Hair Pulling Disorder in Children

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KEY POINTS

• Hair pulling disorder involves repeatedly pulling out hair from the scalp, eyelashes, eyebrows, or other parts of the body.
• Treatment may include therapy, medicine, or habit reversal training.

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What is hair pulling disorder?

Hair pulling disorder involves repeatedly pulling out hair from the scalp, eyelashes, eyebrows, or other parts of the body. It is also called trichotillomania.

What is the cause?

The exact cause of this disorder is not known. People often start hair pulling around the ages of 12 or 13. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. People with this disorder may have too little or too much of some of these chemicals.
• Stress plays a part. Your child may be at higher risk due to problems such as a change of schools, abuse, family conflict, or the death of a loved one. If your child starts pulling their hair out at school age, it may be school-related stress.
• Your child’s risk is higher if someone in the family has this disorder or obsessive-compulsive disorder.

Hair pulling may be a simple habit for a young child. For most children, hair pulling ends within 12 months. Children who start pulling hair before 6 years of age tend to do better than those who start later. If hair pulling starts in teen years, it is likely to be more serious and long lasting.

Hair pulling may be a sign of anger, depression, or stress. Often young children find it hard to put feelings into words. Hair pulling can be a way to deal with stress and tension.

What are the symptoms?

Symptoms may include:

• Constant tugging and twisting of hair
• Repeatedly pulling enough hair over a long enough period of time to cause hair loss, thinning, or bald spots on the head, or missing eyelashes, eyebrows, or other body hair.
• Repeatedly trying to stop hair pulling
• Feeling tense right before pulling out the hair or if they try to resist the urge to pull hair
• Feeling pleasure or relief when pulling out the hair
• Denying that they are pulling hair or pulling hair in secret

How is it diagnosed?

Your child's healthcare provider or therapist will ask about your child's symptoms, medical and family history, and any medicines the child is taking. Your child’s provider will check for a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

The disorder may come and go for weeks or years if it is not treated.

A mental health therapist can help your child to explore feelings and behaviors.

Cognitive behavioral therapy (CBT) is a way to help your child identify and change views your child has about self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new ways to think and act.

Acceptance and commitment therapy (ACT) helps your child accept that your child can have thoughts and feelings without acting on them. It also helps your child learn ways to make changes and stick to goals.

Habit reversal training helps your child become aware of when he or she is about to pull hair. Then your child can choose what is called a competing response. This means that, for example, when your child feels like needing to pull hair, your child would make a fist and keep his or her hands in the lap instead.

Several types of medicines can help. Your child’s healthcare provider will work with you to select the best medicine for your child. Your child may need to take more than one type of medicine. If a child has severe symptoms, both behavioral therapy and medicine may be best.

How can I help my child?

• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax such as by taking up a hobby, listening to music, playing, watching movies, or taking walks.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.
• Check your child’s medicines. To help prevent problems, tell your child’s healthcare provider and pharmacist about all the prescription and nonprescription medicines, natural remedies, vitamins, and supplements your child takes. Make sure your child takes all medicines as directed by your provider or therapist. It is very important that your child takes the medicine even when feeling and thinking well. Without the medicine, your child’s symptoms may not improve or may get worse. Talk to your provider if your child has problems taking the medicine or if the medicines don't seem to be working.
• Contact your child’s healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.