The clinical presentation of TTM may be confusing.
Patients with TTM are markedly embarrassed and ashamed,
so they may deny their hair-pulling behavior. The patient
described in this report was rejected from participation in a
research study of TTM because she denied such behavior
when she was screened in a telephone interview. Before diagnosing
TTM, physicians must first rule out hair loss that is
related to dermatologic conditions or other systemic disorders.
They must also exclude it as an act of another person’s
abuse of a youth.4 Hair pulling also has been reported in association
with cocaine use.