Quick Guide to Trichotillomania

Trichotillomania, also known as hair-pulling, is a mental health disorder that causes kids to have an uncontrollable urge to pull out their hair. Pulling out hair from the head is most common. Some children also pull out hair from other parts of the body, including eyelashes, eyebrows, genitals, arms and legs. A lot of kids pull out their hair without knowing it. Some children with trichotillomania also play with or eat their hair after pulling it out. 

Sometimes, kids with trichotillomania don’t realize they are doing it until after they’ve been pulling for a long time. For example, the child could be zoning out watching TV, then look down and realize that the couch is covered in hair they have pulled. This is called automatic trichotillomania. 

Other kids with trichotillomania are aware of what they are doing. They pull because it makes them feel better or even good. Often, they wait until they are alone before they start pulling. This is called focused trichotillomania. 

Signs that a child might have trichotillomania include: 

• Uneven or one-sided hair loss 
• Suddenly losing a lot of hair 
• A lot of hair on the floor or pillows in the child’s room 
• Constantly holding their hands near their head 
• Wearing hats or other cover-ups because they don’t want others to see their bald spots 
• Constantly looking in the mirror 
• Low self-esteem 
• Feeling ashamed about what they look like or because they can’t stop pulling out hair 

Trichotillomania usually starts around age 12, but younger kids can experience it too. 

Trichotillomania is diagnosed when a child has been pulling out their hair for a long time and is very upset about it. To be diagnosed, the child must have tried and failed to stop hair-pulling on their own. 

Before getting a diagnosis, children are often tested for scalp infections or other medical reasons for their hair loss.  

Trichotillomania is usually treated with a form of cognitive behavioral therapy called habit reversal therapy (HRT). This treatment helps children understand the emotions and situations that give them the urge to pull. They then learn skills and tools to stop the pulling or replace it with a different action. Increasingly, clinicians are now using comprehensive behavioral treatment (ComB), which is based on HRT but takes things a step further by incorporating strategies from other approaches such as dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT).

Sometimes, something as simple as pulling back their hair or wearing loud, dangling bracelets can make kids more aware and help them stop. Some doctors suggest tricks that make hair pulling more difficult, like wearing band-aids around their fingers. Kids who play with their hair after pulling it can also try carrying around other small objects to play with instead, like paperclips or erasers.

In ComB clinicians also work with kids to address the things that are triggering the behavior, including stress and uncomfortable feelings.

Medication is not the main treatment for trichotillomania, but some children might benefit from taking it to help with other disorders they may have, such as depression or anxiety while they are learning new skills in therapy.