Increased Risk of Trichotillomania in Neurofibromatosis Type 1: A Retrospective Cohort Study
Nuran C Golbasi1, Natalia Chalupczak2, Shari R Lipner3
1Weill Cornell Medicine, New York, NY, USA.
Introduction:
Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder associated with substantial psychiatric comorbidity. Although repetitive and compulsive behaviors are reported in NF1, the risk of body-focused repetitive behaviors is understudied.
Methods:
We performed a retrospective cohort study using the TriNetX research network (2006-2026). On January 14, 2026, individuals with a first recorded diagnosis of NF1 were compared with matched controls. Patients with prior trichotillomania or skin-picking disorder were excluded. Cohorts were balanced using 1:1 propensity score matching for demographics, psychiatric comorbidities, and healthcare utilization. Five-year hazard ratios (HRs) were calculated using Cox proportional hazards models with Bonferroni correction.
Results:
After matching, 33,841 individuals were included in each cohort. NF1 was significantly associated with increased incidence of trichotillomania over 5 years compared with controls (HR 2.46; 95% CI: 1.43-4.22; p < 0.001), which remained significant after Bonferroni correction. No significant association was observed for skin-picking disorder (HR 1.25; 95% CI: 0.65-2.40; p = 0.670). In sensitivity analyses adjusting for ADHD, autism, and tic disorders, NF1 remained significantly associated with trichotillomania.
Conclusion:
We found that NF1 was associated with increased risk of trichotillomania. Increased clinical awareness and screening may help improve recognition and management and improve quality of life.
