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Ask the Experts

Help! My Child Pulls Her Hair Out

By Dr. Joseph Gianesin, Behavioral Consultant

Question:

My fifth-grader began pulling her hair out when she was in third grade. We first got help from her school guidance counselor and then her pediatrician. We take her to a nutritionist who gives her natural-herbal remedies, and we had her see a therapist (on a weekly basis) for about a year.

The situation has improved, but sometimes, especially when she has a test or feels like she isn't popular, she will pull her hair. I've done some research on Trichotillomania (TTM), but I am not sure about the diagnosis. What can I do to best help her?

Answer:

Trichotillomania (TTM) is an impulse control disorder or a form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, eyebrows, or other body hair, that often leads to noticeable bald patches. Trichotillomania is classified as an impulse control disorder, but some experts believe it has some characteristics of a habit or obsessive-compulsive disorder.

Trichotillomania is common among girls, and there seems to be a strong stress-related component. In low-stress environments, some individuals exhibit no symptoms whatsoever, but as soon as stress comes into the picture, the symptoms reappear. This seems to be the case with your daughter. There is a high incidence of this during the onset of adolescence and because your daughter has a history of this behavior, she has a predisposition to use it as a coping mechanism. It's encouraging that her situation has improved with therapy. She may need periodic therapy as she enters puberty and adolescence.

According to the experts in this field, habit reversal training (HRT) has been shown to be a successful treatment for Trichotillomania. Basically, HRT professionals train the individual to learn to recognize the impulse to pull and also teach them to redirect this impulse. A colleague of mine suggests a rubber band on the wrist so that when the client feels the impulse to pull her hair, she snaps the rubber band on her wrist. She could also twist the rubber band which is a common motion among hair-pullers. Many of my clients who suffer from this will twist the hair strand to such a degree that the hairs are pulled from the roots. As part of the HRT process, clients are asked to keep a journal of their hair pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled as well as what they were thinking or feeling at the time.

Some medications have been shown to have limited usefulness when used in conjunction with HRT. You should consult your pediatrician regarding this. It sounds like you have taken all the appropriate steps to helping your daughter. She will continue to experience stress in her life, but how she copes and deals with stressful situations is the key to her living a normal life. Don't be reluctant to take her back to the therapist as she approaches a developmental milestone and life stage that is crucial in her development.


Dr. Joseph Gianesin is a professor at Springfield College School of Social Work. He has more than 25 years of experience as a child and family therapist, a school social worker and a school administrator. Along with his academic appointment, Dr. Gianesin is a program and behavioral consultant for public schools in Massachusetts, helping them develop and manage programs for children with significant mental health problems.

Advice from our experts is not a substitute for professional diagnosis or treatment from a health-care provider or learning expert familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's condition.

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