The clues for trichotillomania were the death of her grandmother suddenly, since trichotillomania is often stress-induced. I also narrowed it down by it saying the hair was in different growth stages in the patchy areas, which makes sense if she’s plucking them out at different times.

Telogen effluvium is most common in middle-aged women, so she doesn’t fit the profile (but you’re right about it being caused by stress).

here's a table showing difference bwtween alopecia vs trichotillomania https://www.semanticscholar.org/paper/Dermoscopic-clues-to-distinguish-trichotillomania-Abraham-Torres/db2ced7e6285879f59272387742d8d7eb1d5e664/figure/0

This is one of those questions I was never going to get. It's not in FA, I don't think I've seen it in class.

DDX:

Trichotillomania: psych, identifiable stressor + repetitive hair pulling resulting in noticeable hair loss. Irregularly shaped patchy hair loss with broken hairs of different lengths

Alopecia areata: chronic, immune-mediated disorder of hair loss.+ diffuse or focal hair loss. Areas may have smooth or irregular borders. Hairs are typically narrower proximally than distally and are prone to breaking. The broken hairs are usually the same length.

Telogen Effluvium: loss is diffuse (not patchy), and may be most evident bitemporally, frontally, or on the vertex. The borders of the hair loss typically appear smoother.