Coping with Compulsive Hair Pulling

Are you noticing bald patches on your child’s head? Is your teen wearing more hats or styling their hair in a certain way to hide part of their scalp? These are a few telltale signs of someone who may be dealing with trichotillomania.

The disorder, which can start in toddlerhood and affects all ages, causes habitual hair pulling, often triggered by certain emotional situations such as stress, anxiety, excitement or boredom.

Dr. Kevin Triemstra, pediatric psychologist at Akron Children’s Hospital, explains that millions of people suffer from trichotillomania, or “trich,” but many parents don’t detect it until bald patches start to appear.

“A lot of times kids will grab strands of hair,” he says. “You’re not necessarily going to find clumps of hair.”

They also may pull hair on other parts of their body including eyebrows or eyelashes, as well as arm and leg hair.

According to Karen Pickett, licensed psychotherapist with PsychBC in Columbus, there is a genetic predisposition for the disorder, which can be triggered by certain environmental factors.

“Happy things, sad things, big changes of any kind can set the condition into action,” Pickett says. “If the child is too over stimulated that could trigger it, if they’re bored or under stimulated, pulling can add stimulation.”

As children become more self aware, they might limit their hair pulling to times when they’re alone or away from peers.

“They might be able to stop doing it when other people are around and only do it when they’re by themselves because of the social pressures on it,” Triemstra says.

If untreated, the disorder could cause self-esteem issues or depression.

“It’s not going to evolve into something morbid or more severe, but it will prevent that person from developing better ways of expressing their discomfort,” says Dr. Felipe Amunategui, associate program director of child psychiatry at University Hospitals Cleveland Medical Center.

If you suspect your child is struggling with trichotillomania, experts say it’s important to approach the subject in a supportive manner.

“You don’t want them to feel like they’ve done something wrong,” Pickett says. “You don’t want to smack their hand or yell at them to stop. Belittling them is absolutely not helpful and will only make it worse.”

Amunategui adds that kids are usually receptive to treatment even if they’re initially embarrassed to talk about it.

“If you sense that your child is very touchy about the subject, take that into consideration,” he says. “However, that means it’s something that is very much affecting the child and should be addressed with a consult to your pediatrician.”

There are different methods of managing the disorder depending on the child and the severity of the case, but the most common form of treatment is habit reversal training.

First, Triemstra says they’ll keep track of when your child pulls their hair.

“We’ll start by figuring out what are some of the triggers for doing it, what’s the environment, what times of day are they doing it, how does it start,” he says. “Then they can start to put in place a different response.”

Next, he says they introduce a “competing response,” or an alternative action other than hair pulling.

“We’ll give them something else they can do with their hands, such as play with a squishy ball or a ring spinner,” Pickett adds.

For toddlers or very young children, treatment may include shaving the child’s head or having them wear soft gloves to prevent them from pulling their hair.

In some cases, kids outgrow the habit on their own.