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My understanding is that trichotillomania is an anxiety disorder so, yes, to the extent anxiety disorders are the result of strep infection and/or immune disorder, certainly it could be strep related. I would proceed down the PANDAS/PANs path, without hesitation.

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I agree that she should investigate the possibility of PANS. In the meantime, though, check out a product called Buzzies. My 20-year-old has PANS which we are just beginning to treat. Until the treatment starts to help, I am using a bilateral stimulation device called Buzzies. They are two small devices that can be worn on wrists or tucked in pockets that vibrate in alternating cycles. They have significantly reduced my daughter's anxieties. She wears them during the morning while preparing to leave the house (about 40 minutes) then removes them. Morning have gone from being full of stress, stomach pain and tears to calm and easy. The devices are $239 for a pair. FYI: I don't work for Buzzies. I have just discovered them and found them to be a lifesaver for us.

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