One of the major problems of clients with trichotillomania is avoidance behaviour due to shame or social phobia. Avoidance of health care services (such as dental, gynecological, primary care) for fear of discovery can cause secondary problems.

Local irritation or local skin infections (including eye problems like conjunctivitis or blepharitis) are other common problems besides the cosmetic problem of local alopezia.

Psychological complications of TTM are

• Major depression and Anxiety disorders (up to 50%)
• Simple phobia / Social phobia / Generalized Anxiety disorder (30%)
• Eating disorders (20%)
• Obsessive-compulsive disorder OCD (15%)
• Body dysmorphic Disorder BDD (22%)

There are clinical reports of a co-occurence of TMM and ADHD.

A distinct of patients with TMM involves chewing or eating hair. About half of the TMM patients have some kind of associated oral behavior (including pulling strands through the teeth or trichophagia).

This can cause dental erosion and trichobezoars (hairballs) with bowel obstruction or perforation. Sometimes chronic pain due to chronic hair pulling is a severe problem.