Trichotillomania and Skin-Picking Disorder: An Update

Focus (Am Psychiatr Publ). 2021 Oct;19(4):405-412. doi: 10.1176/appi.focus.20210013. Epub 2021 Nov 5.

Abstract

Trichotillomania (hair pulling disorder) and skin-picking (excoriation) disorder are common neuropsychiatric disorders (each with a point prevalence of around 2%) but are underrecognized by professionals. Affected individuals repeatedly pull out their own hair or pick at their skin, and these symptoms not only have a negative impact on these individuals because of the time they occupy but can also lead to considerable physical disfigurement, with concomitant loss of self-esteem and avoidance of social activities and intimate relationships. The behaviors may also have serious physical consequences. Trichotillomania and skin picking frequently co-occur, and both disorders commonly present with co-occurring depression, anxiety, impulsive, and obsessive-compulsive disorders. Behavioral therapy currently appears to be the most effective treatment for both. Pharmacotherapy, in the form of N-acetylcysteine or olanzapine, may also play a role in treatment.

Keywords: Obsessive-Compulsive Disorder - AJP0019trichotillomania; phenomenology; skin picking disorder; treatment.