Trichotillomania factsheet
Introduction
Trichotillomania, or hair-pulling, is a mental health condition where a child feels the urge to pull out their hair. This can include:
- hair on the head
- eyebrows
- eyelashes.
Trichotillomania is compulsive, which means your child may not be able to control the urge to touch or pull their hair, even if it is upsetting them.
Trichotillomania can start in childhood or adolescence and can be linked to other conditions like:
- obsessive-compulsive disorder (OCD)
- anxiety
- depression.
This behaviour can occur when your child is stressed, anxious, or relaxed. Hair-pulling may feel soothing at the time, but it can have serious physical, emotional, and social effects on your child. Early treatment can be effective for trichotillomania.
Signs and symptoms
The main symptom of trichotillomania is repeated pulling, twisting, or plucking of hair.
Your child may have a specific part of the body or head they pull from, or they might only pull when they are:
- anxious, stressed or upset
- relaxed
- distracted, like watching television or reading
- falling asleep
- having trouble communicating their feelings.
Trichotillomania can also lead to more severe issues, including:
- noticeable hair thinning or bald spots
- sores and infections in the skin and hair follicles
- stomach issues from eating or chewing pulled hair
- hand strain from repeated movement in plucking and pulling
- low self-esteem and feelings of shame
- withdrawing from friendships, family, and other social situations
- development of other compulsive behaviours like skin-picking
- distress about their appearance.
Diagnosis
See your local doctor as soon as possible if you are concerned your child has developed hair-pulling behaviours. They will do a physical check of your child’s symptoms and refer you to a specialist.
Trichotillomania can be diagnosed by a:
- paediatrician – a specialist children's health doctor
- psychiatrist – a specialist mental health doctor.
Your child’s specialist will check:
- any other conditions that could be causing the hair loss
- areas of hair loss
- whether the behaviour affects how your child feels or functions
- whether your child has been able to stop the behaviour at any point.
Treatment
Treatment of trichotillomania will be different for every child and will depend on what is causing the behaviour to happen.
Treatment could include:
- therapies like cognitive behaviour therapy (CBT)
- medications to manage mental health conditions like depression
- distraction strategies at home.
Your child’s treatment team will discuss options with you based on what is most suitable for your child.
Management
Managing hair-pulling at home
Some children may pull or twist their hair to self-soothe. They may like the feeling of the hair strand or find the repetitive motion calming.
You can help your child by:
- identifying high-risk times for hair-pulling
- giving your child safe, soothing activities before hair-pulling happens
- gently redirecting your child to safer soothing activities when hair-pulling is happening
- talking to them about things that might be stressful or worrying them and seeking help.
Some children respond well to objects or toys that involve pulling or fidgeting with their hands.
These could include items like:
- stretchy noodles
- textured slime, putty, or playdough
- spiky balls
- popping toys
- ribbons or fabric
- craft items like chenille sticks or pipe cleaners.
Speak to your child’s doctor or therapist about other strategies that may help, including:
- haircuts
- hair nets or caps
- cotton gloves or mittens.
Developmental hair-pulling
Some types of hair-pulling in babies and toddlers can be developmentally normal and are not usually signs of trichotillomania.
- Babies: 1 month to 2 years
At this age, hair pulling can be a self-soothing behaviour that goes with thumb sucking. A baby may twist or gently pull their own or your hair while sucking their thumb or fingers before falling asleep or when they are distressed.
- Toddlers: 2 to 5 years
Children who pull their hair to self-soothe as a baby may continue the habit as they get older. At around three years old, toddlers may notice how you respond to their different behaviours.
If a parent or carer becomes worried or upset in response to hair-pulling, a toddler may start to use the behaviour to show frustration or the need for attention when upset.
