Quick reference
- When to use
- Use F63.3 when the client presents with obsessions, compulsions, or related symptoms consistent with Trichotillomania (Hair-Pulling Disorder) that are time-consuming (>1 hour/day) or cause significant distress or impairment. Specify insight level.
- Duration
- No minimum duration specified in DSM-5, but symptoms should be persistent and not transient. Track severity with Y-BOCS at baseline and every 4-6 sessions. Document insight level (good/fair, poor, absent).
- Session codes
- Pair with CPT 90837 (60-min, preferred for ERP sessions). 90834 for maintenance. 90791 for initial evaluation. 96127 for Y-BOCS screening. Intensive programs may use 90837 multiple times per week.
- Key indicators
- Intrusive, unwanted thoughts (obsessions) • Repetitive behaviors or mental acts (compulsions) • Time-consuming rituals • Distress when unable to perform rituals • Insight varies • Significant functional impact
What F63.3 represents
Trichotillomania involves recurrent, compulsive pulling out of one's own hair from any body site. It often results in noticeable hair loss and significant distress. It's classified with OCD-related disorders in DSM-5.
Key diagnostic criteria
- Recurrent pulling out of one's hair
- Repeated attempts to decrease or stop
- Causes clinically significant distress or impairment
- Not attributable to another medical condition
- Not better explained by another mental disorder
Documentation essentials
Document pulling sites, patterns (focused vs. automatic), functional impact, and any secondary complications.
Differential diagnosis
Distinguish from OCD, stereotypic movement disorder, body dysmorphic disorder, and dermatological conditions.
Treatment planning
Habit reversal training (HRT), comprehensive behavioral treatment (ComB), ACT. N-acetylcysteine may have some benefit.
Insurance & billing
Accepted code. Document severity and functional impact.
Updates & changes
Moved from impulse control disorders to OCD-related disorders in DSM-5.
Documentation pitfalls
Don't minimize the disorder. It can cause significant distress and impairment.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).