Trichotillomania DSM-5 Criteria and ICD Codes Explained

Trichotillomania (trich, or hair-pulling disorder) appears in both of the main manuals used to diagnose health conditions. This page sets out, in plain English, what each one says and which code it uses. It’s for clinicians, students, and anyone who has seen a code like F63.3 on a letter.

The DSM-5 is the American Psychiatric Association’s manual of mental health conditions. The ICD, or International Classification of Diseases, is the World Health Organization’s system for recording diagnoses worldwide; ICD-11 is its newest version.

What are the DSM-5 criteria for trichotillomania?

The DSM-5 lists five criteria for trichotillomania, and all five must apply. In plain English:

Hair pulling that causes hair loss. You pull out your own hair again and again, and it leads to hair loss.
Repeated attempts to stop. You’ve tried more than once to cut down or stop.
Distress or impact. The pulling causes real distress, or gets in the way of your social life, work, school or other important parts of life.
Not caused by a medical condition. The pulling or hair loss isn’t down to another medical problem, such as a skin condition.
Not better explained by another mental health condition. For example, removing hair to fix a flaw you see in your looks points instead to body dysmorphic disorder, where someone is preoccupied with a perceived flaw in their appearance.

All five DSM-5 criteria need to apply for a diagnosis of trichotillomania.

The first criterion asks for hair loss, not visible hair loss. Many people pull single hairs from across an area, or cover the loss with styling, makeup, scarves or wigs, so having no bald patches doesn’t rule trich out. Hair removed only for cosmetic reasons, such as tidying eyebrows, doesn’t count. The DSM-5-TR, the 2022 text revision of the manual, uses the same criteria.

There’s no minimum number of hours, no required spot on the body, and no need to feel tension before pulling or relief afterwards.

What changed between DSM-IV and DSM-5?

Two things changed in 2013: the group trich sits in, and what a diagnosis needs. Trich first entered the manual in 1987 as an impulse-control disorder, grouped with conditions such as kleptomania (compulsive stealing), and it stayed there until the DSM-5.

The DSM-5 also changed the criteria:

Removed: the need for rising tension before pulling and pleasure or relief afterwards.
Added: repeated attempts to cut down or stop.
Changed: hair loss no longer had to be “noticeable”.

The reason came from research. In a 2012 survey of 84 people with hair-pulling symptoms, nearly all (98%) said they had tried again and again to stop. Many, but not all, described urges, tension or relief. Those who did tended to pull more severely, but because these feelings weren’t universal, the researchers concluded they shouldn’t be required for a diagnosis.

What is the ICD-10 code for trichotillomania?

The ICD-10 code for trichotillomania is F63.3. It sits in the group “habit and impulse disorders” (F63), in the section on adult personality and behavior, next to codes for pathological gambling and compulsive stealing.

WHO’s ICD-10 description is older than the DSM-5’s. It describes noticeable hair loss from repeatedly failing to resist urges to pull, usually with mounting tension beforehand and relief afterwards. It says the diagnosis shouldn’t be made if there’s existing inflammation of the skin, or if the pulling is a response to delusions or hallucinations.

In the US, insurance claims use ICD-10-CM, a US version of ICD-10. There the code is also F63.3, listed under “impulse disorders”, and the DSM-5 uses the same code. You’ll sometimes see F63.2 given for trich online. In ICD-10, F63.2 is kleptomania, and the American Psychiatric Association’s 2013 coding updates confirmed F63.3 for trich.

What is the ICD-11 code for trichotillomania?

The ICD-11 code for trichotillomania is 6B25.0. It belongs to 6B25, “body-focused repetitive behavior disorders”, which also covers excoriation disorder (skin picking, 6B25.1) and codes for other or unspecified body-focused repetitive behaviors (6B25.Y and 6B25.Z).

A body-focused repetitive behavior (BFRB) is a repeated action aimed at your own body, such as pulling hair, picking skin or biting lips, that you find hard to stop. ICD-11 describes trichotillomania as repeated pulling of your own hair that leads to significant hair loss, together with unsuccessful attempts to cut down or stop. Pulling can happen anywhere hair grows, most often the scalp, eyebrows and eyelids, and in short bursts or longer sessions. Like the DSM-5, it requires significant distress or impact on daily life, and it doesn’t require tension or relief.

ICD-11 came into effect on 1 January 2022, but countries are switching over at their own pace. In May 2024, WHO reported that 132 countries and areas were at some stage of adopting it, and 14 had started collecting or reporting data with it. That’s why many health records still show the ICD-10 code, F63.3.

Which category is trichotillomania in?

In both current manuals, trich sits in the group for obsessive-compulsive and related conditions. In the DSM-5 that chapter is “obsessive-compulsive and related disorders”, alongside OCD (obsessive-compulsive disorder), body dysmorphic disorder, hoarding disorder and excoriation disorder. ICD-11 uses a similar group, “obsessive-compulsive or related disorders”, with trich in its BFRB subgroup. The older ICD-10 still lists it under habit and impulse disorders.

Trichotillomania has moved from the impulse group to sit beside OCD-related conditions, first in the DSM-5 and later in ICD-11.

Sharing a group with OCD doesn’t make trich a type of OCD. Experts advising WHO on ICD-11 noted that hair pulling is rarely driven by obsessions (unwanted, distressing thoughts), and that treatment differs. Habit Reversal Training (HRT), which teaches you to notice pulling and do something else with your hands instead, has the most research behind it for trich, while OCD is usually treated with a therapy called exposure and response prevention. They backed the grouping because it matches how most clinicians see these behaviors.

Our guide to trichotillomania and OCD explains how the two differ and how they overlap.

Here’s how the three manuals compare:

	DSM-5 and DSM-5-TR	ICD-10	ICD-11
Published by	American Psychiatric Association	World Health Organization	World Health Organization
Code	F63.3 (the ICD-10-CM code)	F63.3	6B25.0
Group	Obsessive-compulsive and related disorders	Habit and impulse disorders	Body-focused repetitive behavior disorders, within obsessive-compulsive or related disorders
How it describes hair loss	Hair loss (may be hidden)	Noticeable hair loss	Significant hair loss
Tension before or relief after	Not required	Usually present	Not required
Attempts to stop	Required	Not mentioned	Required

What does a diagnosis code mean for me?

A code is a short label for records, not a verdict on you. It lets doctors, therapists and insurers record the same condition in the same way, wherever you’re seen. Seeing F63.3 or 6B25.0 on a letter simply means someone has recorded trichotillomania.

If you’re wondering whether this describes you, our quick self-check walks through the signs. The diagnosis section of our complete guide explains what to expect when you talk to a professional.

When should I get help?

You don’t need a formal diagnosis, or a code on your records, to ask for help. If pulling upsets you or gets in the way of your life, it’s worth talking to someone. Everyone in our directory has told us they understand trichotillomania and already help people who pull. You can search the directory for a practitioner near you or online.

If you’re a practitioner who works with people who pull, you can get listed in our directory so people looking for help can find you.

Questions people ask

Is trichotillomania in the DSM-5-TR?

Yes. The DSM-5-TR, the 2022 text revision of the DSM-5, keeps trichotillomania (hair-pulling disorder) in the obsessive-compulsive and related disorders chapter with the same diagnostic criteria. The ICD-10-CM code it uses for trichotillomania is F63.3.

What was the old DSM code for trichotillomania?

The older code was 312.39, from the ICD-9-CM system the US used before ICD-10-CM. When the DSM-5 came out in 2013 it listed both codes as 312.39 (F63.3). Since October 2015, US insurance claims have used ICD-10-CM, so F63.3 is the code in use.

Why do some websites list F63.2 for trichotillomania?

It’s a mistake. In ICD-10, F63.2 is the code for kleptomania (compulsive stealing). The American Psychiatric Association’s 2013 coding updates to the DSM-5 set F63.3 as the code for trichotillomania, which matches WHO’s ICD-10.

Is trichotillomania still classed as an impulse control disorder?

Not in the current manuals. The DSM-5 and ICD-11 both place it with obsessive-compulsive and related conditions. The older ICD-10, which many health records still use, lists it under habit and impulse disorders, and the US version, ICD-10-CM, lists it under impulse disorders.

What ICD code is used for skin picking?

In ICD-11, skin picking is excoriation disorder, code 6B25.1. It sits in the same body-focused repetitive behavior group as trichotillomania (6B25.0). The older ICD-10 has no specific code for skin picking, so records made under ICD-10 may describe it in other ways.

Has ICD-11 replaced ICD-10?

Officially, yes: ICD-11 came into effect on 1 January 2022. In practice, countries are switching at different speeds. In May 2024, WHO said 132 countries and areas were at some stage of adopting it, so you may still see the ICD-10 code F63.3 on records.

Who can diagnose trichotillomania?

A family doctor, psychiatrist, psychologist or skin doctor can diagnose it. There’s no blood test or scan. They talk with you about your pulling and compare it with the criteria, sometimes checking your scalp to rule out other causes of hair loss.