FFFHair Pulling (Trichotillomania)

No. 96; Updated October 2023

It is common for children and adolescents to play with their hair. However, frequent or obsessive hair pulling can lead to serious problems. The medical term for severe hair pulling is trichotillomania.

People with trichotillomania pull hair all over their bodies, including the head, face, arms, legs and pubic areas. They may not notice the effects of the hair pulling until they find a need to cover up bald patches with hair clips, a hat, wig or scarf. People with trichotillomania are not able stop pulling their hair without support.

As many as 1 - 2 people in 100 has the following signs and symptoms of trichotillomania:

  • Hair pulling resulting in notable hair loss, unrelated to common baldness or forms of alopecia
  • Pleasure, excitement, or relief when pulling out hair
  • Embarrassment or shame resulting from hair loss
  • Problems at home, school or work

The cause of trichotillomania is not known. For some children, trichotillomania becomes very difficult to control. Hair pulling can occur anytime but may become worse in stressful situations.

Most youth with trichotillomania feel shame, embarrassment or guilt about their hair loss. Younger children may not notice or be bothered by hair loss. Older children and adolescents may be teased, have low self-esteem, anxiety or depression.

Parents can become frustrated, as it is very difficult to understand that children with trichotillomania can’t simply stop pulling their hair. Neither parents nor children are to blame for the hair pulling behavior. Punishing children for pulling hair is unlikely to decrease the behavior and can lead to problems with self-esteem. In order to avoid punishment or embarrassment, it is common for children to try to hide or deny they are pulling their hair.

Frequently used treatments for trichotillomania include:

  • Habit reversal therapy is a cognitive behavioral therapy (CBT) and specialized form of behavior therapy. It involves helping a child recognize thoughts, feelings and behaviors associated with hair pulling. The goal of this therapy is to increase the awareness of hair pulling and replace it with behaviors that compete with the urge to pull
  • Medication therapy is also used to decrease the anxiety, depression and obsessive compulsive symptoms that often accompany trichotillomania

Family therapies and support groups are also available. Children with trichotillomania should be evaluated by a trained and qualified mental health professional. Treatment is most effective when it is covers the symptoms unique to each person and individualized to the needs of the child and family.

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