NBME 21 Answers ↦
(44.0 difficulty score)
A 14-year-old girl is brought to the ...
What about telogen effluvium? psychological stress-related hair loss.
Just to add on, telogen effluvium is usually due to physical stressors such as surgery, pregnancy, serious illnesses, or severe/life-threatening psychological stress. So although this patient is going through psychological stress, it's not exactly life-threatening enough to result in hair loss unless personally inflicted. I think the question stem also kind of hints at trichotillomania with her doing more things to her hair.
But this article is pretty useful in distinguishing between different causes of hair loss: https://www.aafp.org/afp/2003/0701/p93.html#sec-4
My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp)
[Turns out it does not](http://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x)
FA 2019, pg 551
Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to
stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the
scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line;
medications (eg, clomipramine) may be considered.
damn its in FA and Ive never ocne read it XO