Hair Pulling

Is your child:

• Pulling, plucking, or picking at hair?
• Showing bare patches or baldness on the scalp, eyebrows, eyelashes, or body?
• Pulling hair more than would be expected for a phase or occasional habit?
• Leaving piles of hair on his or her pillow or on the floor?
• Attempting to hide bare patches with hats or by rearranging hair?
• Seeming embarrassed or upset when you ask about hair pulling behaviors?
• Repeatedly pulling hair out? If so, your child may struggle with what psychologists call “trichotillomania.”

Is your child pulling her hair out? Some children engage in hair pulling behavior. Hair pulling symptoms can present in a variety of ways. Some children pull large amounts of hair at a time, while others pull single strands at a time.

Children may engage in ritualistic or patterned behaviors of hair pulling, meaning the child pulls out his or her hair methodically and in the same way each time. Others report they are not aware that they have engaged in hair pulling, indicating a distracted approach without conscious action.

Thus, some children may be purposely and repetitively pulling hair, while others may be somewhat unaware of their behavior. Hair pulling can occur during sleep, play, and/or studying, and hair pulling can occur when a child feels bored, lonely, or frustrated.

Some parents first notice bare or bald patches on their child’s scalp, eyebrows, eyelashes, or arms and legs. Parents may observe their children to pick, pluck, or twirl pieces of hair until they come loose.

In some cases, children will put pieces of hair in their mouths.

Parents are often distressed by hair pulling behaviors because it is upsetting to see your child engage in a behavior that results in noticeable physical changes and causes them discomfort or distress. You may feel helpless when trying to help your child stop hair pulling behaviors.

Clinically, this problem is referred to as Trichotillomania. Trichotillomania is a complicated disorder; it is often underdiagnosed in children, partly due to limited availability of information on how this disorder affects children and on how it can best be treated. Children who are affected tend to hide their hair pulling due to concerns about bare patches or embarrassment about the behavior.

Trichotillomania affects girls more than boys. While very young children may engage in hair pulling behaviors, the most common age of onset is between 9 and 13 years old.

Younger children typically engage in hair pulling for a short amount of time, and their engagement is largely associated with anxiety or attachment-related issues. In older children, it can be more difficult to help them stop hair pulling behavior.

The most common symptoms of trichotillomania are as follows: A) Recurrent pulling of hair that results in noticeable hair loss; and B) Pleasure, gratification, or relief when pulling out the hair.

In clinical work, children have reported that they look forward to hair pulling rituals or identify a hair they need to remove and are satisfied after pulling it.

Hair pulling can become such a habit that some children do not even recognize they have pulled hair. Some cases have occurred in which children wake up and have piles of hair on their pillow. Other times, after engaging in something like video games, they find a pile of hair around where they were sitting.

The most common time children hair pull is when they are at rest, meaning that the child may be in his or her room, may be watching T.V., or may be playing a videogame. Because the children often pull hair when alone, it can be difficult to stop hair pulling; it goes unnoticed by the children and their parents.

If you suspect your child has trichotillomania, it is important to consult with a Psychologist or Psychiatrist. Some reports have indicated that psychotropic medication has been helpful in limiting hair pulling behaviors when children have co-occurring psychological disorders. For example, anti-depressants have been found to ease hair pulling if a child is experiencing depression. A psychiatrist can determine if your child would benefit from psychotropic medication.

Research has also shown that Cognitive Behavioral Therapy (CBT) can be effective in eliminating hair pulling behaviors and addressing underlying issues. CBT helps children interrupt the undesired behavior (hair pulling) and bring awareness to when a child engages in the behavior.

Cognitive Behavior Therapy can also help to uncover underlying issues, such as anxiety, depression, or social phobia. By treating the behavior (hair pulling) and any other psychological issues a child is experiencing, your child can learn important skills to manage negative emotions and to control hair pulling.

If your child indeed has Trichotillomania, your child is not alone; treatment options are available. Sometimes, all a child needs is a replacement activity, such as or fidget toy or other sensory strategy, and an awareness of the urge to hair pull.

In more persistent cases, the best option is psychotherapy, such as CBT, so the child can develop more insight into the emotions or feelings that trigger hair pulling. A provider who is warm and understands trichotillomania will be the best option for your family.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• General anxiety: some children pull hair to alleviate excessive worry or anxiety
• Compulsions: some children may engage in various repetitive behaviors that they feel they ‘have to’ do to alleviate negative feelings
• Alopecia areata: hair loss that is usually successfully treated
• Folliculitis: infection of one or more of the pockets (follicles) from which hair grows
• Fungal infection: when hairs are broken and shortened, a superficial fungal infection of the hair shaft can occur. This infection may look like scabs or ‘scales,’ depending on the bacteria that has caused the infection
• Medication effects: hair loss from a reactive process caused by a metabolic or hormonal stress or by medications

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Attention Deficit/Hyperactivity Disorder: trouble paying attention and focusing on tasks, acting without thinking, and has trouble sitting still
• Depression: depressed mood, or, in children, irritability that is pervasive; decreased interest or pleasure in activities that used to be enjoyable
• Generalized Anxiety Disorder (Anxiety Disorders): pervasive worries that get in the way of everyday functioning
• Obsessive Compulsive Disorder: a pattern of thoughts/fears (obsessions) that lead one to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress
• Social Phobia (Anxiety Disorders): Significant anxiety, fear, self-consciousness and embarrassment in social or everyday settings due to worries about being judged or scrutinized

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child, or to consult ‘live’ with a psychologist
• Psychologist: to consider symptoms in mental health context
• Psychiatrist: to determine if a pharmacological approach can aid in treating hair pulling

[1] Trich Stop: https://www.trichstop.com/info/children/trichotillomania-in-children

[2] Previously trich.org, now Body-Focused Repetitive Behaviors: http://www.bfrb.org/

[3] Walther, M.R., Snorrason, I., Flessner, C.A., Franklin, M.E., Burkel, R., & Woods, D.W. (2014). The trichotillomania impact project in young children (TIP-YC): Clinical characteristics, comorbidity, functional impairment and treatment utilization. Child Psychiatry and Human Development, 45, 24-31. https://www.researchgate.net/profile/Ivar_Snorrason/publication/236128908_The_Trichotillomania_Impact_Project_in_Young_Children_TIP-YC_Clinical_Characteristics_Comorbidity_Functional_Impairment_and_Treatment_Utilization/links/0a85e53188332a092b000000/The-Trichotillomania-Impact-Project-in-Young-Children-TIP-YC-Clinical-Characteristics-Comorbidity-Functional-Impairment-and-Treatment-Utilization.pdf

[4] Mouton-Odum, S. (2013). A Parent Guide to Hair Pulling Disorder: Effective Parenting Strategies for Children with Trichotillomania. London, UK: Goldum Publishing https://www.amazon.com/Parent-Guide-Hair-Pulling-Disorder/dp/0615657400/

This article was contributed by guest author and subject matter expert:

Chesleigh Keene, MA

Chesleigh is a doctoral candidate in Counseling Psychology at the University of Denver. She is a predoctoral intern at the University of Utah Neuropsychiatric Institute. She has clinical and research training in traumatic brain injury, developmental disorders, child/family therapy, serious mental illness in adults, and topics of diversity.

Image Credit:
Description: Little girl with long hair holding a strand of hair in her hand…
Stock Photo ID: #85562564 (Big Stock)
By: MilanMarkovic
Pulling hair out
Previously Licensed on: June 6, 2017
Stylized by Katie Harwood exclusively for Clear Child Psychology

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