The impairment and distress due to trichotillomania should not be underestimated. It can be associated with serious sociological and psychological effects (e.g. strong feelings of shame and embarrassment) as well as avoidance behavior including potentially dangerous avoidance of medical care. It can easily lead into a significant decline in quality of life for patients and their family members. In the background, violence or abuse can often be ruled out, but can be associated with other disease such as mental retardation, schizophrenia, autism and drug-abuse. For the effective treatment collaboration with the family, involving the help of a psychologist or a psychiatrist is required.