Trichotillomania is commonly known as the “hair pulling” disorder in which an individual consistently pulls out their own hair in connection to emotional dysregulation, which can lead to hair loss or functional impairment. When a child is struggling with trichotillomania, it can be distressing for the whole family to see them engage in these behaviors, and it can often be hard to understand why the child feels the need to pull at their hair.
While we don’t see this disorder very often, the presence of trichotillomania can be seen in medical literature throughout the last century and was classified as a psychiatric disorder in 1987. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, trichotillomania was included in the section on obsessive-compulsive and related disorders alongside obsessive-compulsive disorder (OCD), but it has some distinct features in presentation and effective treatments that differentiate the two.
The onset of trichotillomania most often occurs between the ages of 10 and 13 years old, and research indicates that this stays consistent across different cultural settings. To meet diagnostic criteria for trichotillomania, a person must:
- Experience recurrent pulling out of their hair resulting in hair loss
- Continuously attempt to decrease or stop hair pulling
- Have clinically significant distress or impairment in social, occupational, or other important areas of functioning due to hair pulling
- Not have hair pulling or loss that can be better attributed to a different medical condition
- Not have hair pulling that is better described by symptoms of a different mental disorder (ex: attempts to perfect appearance or remove flaws from a physical point of view)
While pulling on your own hair can be seen as an intentional act to outsiders, those who struggle with trichotillomania don’t have control in the moment over their actions. They feel an urge to pull at their hair, and it feels like they do not have a choice, even if stopping the behavior would make those around them feel better.
Overall, research shows that approximately 0.6% of the population may have met criteria for trichotillomania at some point in their lives. It is worth noting that hair-pulling itself is more common, but it takes a higher level of distress and impairment to meet diagnostic criteria. In addition, many people who have trichotillomania experience feelings of shame around have the disorder, so studies may not capture the full prevalence.
The hair-pulling aspect of trichotillomania can be targeted at any body region that has naturally occurring hair. It is most common for those with trichotillomania to pull at their scalp, followed by eyebrows, and then the pubic region. Individuals who have trichotillomania may not even be fully aware of their pulling behaviors, and sometimes the urge and action to pull will feel more automatic and less conscious.
Across those with trichotillomania, there could be many reasons that trigger the need to pull hair. These triggers could be a need for, or reaction to, a sensory feeling, the experience of an unpleasant emotional feeling, or having thoughts that cause distress. The episodes of hair pulling can last anywhere between a few minutes to a few hours at a time.
Individuals with trichotillomania have been found to experience social challenges, to have low self-esteem, and to be more likely to develop social anxiety. For the most part, these effects are a result of the physical appearance that trichotillomania brings upon those suffering, oftentimes being a more permanent development of alopecia (baldness). Those who have noticeable physical changes as a result of trichotillomania may experience anxiety about letting others see their hair loss, which can impact function in relationships, in school, or at work. Research has also shown that about 20% of those with trichotillomania also eat their hair after pulling it out (trichophagia), which is often hard to tell medical professionals because of embarrassment. Eating hair can cause major gastrointestinal medical issues that could require intensive medical intervention.
Trichotillomania is often seen occurring co-jointly with other disorders including major depressive disorder, anxiety disorders, and substance use disorders, and studies find that the experience of trichotillomania often occurs prior to the development of other mental disorders.
If left untreated, studies have found that symptoms may change in intensity throughout the lifetime, but they will persist. Although the experience of trichotillomania can be distressing, not many people seek out treatment from mental health professionals, likely because of shame, a misunderstanding of the mental aspect of the disorder, and a lack of knowledge that there are treatments for trichotillomania that are effective.
When a child or teen has trichotillomania, the presence of hair-pulling may be distressing for caregivers as well as the individual. Understanding that an individual with trichotillomania feels a strong urge to pull their hair to relieve an internal feeling, and they are not doing it to intentionally cause challenges, is important. When caregivers and children work as a team to address the symptoms of trichotillomania, there is a strong likelihood that the child will benefit from an effective intervention that can target their challenges.