Hair pulling can be confusing and concerning. Known as trichotillomania, it’s often a way for kids to cope or stress or overwhelming feelings.
Rogers Behavioral Health’s Dr. Andrew Butchart, DO, psychiatrist and medical director for child and adolescent residential care in Oconomowoc, breaks down the signs, causes, and when to seek help.
What is trichotillomania?
Trichotillomania is a mental health condition that involves repeated hair pulling. An individual may pull hair from anywhere on their body, but most commonly from the scalp. This behavior is often linked to anxiety, stress, boredom, or a need to relieve tension. It’s similar to nail biting in that it provides a sense of relief and often happens when someone is distracted.
A lot of times, people will discard the hair. I’ve had others tell me they need to inspect it and see the follicle. It can feel satisfying to know that they pulled the entire strand of hair. Some people ingest it, which in rare cases can lead to medical complications.
What mental health disorders are associated with trichotillomania?
Hair pulling falls into the category of body-focused repetitive behaviors, or BFRBs. It can be associated with:
- Anxiety
- Obsessive-compulsive disorder (OCD)
- Depression
For many, hair pulling is a way of coping when they feel overwhelmed or out of control.
What age does trichotillomania typically start and why?
While trichotillomania can occur at any age, it most often begins between nine and 13, during late elementary school into early high school. That’s when we typically see anxiety disorders begin to appear in kids. There are a couple of reasons for that, including an increase in:
- Social expectations
- Academic expectations
- Awareness of the world around them, such as bad things in their communities on the local news, natural disasters, and world affairs
- Concerns about their families, including financial worries
Why is there stigma around trichotillomania?
Trichotillomania is not that common. Most studies indicate 1 to 2% of the population is affected, while some estimate as high as 4%.
I think there’s shame and stigma because hair pulling can lead to noticeable and alarming changes in physical appearance, such as bald patches or missing eyelashes. People can try to cover these areas by styling their hair differently, wearing hats, or using artificial hair.
How does trichotillomania affect a person’s life?
There are several ways we see the disorder impacting kids’ lives:
- Avoidance: They feel ashamed about their appearance, so they won’t attend school or extra-curricular activities. They’re self-conscious that they’ve pulled out eyebrows and eyelashes or have patches on their scalp.
- Negative self-talk: Sometimes we see kids feeling very overwhelmed because they can’t manage their hair pulling. It might start with the urge to pull one hair, then they keep going. They realize they’ve lost control and know they should stop but aren’t able to, so they experience a sense of failure.
What is a common misunderstanding about trichotillomania?
People may not recognize that it’s closely related to anxiety. Just like someone might have panic attacks or bite their nails, someone else may engage in hair pulling. For some kids, hair pulling is simply how anxiety shows up. We often treat children with trichotillomania in Rogers’ OCD and Anxiety residential care programs for children and teens.
When should someone get help?
I recommend seeking help when it interferes with a person’s ability to function in everyday life or leads to avoidance. This might look like a child who is so worried about their appearance that they stop going to school, sports, or other activities. They may not want to leave the house, even for things like going out to dinner with family, because they’re afraid others will notice or judge them.
It’s also a sign to seek help if a child feels unable to control or stop the behavior, or if it starts to take priority over other parts of their life.
How does mental health treatment help?
Using cognitive behavioral therapy, or CBT, we look at the connection between thoughts, feelings, and behaviors. We explore what thoughts and feelings might contribute to hair pulling. For example, are there certain times of day or situations when someone is more likely to do it? Sometimes it can happen before school because a child is stressed out about what’s ahead. It might not even be a conscious worry, but they go into the bathroom to get ready to leave and end up spending 20 minutes hair pulling. Or it may happen in the evening, when there are fewer distractions and anxious thoughts begin to cycle as they try to wind down.
Medications can sometimes be a helpful addition to therapy.
Additionally, we use habit reversal training. We work on ways for kids to respond differently to the urge to pull hair. For example, they may learn how to keep their hands busy or use other coping strategies when the urge arises.
The good news is that trichotillomania is highly treatable with a good chance of recovery.
Rogers offers mental health treatment
When a child is struggling with their mental health, it can feel very isolating and overwhelming. Help is available, and taking the first step can open the door to hope and healing for your child.
Call 833-308-5887 for a free, confidential screening.
Trichotillomania is a mental health condition that involves repeatedly pulling out hair. It most commonly affects the scalp, but hair can also be pulled from the eyebrows, eyelashes, or other parts of the body. The behavior is often linked to anxiety, stress, boredom, or a need to relieve tension.
There isn’t a single cause. Hair pulling is often a way of coping with stress, anxiety, or feeling overwhelmed. For some people, it provides temporary relief from uncomfortable emotions.
Signs may include pulling hair from the scalp, eyebrows, eyelashes, or other areas, bald patches or thinning hair, difficulty controlling the urge to pull, avoiding school or social activities, and negative self-talk or frustration about the behavior.
It’s a good idea to seek professional help if hair pulling interferes with daily life, causes avoidance of school or activities, or feels impossible to control.
Treatment often includes cognitive behavioral therapy (CBT), which helps children understand the connection between their thoughts, feelings, and behaviors. Habit reversal training teaches children new ways to respond to the urge to pull hair, and medication may also be a helpful part of treatment for some children.
