Patient presents with symptoms consistent with trichotillomania (hair-pulling disorder).  The patient reports recurrent pulling of hair resulting in noticeable hair loss.  Areas of hair pulling include the scalp, eyebrows, and eyelashes.  The patient acknowledges attempts to decrease or stop hair pulling, but reports difficulty controlling the urge.  The patient experiences increasing tension immediately before pulling hair or when attempting to resist the behavior, followed by a sense of gratification, pleasure, or relief when pulling the hair.  The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  Differential diagnoses considered include other body-focused repetitive behaviors such as skin picking disorder (excoriation disorder) and obsessive-compulsive disorder (OCD).  The patient denies current suicidal ideation or intent.  Current medication list reviewed and no known contraindications to recommended treatment were identified.  Diagnosis of Trichotillomania (ICD-10-CM code F63.3) confirmed based on DSM-5 criteria.  Treatment plan includes habit reversal training (HRT), a form of cognitive behavioral therapy (CBT) specifically effective for trichotillomania, and stimulus control techniques.  Patient education provided regarding the nature of the disorder, its chronic course, and the importance of adherence to the treatment plan.  Scheduled follow-up appointment in two weeks to monitor progress and adjust treatment as needed. Patient understands the plan and agrees to follow-up.