Ms. A, a 22-year-old woman with trichotillomania and obsessive-compulsive disorder, had been treated in our clinic for 3 years. She had received adequate trials of clomipramine, sertraline, sertraline with lithium, fluvoxamine, fluvoxamine with desipramine, fluvoxamine with risperidone, fluvoxamine with perphenazine, and fluoxetine. Of these, sertraline, fluvoxamine, and fluoxetine monotherapies effectively reduced depressive and obsessive-compulsive symptoms. Ms. A continued to engage in hair pulling so severe that at times, eyebrows and eyelashes were totally removed and large bald spots appeared on her scalp. The only trial associated with significant decrease in hair pulling was risperidone, 1 mg/day, and augmentation of fluvoxamine, 300 mg/day. However, Ms. A developed hyperprolactinemia (prolactin level=97.7 ng/ml; upper limit of normal=29.2 ng/ml) and intolerable galactorrhea, which resolved upon risperidone discontinuation.