Trichotillomania and excoriation disorder

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Target exams

Red flags

• Trichophagia with abdominal pain, vomiting, or obstruction signs — consider trichobezoar/Rapunzel syndrome and urgent surgical/GI pathway
• Cellulitis, abscess, or systemic sepsis from extensive skin picking — medical/surgical toilet and antibiotics
• Active suicidal ideation with comorbid depression or severe shame-driven isolation — full risk assessment and safety plan
• Rapid tissue destruction, scarring risk to eyes/eyelids, or self-surgery attempts — escalate intensity of care
• New late-onset picking with pruritus or neurologic signs — do not assume idiopathic BFRB; exclude medical dermatoses and organic disease
• Stimulant or other substance-associated picking exacerbation without review of regimen