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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Trichotillomania (Hair Pulling)

Trichotillomania is an impulse control disorder, which involves the obsessive urge to pull hair. The disorder causes people to engage in extensive hair pulling, resulting in noticeable bald patches. Hair may be pulled from the scalp, eyebrows, eyelashes, beard, underarms, or pubic area. The cause of trichotillomania is unknown but it is possibly a combination of hormones, genetics and stress. Children who seek tactile, oral and skin stimulation are more likely to engage in hair pulling as an additional form of self-stimulation. Hair pulling may also have a self-soothing effect similar to that achieved through thumb sucking or the use of a pacifier.
Trichotillomania is seven times more common in children than adults and usually begins during the preteen years. The mean age of onset is 12 years for girls and 8 for boys. Children with the disorder may not have the same degree of self-insight as their adult counterparts but they will notice that they are different to their peers or that there is “something wrong with them”. Trichotillomania can have a negative impact on a child’s self-esteem and they may be bullied or teased for their hair pulling behaviour and the resultant hair loss. The quicker the problem is identified and treated, the faster the recovery time.
The symptoms of trichotillomania generally appear before the age of 17 and commonly include:
  • Recurrent hair pulling resulting in noticeable hair loss, unrelated to baldness or alopecia
  • Bare patches of skin in the hair or at the hairline that are uneven
  • Constant pulling, tugging or twisting of hair
  • Experiencing pleasure, excitement or relief when pulling out hair
  • Embarrassment, guilt or shame due to hair loss
  • Denial of hair pulling and a sense of building tension before the pulling begins
  • Some people eat some or all of the hair, stroke, count, store or fiddle with the hair after pulling
  • Problems at home, school or work
  • Engaging in other forms of self-injurious behaviour

Emotional symptoms may include:

  • Low self-esteem
  • Shyness or an inability to get close to people
  • An obsession with physical appearance
  • Difficulty expressing strong emotions, such as anger
  • Adolescents may be unwilling to go without make-up or spend a significant amount of time styling their hair to cover signs of hair loss
  • Reluctance to visit hairdressers
The exact cause of trichotillomania is unknown and although hair pulling can occur at any time, it may be worse in stressful situations. Parents often find it difficult to understand why their child is unable to simply stop pulling their hair. Neither parents nor children are to blame for the hair pulling behaviour. Younger children may not notice or be bothered by the hair loss but older children commonly experience feelings of anxiety, depression and have low self-esteem. They may be teased about their hair loss and may try to hide or deny that they are pulling their hair, due to fear of punishment or feelings of embarrassment, shame or guilt.
It is normal for young children to be curious about different sensations and to explore their bodies using touch. Many children will pull hair as a brief childhood phase and this behaviour will not develop into a problem. If your child is doing damage to their body because of hair pulling, such as pulling out large chunks of hair from the eyebrows or scalp; they express an inability to stop hair pulling; or the pulling persists beyond pre-school age, a diagnosis of trichotillomania should be considered.
Children with possible trichotillomania should be evaluated by a trained and qualified mental health professional. It is important to involve your family doctor if your child is pulling their hair. He or she will be able to rule out other causes of hair pulling, such as ringworm or alopecia areata. If your child is of school going age, their teacher may be able to provide insight into school stressors.
Punishing children for hair pulling is unlikely to decrease the behaviour and is frequently associated with problems in self-esteem. Common treatments include:
  • Cognitive behavioural therapy (CBT), which aims to help children identify their thoughts, feelings and behaviours associated with hair pulling. The goal is to increase their awareness about hair pulling and replace it with more appropriate behaviours.
  • Some children may require medication to alleviate the depressive, anxious and obsessive-compulsive symptoms that accompany trichotillomania.
  • Hypnotherapy has been proven to be effective in the treatment of trichstars (hair pullers)
  • Family therapy and support groups are available.
How to help your child:
Identify triggers that cause the behaviour. Common triggers of hair pulling include; while going to sleep, while watching TV or a movie, or during times of boredom such as long car journeys.
When you see the behaviour tread carefully. Parental over involvement can lead to stress and exacerbate the problem. Parental attention can also reinforce the behaviour if it is excessive.
Place something in your child’s hands as an alternative, such as Lego, markers, a soft toy or a piece of play-doh. A stress ball may be particularly effective.
Elastic bandages may be wrapped around the thumb, which minimizes your child’s ability to grip their hair, making it harder to pull. Alternatively, allow them to wear mittens, as it is almost impossible to pull hair while wearing mittens.
Allow your child to wear a hair net or cap to bed, if their hair pulling tends to be problematic at night.
Wearing a hat in general may serve as a deterrent. Every time your child reaches up to their head out of habit, they will touch the hat instead of their head, and this may help remind them not to pull their hair.
Younger children may want to draw or paint a trich monster. If they are of school going age, they may want to write something about their monster too. This exercise helps children see their trichotillomania as something that exists outside of themselves and something that can be defeated or overcome.
Encourage older children to acknowledge their behaviour and express how they are feeling. Ask your child what else they might do with their hands to minimize their stress or anxiety. Journal writing or talking to a qualified therapist may help your child discover additional coping skills.
Some children eat their hair after pulling it. This may result in intestinal blockages or general poor nutrition. Eyelash pullers may develop an infection and scalp pullers may develop sores. Trichotillomania sometimes co-occurs with obsessive-compulsive disorder, body dysmorphic disorder, dermatillomania (skin picking), generalized anxiety disorder, eating disorders and depression.
Trichotillomania can be cured and it is more readily remedied in children than it is in adults. Trichotillomania does not cause permanent hair loss or harm to the hair follicles. When your child stops pulling, plucking or twisting, their hair will grow back normally. The most effective treatment for hair pulling appears to be a combination of behavioural modification techniques and a non-judgmental attitude towards the hair pulling behaviour.
American Psychiatric Association (1994). Quick Reference To The Diagnostic Criteria From DSM-IV. APA: Washington D.C.