Symptoms:

Symptoms usually begin before age 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.

These symptoms are usually seen in children:

• An uneven appearance to the hair
• Bare patches or all around (diffuse) loss of hair
• Bowel blockage (obstruction) if people eat the hair they pull out
• Constant tugging, pulling, or twisting of hair
• Denying the hair pulling
• Hair regrowth that feels like stubble in the bare spots
• Increasing sense of tension before the hair pulling
• Other self-injury behaviors
• Sense of relief, pleasure, or gratification after the hair pulling

Most people with this disorder also have problems with:

• Feeling sad or depressed
• Anxiety
• Poor self image

Signs and tests:

People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).

A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.