Trichotillomania: an integrative review of clinical, diagnostic and therapeutic aspects

Trichotillomania is a chronic neuropsychiatric condition belonging to the spectrum of Obsessive-Compulsive and Related Disorders, characterized by recurrent hair-pulling behavior, usually associated with prior tension and a subsequent sense of relief. This behavior results in functional impairment, psychosocial distress, and a significant negative impact on quality of life. An integrative review was conducted using PubMed/MEDLINE, SciELO, LILACS, and Google Scholar databases, prioritizing systematic reviews, randomized trials, and contemporary clinical guidelines. This review synthesizes historical, epidemiological, clinical, diagnostic, and therapeutic evidence, as well as the high prevalence of comorbidities such as anxiety, depression, obsessive-compulsive disorder, and excoriation disorder. The interface with dermatology is essential, considering the wide range of differential diagnoses, including alopecia areata, tinea capitis, and traumatic alopecias. Regarding treatment, behavioral interventions, especially Habit Reversal Training and the ComB model, constitute the gold standard, supported by robust evidence of efficacy. Pharmacotherapy, despite the absence of agents specifically approved for this disorder, has demonstrated promising results with glutamatergic modulators such as N-acetylcysteine and memantine; however, clinical trials are limited by methodological weaknesses, small sample sizes, and inconsistent findings, particularly in pediatric populations. This review aims to systematize the available knowledge, promote early diagnosis, guide evidence-based therapeutic strategies, and stimulate the development of future research, contributing to greater awareness and interdisciplinary management of trichotillomania.