Many patients meet all the criteria for TTM except tension
before or relief after pulling out hair. The patient described here
had neither criterion and did not meet DSM-IV-TR criteria for TTM, even though she had a long history of both disfiguring
hair pulling and trichophagia (ingesting the pulled out hair).
In one study of adults with TTM, 17% did not describe tension
before or relief after pulling out their hair2 and therefore did
not meet DSM-IV-TR criteria for the diagnosis. Thus, the current
diagnostic criteria may exclude patients with clinically
significant symptoms of TTM