Trichotillomania for Youth

Trichotillomania or compulsive hair pulling occurs in people of all ages.

In children, it appears there are several behaviours that are important in the hair pulling habit such as

  • feeling the texture of the hair, rubbing fingers along the hair shaft,
  • biting the hair bulb, eating the hair, sucking on hair, or “playing” with the hair in the mouth,
  • rubbing the hair along the cheek, nose or lip.

For many children these behaviours are motivated by touch, which apparently has a self-quieting effect similar to that achieved by rocking, thumb sucking, rubbing a favourite blanket or stroking a stuffed animal.

It is possible that some adult hairpullers began pulling and continue to pull for similar reasons.  Years of practice, however, allow the habit to evolve into a behaviour pattern which is hard to change with complex emotional and situational influences. Over time, the effects of hair pulling can have negative consequences on emotions, self-esteem and social confidence.

The effects of hair pulling

Young children who pull often do not experience the same degree of self-consciousness as pre-adolescent children, adolescents, and adult sufferers. Older children experience more shame and other socially inspired effects of hair pulling.  While hairpulling may be a sign of stress in the child, this is not always the case, and should not automatically be assumed so.  Although severe environmental and interpersonal stressors can certainly contribute to hair pulling behaviour.

Although young children may not experience the same degree of emotional stress as older hair pullers, these children often do have some sense of being different, usually derived from their parents' attention to their hair pulling, the comments of other adults, and the reactions of their peers.  These can negatively affect the child’s emotions and behaviour.  Left unaddressed, it is possible that these feelings can lead to the more severe emotional side effects such as those experienced by many adults with trichotillomania.

How can parents help?

So what can parents do when they discover that their young child has been pulling out hair?  First and foremost, don’t panic! Many parents, particularly if they are individuals who have struggled with hair pulling themselves, tend to be quite sensitive about their children’s interest in their own hair.  It is very common for children to be curious about different textures and to explore their heads, hair, and bodies by touch.  Remember, for some children hair pulling is a brief childhood phase associated with self exploration and self quieting, and will not develop into a clinical problem.  However, if a child's hair pulling has caused substantial damage, or they express a wish to end hair pulling, here are some general approaches a parent might consider.

  • Adopt a non-punishing, non-critical attitude toward the hair pulling.
  • Observe your child’s hair pulling habits.  Determine which activities and what situations seem to increase the likelihood that there will be a pulling episode.
  • Some of these activities might include watching TV, reading,  studying, listening, riding in the car, daydreaming, settling down, and trying to fall asleep.
  • Often children can be helped to establish alternative non-damaging routines while involved in situations that would typically trigger a pulling episode.

You may want to explore with the child a variety of “toys” that may interest your child and distract him/her from hair.  Ones that provide tactile stimulation are particularly useful.  Some examples include koosh balls, nerf balls, stuffed animals, pieces of velcro, felt or velvet, etc.  The list is only limited by one’s imagination!  Introduce one toy at a time in situations where the child is vulnerable.  Be positive and encouraging.  Help your child incorporate handling and playing with the toy into the activities and situations where they are vulnerable.  For example, if your child has typically pulled while watching TV, you might introduce a “TV toy” and encourage your child to play with it while watching TV.  Provide lots of praise for these alternative behaviours until the pattern is changed.  This process could take from a few days to much longer but even a diligent effort may in fact, not succeed.  Be patient and be careful not to nag.  It is perfectly acceptable to drop the effort for a time and reintroduce it later.  If you suspect that your child’s hairstyle and length may be contributing to the problem, it may help to experiment with a different style, particularly one that keeps the hair away from face and fingers.  Remember this is a complex behaviour pattern, the causes of which are as yet unknown.  If you need additional support and/or guidance, don’t hesitate to seek the assistance of a qualified therapist.

Although little has been written about treatment outcome for childhood trichotillomania, early intervention appears to be successful in reducing or eliminating hair pulling in most children. Therapy involving family members, with a learning-based intervention, introduced before there are significant emotional side effects, allows children to gain healthy perspectives of themselves while developing positive self-esteem.  In addition, teaching children about their own unique needs and helping them to develop coping skills within a positive and encouraging atmosphere provides an opportunity for them to learn valuable lessons about gaining control over their own lives and behaviour. A low profile, “wait and see” approach may be ok for preschoolers, however, for some school age children, early intervention can help to ensure that young hair pullers are protected from the potentially devastating problems associated with adult trichotillomania.

Adapted from an article By Ruth Goldfinger Golomb, M.Ed. and Charles S. Mansueto, Ph.D;  Behaviour Therapy Associates, Silver Spring, Maryland. 

Editors Note:  This article originally appeared in “In Touch” a quarterly newsletter of The Trichotillomania Learning Centre

References:

Mansueto, C. (1991).  Trichotillomania in Focus, OCD Newsletter, 5, 10-11.

Swedo, S (1991).  Childhood Trichotillomania Update. OCD Newsletter, 5, 4.

 

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