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In young adults, establishing the diagnosis and raising awareness of the condition pullkng an important reassurance for the family and patient. In this age range, trichotillomania is usually chronic, and continues into adulthood. Family members may need professional help in coping with this problem. Some people with trichotillomania wear hats, wigs, false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile.
Hair is often pulled out leaving an unusual shape. This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure.
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They produce sound or vibration notifications to notify users of passive hair pulling and they can uplling rates of these events over time. For these children, hair-pulling is pullinb either a means of exploration or something done subconsciously, similar to nail-biting and thumb-sucking, and almost never continues into further ages. Non-pharmacological interventions, including behavior modification programs, may be considered; referrals to psychologists or psychiatrists may be considered when other interventions fail. Scaling on the scalp is not present, overall hair density is normal, and a hair pull test is negative the hair does not pull out easily. Treatment with clomipraminea tricyclic antidepressantwas shown in a small double-blind study to improve symptoms,  but results of other studies on clomipramine for treating trichotillomania have been inconsistent.
Trichotillomania can go into remission-like states where the individual may not experience the urge to "pull" for days, weeks, months, and even years. Trichiotillomania that begins in adulthood most commonly arises from underlying psychiatric causes.
In comparisons of behavioral versus pharmacologic treatment, cognitive behavioral therapy including HRT have shown significant improvement over medication alone. Several mobile apps exist to help log behavior and focus on treatment strategies. Hair pulling can lead to great tension and strained relationships with family members and friends. This "pulling" often resumes upon leaving this environment. Another school of thought emphasizes hair pulling as addictive or negatively reinforcing, as it is associated with rising tension beforehand and relief afterward.
Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels "just right", or pulling in response to a specific sensation.