Differential Diagnosis for Hair Pulling During Concentration

• Single most likely diagnosis:
  • Trichotillomania: This condition is characterized by an irresistible urge to pull out one's own hair, often in response to stress, anxiety, or as a habit during activities that require concentration such as reading or analyzing. The behavior described fits well with the diagnostic criteria for trichotillomania.
• Other Likely diagnoses:
  • Anxiety Disorder: Individuals with anxiety disorders may exhibit hair pulling as a coping mechanism or a manifestation of their anxiety, especially during tasks that demand concentration.
  • Obsessive-Compulsive Disorder (OCD): While not as directly related to hair pulling as trichotillomania, some individuals with OCD may have compulsions that involve hair pulling, especially if it's part of a ritualistic behavior to reduce anxiety during concentrated activities.
• Do Not Miss diagnoses:
  • Neurodevelopmental Disorders: Certain neurodevelopmental disorders, such as autism spectrum disorder, can sometimes present with self-soothing behaviors that might include hair pulling, especially during focused activities.
  • Psychotic Disorders: In rare cases, hair pulling could be a symptom of a psychotic disorder, where the individual might have delusional beliefs about their hair or body.
• Rare diagnoses:
  • Body-Focused Repetitive Behavior (BFRB) Spectrum: This includes conditions like trichotillomania but also other behaviors like skin picking. While trichotillomania is the most likely diagnosis within this spectrum for hair pulling, considering the broader BFRB spectrum can be helpful.
  • Factitious Disorder: A condition where a person acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms. Hair pulling could potentially be a fabricated symptom, although this would be less common and typically identified through inconsistencies in the patient's history or behavior.