Psychiatric comorbidities and treatment in adults with trichotillomania and excoriation disorder: A retrospective cohort study.

Trichotillomania (TTM) and excoriation disorder (ED) are body-focused repetitive behaviors (BFRBs) characterized by recurrent hair-pulling or skin-picking; they may present with psychiatric comorbidities worsening outcomes. While cross-sectional and case-control studies report high comorbidity rates, longitudinal analyses remain limited. We looked to determine incidence of new psychiatric diagnoses, psychopharmacologic prescriptions, and psychotherapy referrals following BFRB diagnosis compared with controls and assess whether psychiatric history modified outcomes. Adults with ICD-10 diagnoses of TTM or ED were matched to controls. Outcomes included new psychiatric diagnoses, psychiatric medications, and psychotherapy referrals within one year. Kaplan-Meier analyses and Cox regression were performed. Among 304 participants (102 BFRB, 202 controls), BFRB patients more frequently initiated psychiatric medications and received psychotherapy referrals after adjusting for prior psychiatric comorbidity. New psychiatric diagnoses did not differ significantly. Adults with BFRBs demonstrate substantial psychiatric treatment burden, underscoring the importance of routine psychiatric screening and coordinated psycho dermatologic care.