I have a friend who has picked their scalp religiously for many years - like a never-healing scab that's like 10 years old. She is diagnosed OCD. Does a picking compulsion of that caliber mean trichotillomania? Also she picks at other scabs, mosquito bites, finger nails, etc. It seems to be worse when nervous (also fidgeting when nervous).

But no pulling out of hair at all... is pulling out here a defining characteristic? Might this be trichotillomania and not OCD? Or is trichotillomania often co-diagnosed with OCD so maybe it's both?

She says that often she picks at her scalp before she even gets out of bed in the morning. She has gone to a psych and diagnosed OCD/ADHD/anxiety but she has hidden the scalp-picking thing from the pysch even...