TABLE 1.

Some common misdiagnoses among patients with trichotillomania and skin-picking disorder

Misdiagnosis	Reasons for and prevention of misdiagnosis
Obsessive-compulsive disorder (OCD)	Trichotillomania and skin picking are often misdiagnosed as OCD because they involve compulsive behaviors. Trichotillomania and skin picking, however, generally lack significant obsessional thoughts and do not appear to respond to traditional OCD treatments.
Anxiety disorder	Many clinicians assume that trichotillomania and skin picking are merely manifestations of anxiety—i.e., nervous habits. Although anxiety may worsen pulling and picking, the behaviors persist even when no anxiety is present.
Stimulant use, misuse, or addiction	It is not uncommon for individuals who use stimulants, either illicit or prescription, to report skin picking (either new onset or worsening) or possibly worsening of hair pulling.
Body dysmorphic disorder (BDD)	BDD is characterized by obsessions about and preoccupation with a perceived defect of one’s physical appearance. In BDD, individuals may pull hair with the aim of correcting a perceived defect of their appearance (e.g., “I know that my arms are too hairy and disgusting to people”) or pick their skin to improve their appearance.
Self-injurious behavior	Hair pulling and skin picking are not the same thing as self-injury. Pulling and picking are often used as a means of correcting a problem with the hair or skin and are not generated from the complex psychological factors that give rise to self-injury, such as cutting behavior.