;
43
(
7
):
869
84
.
18.
Grant
JE
,
Odlaug
BL
,
Kim
SW
.
N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study
.
Arch Gen Psychiatry
.
2009
;
66
(
7
):
756
63
.
19.
Grant
JE
,
Odlaug
BL
,
Chamberlain
SR
,
Kim
SW
.
Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: a pilot study
.
Psychopharmacology
.
2011
;
218
(
3
):
493
502
.
20.
Leppink
EW
,
Redden
SA
,
Grant
JE
.
A double-blind, placebo-controlled study of inositol in trichotillomania
.
Int Clin Psychopharmacol
.
2017
;
32
(
2
):
107
14
.
21.
Phillips
TG
,
Slomiany
WP
,
Allison
R
.
Hair loss: common causes and treatment
.
Am Fam Physician
.
2017
;
96
(
6
):
371
8
.
22.
Grant
JE
.
Trichotillomania (hair pulling disorder)
.
Indian J Psychiatry
.
2019
;
61
(
7
):
136
.
23.
Tolin
DF
,
Franklin
ME
,
Diefenbach
GJ
,
Anderson
E
,
Meunier
SA
.
Pediatric trichotillomania: descriptive psychopathology and an open trial of cognitive behavioral therapy
.
Cogn Behav Ther
.
2007
;
36
(
3
):
129
44
.
24.
Franklin
ME
,
Edson
AL
,
Ledley
DA
,
Cahill
SP
.
Behavior therapy for pediatric trichotillomania: a randomized controlled trial
.
J Am Acad Child Adolesc Psychiatry
.
2011
;
50
(
8
):
763
71
.
25.
Twohig
MP
,
Petersen
JM
,
Fruge
J
,
Ong
CW
,
Barney
JL
,
Krafft
J
, et al
.
A pilot randomized controlled trial of online-delivered ACT-enhanced behavior therapy for trichotillomania in adolescents
.
Cognit Behav Pract
.
2021
;
28
(
4
):
653
68
.
26.
Rahman
O
,
McGuire
J
,
Storch
EA
,
Lewin
AB
.
Preliminary randomized controlled trial of habit reversal training for treatment of hair pulling in youth
.
J Child Adolesc Psychopharmacol
.
2017
;
27
(
2
):
132
9
.
27.
Bloch
MH
,
Panza
KE
,
Grant
JE
,
Pittenger
C
,
Leckman
JF
.
N-acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-on trial
.
J Am Acad Child Adolesc Psychiatry
.
2013
;
52
(
3
):
231
40
.
28.
Popova
L
,
Mancuso
J
.
Dramatic improvement of trichotillomania with 6 months of treatment with N-acetylcysteine
.
Glob Pediatr Health
.
2022
;
9
:
2333794X221086576
.
29.
Hautmann
G
,
Hercogova
J
,
Lotti
T
.
Trichotillomania
.
J Am Acad Dermatol
.
2002
;
46
(
6
):
807
26
.
30.
Zhou
C
,
Li
X
,
Wang
C
,
Zhang
J
.
Alopecia areata: an update on etiopathogenesis, diagnosis, and management
.
Clin Rev Allergy Immunol
.
2021
;
61
(
3
):
403
23
.
31.
Christensen
RE
,
Schambach
M
,
Jafferany
M
.
Microneedling as an adjunctive treatment for trichotillomania
.
Dermatol Ther
.
2022
;
35
(
11
):
e15824
.
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