The difficulties involved in trichotillomania diagnosis are easily resolved by paying attention to the many details of the many behaviors of many different types of people.
For example, trichotillomania diagnosis should only be given to children if symptoms are persistent, as with children, hair pulling behavior can be merely a phase, much like when children suck their thumbs.
Also, trichotillomania diagnosis would not be needed for someone who merely twists or plays with their hair as a result of nervousness, because this is only a very minor and harmless response to stress, which is clearly not a manifestation of trichotillomania.
Hair loss in and of itself may not be connected, as the cause may be medical.
This symptom alone is not an example of this condition taking effect.
Hair pulling, however, may have a psychological cause which may be any of a few other things, such as a delusion or hallucination due to schizophrenia.
Any time a trichotillomania diagnosis is undergone, there is a need to consider all of these and other possibilities in order to rule each of these out as evidence dictates.
If the symptoms are undetectable or very minor, a trichotillomania diagnosis should only be given if the person expresses significant distress.
If a person denies their symptoms, perhaps out of embarrassment or fear, their hair pulling behavior can be detected and assessed through objective means, such as observing the presence of short, broken hairs or damaged follicles.
Trichotillomania diagnosis must be thorough, while at the same time it should be stress free for the patient.