Betty W. Phillips, Ph.D., Psychology
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More Help for Parents: Hair Pulling


A Chatham County grandparent wrote with a question about trichotillomania (compulsive hair pulling) symptoms seen in their grandchild, questioning whether this problem is similar to the self injury behavior described in the last Advice Line column. While there are some similarities between hair pulling and other kinds of self injury, there are also differences seen in individuals diagnosed with trichotillomania.

Parents and grandparents should be commended for observing their children carefully, noting unusual behavior patterns and discussing these with support personnel such as school counselors, doctors and mental health professionals. In the case of trichotillomania, parents may note that children or adolescents appear to be absent mindedly pulling their hair while watching television or doing homework or they may start to notice missing eyelashes, eyebrows or bald spots on the child's head. In most cases the child will be embarrassed about this condition and will minimize, deny or even lie about this behavior. Therefore, it is important that family members are very discreet about discussing this condition with a child and sensitive to the child's embarrassment about experiencing this disorder. Frequently the children are perplexed and confused about this behavior and have no explanation except they cannot stop on their own. It is extremely important not to criticize or punish the youngster suffering from this condition. Other children will notice hair pulling or bald spots and may ridicule the child with trichotillomania, causing shame and embarrassment and increased attempts to hide the disorder from others.

Trichotillomania usually begins during puberty and occurs more often in girls than boys, although it can be seen at any age and sex. It was thought that the condition occurs in only 1 to 3% of the population, and although new research suggests that the actual rate may be 10% or higher. Sometimes the only behavior observed is hair pulling, while other children may also pick at their skin or bite their nails compulsively. At times the behavior may appear stress-related, while other hair pulling behavior may occur only during quiet activities. Studies of individuals with trichotillomania find that a considerable amount of time is lost to hair pulling and in efforts to cover up the damage. Most experience an uncontrollable urge to pull, with relief occurring as the hair is pulled. The tension relief, however, is only temporary and the urge will recur. The urge to pull hair may be episodic or continuing, often lasting into and through adulthood. Efforts to cover up and keep this disorder secret often block treatment while increasing shame and embarrassment and impairing self-esteem. While the behavior may appear unusual or bizarre, the youngster is not "crazy". The condition is classified as an impulse control disorder, sometimes with characteristics of an anxiety or obsessive-compulsive disorder.

Treatment can be effective with a specially trained therapist, although recovery can be difficult. Some experts feel that medications for anxiety can be helpful while others challenge this, although most experts do agree that medication alone is never the treatment of choice. Cognitive-behavioral therapists may be trained in treating trichotillomania with stimulus control techniques and habit reversal therapy. Relapse prevention is an important part of the therapy as the behavior often reoccurs episodically or continuously.

Family members should never be ashamed if trichotillomania occurs in their family but instead should be compassionate about the distress of a child with this disorder and as comfortable in seeking help from professionals as they would be in helping a child with any other medical or emotional condition.