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 (BFRBs) 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 five 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.
Golbasi et al. (Fri,) studied this question.