A 22-year-old female college student presents with noticeable hair loss on her scalp that she attributes to stress. On examination, the PMHNP observes an irregular patch of hair loss on the right frontotemporal region with hairs of varying lengths within the patch, some broken at different levels. The patient reluctantly admits to repeatedly pulling and twisting her hair during study sessions, experiencing a sense of mounting tension before pulling and relief afterward. She has attempted to stop on multiple occasions but has been unable to do so. She reports no scalp itching, burning, or skin changes. Dermatologic consultation reveals no exclamation point hairs, no pitting of the nail beds, and a negative hair pull test. She reports significant distress about the hair loss and has begun wearing a hat to classes. What is the MOST likely diagnosis?