Trichotillomania

Trichotillomania is a disorder characterized by the urge to pull out hair from the scalp or other parts of the body, including the eyelashes, brows, genitals, back, arms and legs. Children are more likely to pull hair out from the scalp. Some with the disorder say pulling hair makes them feel good, but not everyone with trichotillomania pulls out hair intentionally. Kids often pull unconsciously, and may not even remember doing so. Others might feel compelled to remove hairs of certain textures or colors, or hair from specific locations, although this is less likely in children. Some people with trichotillomania also compulsively eat their hair after pulling it out. This is considered a related disorder known as trichophagia. Trichotillomania may be related to obsessive-compulsive disorder.

Kids tend to play with their hair when they are relaxing; watching TV, reading, and even sleeping are all risky times for kids with trichotillomania, for whom playing with hair progresses to actual removal of significant amounts of it. Some children describe feeling a release of tension after pulling out their hair, although those who pull unconsciously won’t experience this sensation. When asked, many children deny pulling out their hair (and, indeed, may really not remember ever doing it). But there are still signs to look for, including hair on the floor and pillows, rapid or asymmetrical hair loss, and having hands constantly near the head. Some kids with trichotillomania have rituals surrounding their hair pulling and may play with the hair afterwards because they enjoy the sensations that come from rolling or bending it, or putting it to their lips. Frequent hair pulling often results in uneven hair growth or even noticeable bald patches. Wearing hats or other cover-ups and constantly checking mirror reflections may also be signs of the disorder. Because severe hair pulling has an effect on a child’s appearance, trichotillomania can be damaging to self-esteem and may interfere with social life and performance in school.  Onset commonly occurs around 12 years of age, but it can appear in much younger children. Girls seem to be more likely to have trichotillomania.

The exact causes of the disorder are unknown; there may be a biological cause. Hair pulling also tends to be a cyclical problem because hair often itches as it regrows, making children more likely to continue pulling their hair to avoid discomfort.

Trichotillomania is only diagnosed in children who have established a recurrent behavior of hair pulling that is causing them significant distress. Before receiving a diagnosis your child will probably be tested for scalp infections, alopecia, or spot baldness, and any other possible medical explanation for hair pulling. Trichotillomania is more difficult to diagnose in very young children.

Psychotherapeutic: Trichotillomania is treated primarily through behavioral therapy.  Cognitive behavioral therapy (CBT), which helps children become more aware of their hair pulling, is very helpful.  Through CBT children can come to recognize the emotions and triggers involved in their hair pulling.  Sometimes something as simple as wearing loud, dangling bracelets can make kids more self-aware.

 

After learning to recognize the habit, children can then begin habit reversal therapy.  Some doctors recommend tricks that make hair pulling more difficult.  For example, wearing bandages around the fingers and nails can make it harder to pull out hair, as does wearing hair pulled back or under a hat.  For kids who enjoy the sensation of playing with the hair after it has been pulled, rolling a paper clip or playing with a textured pencil topper can help recreate the desired sensation and keep the hands distracted.  Some kids in treatment carry kits around with bandages, paper clips, hair ties and other items that will help them.  For children who compulsively pull out their hair, exposure and response prevention therapy, which diminishes the compulsion to pull hair by gradually increasing exposure to the triggers, can also be helpful.

 

Trichotillomania is sometimes difficult to treat because some children consider the sensations derived from pulling hair enjoyable, and they may need to be convinced that pulling out hair is a problem.  If reluctant, children may undergo motivational interviewing, a technique used to help them commit to treatment.

 

Pharmacological: Medication is usually not the first choice in treating trichotillomania, although your child may be prescribed antidepressants like SSRI’s while she participates in behavioral therapy.

Is my child just stressed out?
No. Although children may experience a building tension that is released through pulling out their hair, this tension is not related to life stress. Pressures at home and school do not produce trichotillomania.
Does medication help?
Behavioral therapy is the preferred method of treating trichotillomania. Medication usually isn’t used in treatment, although in some cases children are prescribed antidepressants to boost the effectiveness of their therapy.
Will my child outgrow it?
Hair pulling usually is not a phase. Those who begin pulling out their hair during adolescence generally need intervention in order to stop. If your child’s hair pulling is becoming a problem you should seek treatment. The earlier treatment begins the better the prognosis will be.
Is it dangerous?
Trichotillomania can be dangerous if your child eats her hair after pulling it out (called trichophagia). Trichophagia can produce hairballs that block the gastrointestinal tract and may even result in death. Chronic hair-pulling can also result in permanent hair loss and infection.