A 16-year-old girl has a bald spot on her scalp and her mother brings her to the PMHNP on the advice of her primary care provider after all medical causes are ruled out. The girl admits to pulling out her hair in class when she is bored, but says she tends to pull it out more often in math class where she is making Cs. This is the first year she is not doing well in math, and her mother says it is "stressing her out." What is the most appropriate diagnosis?

Choice A reason: Generalized anxiety disorder involves pervasive worry and anxiety across multiple domains, but it does not account for repetitive hair-pulling behaviors. Choice B reason: This is the correct answer. Trichotillomania is a disorder characterized by recurrent hair pulling, often triggered by stress or boredom, resulting in noticeable hair loss and distress. The patient’s behavior aligns with this diagnosis. Choice C reason: Body dysmorphic disorder involves preoccupation with perceived flaws in appearance, but the behavior in this case is hair-pulling as a coping mechanism rather than due to distorted body image. Choice D reason: Delusional disorder, somatic type, involves false beliefs regarding bodily functions or sensations. The patient’s hair-pulling is voluntary and related to stress, not delusional beliefs.