Trichotillomania

Tamika is an 18-year-old single female referred by her dermatologist. Hair-pulling behavior began at age 14, initially limited to her scalp while studying or watching TV, and progressed over time to include eyebrows and eyelashes during periods of high anxiety (e.g., before exams). She currently has noticeable bald spots, frequently wears hats to conceal hair loss, and reports a cycle of temporary relief followed by guilt after pulling. She completed a brief course of habit reversal therapy at age 17 but with limited benefit, and family attempts to intervene have been largely unsuccessful.