Hair Pulling in Children and Adolescents
Trichotillomania, or compulsive hair pulling, usually begins with the onset of puberty, but it can start earlier in childhood. While the underlying cause is still unknown, there is no cure for trichotillomania, so early recognition and prompt treatment is vital for kids to learn to manage behaviors.
What Trich Is
Compulsive hair pulling tends to start around age 12 and is thought to be associated with hormonal changes. While for some children pulling hair is a development phase that eventually goes away, for children who genuinely have trich, it is a compulsion much like those involved in obsessive-compulsive disorder. Those who have first-degree relatives with obsessive-compulsive disorder are more likely to have it, and girls are more likely to have it than boys. There can be confusion during diagnosis, however, because trich can be mistaken for a movement disorder such as the kind experienced by those with autism, or those with a stereotypic movement disorder, or tic disorder. Diagnosis is further complicated in children because pulling hair could be the result of a medical condition such as scalp infections, itching, alopecia,
Kids who pull their hair tend to so in private. However, signs of trichotillomania include sudden or asymmetrical hair loss, excessive hair on pillows or other areas where the child spends time alone, hands always near their hair, wearing hats or covering the head, or frequent checking hair in mirrors. Children will exhibit anxious behaviors and try to hide hair loss.
There are two types of pulling behaviors, focused and automatic. Kids who pull intentionally do so because they are removing perceived imperfections, or because it results in an emotional response. Those who pull automatically are not aware of what they are doing and often do not remember it. Ritualistic behaviors often develop and not only include the act of pulling out hair but what happens to it afterward. Some kids play with it while others swallow it which can be very dangerous and cause digestive problems.
Hair is an essential part of one’s appearance, and kids who have problems with their hair because of compulsive pulling experience physical as well as emotional complications. The most common areas hair is pulled from are the scalp, eyebrows, and eyelashes. Depending on the frequency of pulling, sometimes that hair does not grow back. If it grows back, it may grow back uneven or with a different texture than the original. A lot of time is spent covering up, masking, or in other ways hiding the physical effects of hair pulling.
Most kids do not understand what is happening to them when the urges to pull overtake them. They fear the judgment from their peers, so they hide their distress and socially isolate to prevent the onslaught of negativity. They often try to stop on their own, and when they cannot, self-esteem plummets leading to increased anxiety and even depression. Increased anxiety and depression is attributed to increases in pulling behaviors which only serves to exacerbate the cycle of negative emotions.
Young children with trichotillomania often respond well to treatment. Because kids are used to adults monitoring their behaviors, treatment for trich involves parents providing guidance and structure consistent with the child’s age. Treatments for trich focus on increasing awareness of behaviors, things that trigger the behaviors, creating new ways to deal with triggers, and developing new habits. Cognitive behavioral therapy, habit reversal training, comprehensive behavioral training, and dialectical behavioral therapy are among the evidence-based treatments used to treat trich. The older the child, the more involved the child is in managing behaviors. Another aspect of treatment includes addressing anxieties and stresses that worsen behaviors and helping children develop emotional regulation and distress tolerance skills to counter the urge to pull.
Treatment is a lifelong process that involves progress and setbacks throughout a child’s life. Each developmental stage brings new challenges both physically and emotionally. Everyone experiences trich differently, so enlisting the help of a qualified body-focused repetitive behavior therapist and positive social support is vital to maintaining lifestyle and behavioral changes.
Trichotillomania is a lifelong condition characterized by compulsive hair pulling, but with early intervention and treatment, children can learn to manage their urges and behaviors successfully.