Trichotillomania is diagnosed in children who have established a recurrent behavior of hair pulling that is causing them significant distress. To meet the criteria for the disorder they must have made repeated attempts to decrease or stop the behavior. Before receiving a diagnosis, children are often tested for scalp infections, alopecia, or spot baldness, and any other possible medical explanation. Trichotillomania is more difficult to diagnose in very young children.
There are two types of trichotillomania:
- In automatic hair pulling, the individual may not even realize she is doing it until after the fact. For example, she could be zoning out watching TV, then look down and realize that the couch is full of hair she has pulled.
- In focused hair pulling, the child is doing it very intentionally because it feels good. Often, focused hair pullers will wait until they are in private to engage in the behavior.