A Parents’ Guide to Trichotillomania
Mummy, I Can’t Stop Pulling Out My Hair…
Trichotillomania, or recurrent compulsive hair pulling, was first described by the French physician Francois Henri Hallopeau (1889), but remains an under-recognised pattern of behaviours. Parents who present to my consulting room often recount first finding out about their children’s hair-pulling when they notice tufts of hair accumulating around the bed, on the floor next to the computer, or hidden behind the study desk. The parents then become concerned when they see patches of hair loss visible on the children’s head or face, but the children are often unable to explain their hair-pulling.
Do we need to be concerned about our children pulling out their hair? Research describes three subtypes of hair-pulling: early onset, automatic, and focused. Early onset hair-pulling typically occurs in children younger than 8, and frequently resolves with little or no intervention. Automatic hair-pulling commonly happens out of awareness (I often explain this as the child’s “autopilot mode”), when the child is engaged and absorbed in thoughts or other tasks, such as watching television, reading, lying in bed, or chatting on the phone. On the other hand, focused hair-pulling is often described as holding the child’s attention, and is related to more intense urges, increased tension and thoughts about hair-pulling.
There are a number of things that you can do to support your children who hair-pull:
1. Help your child identify the triggers associated with hair-pulling. Just as every child is unique, so is their pattern of pulling behaviour. Some children hair-pull to fulfill their sensory needs, for example to self-soothe or have a hair to “play with”. Other children’s hair-pulling is triggered by emotions (e.g., anxiety, stress, anger, frustration, boredom, or other strong emotions) or thoughts (e.g., my hair is out of place or the wrong colour).
2. Understand the context of hair-pulling. Another powerful cue to hair-pulling is environmental, and hence, it can be instrumental to identify the locations and activities your children are engaged in when they tend to pull out their hair. For example, watching the television, talking on the phone, using the computer for school work or entertainment, sitting in the bus/car or lying in bed. Most of these activities are sedentary and they are situations where there is an easy access to head or face. Some children tended to pull their hair when they are alone. Increased family time and activities in the lounge and having the child tie up their hair can be simple environmental modifications to reduce hair-pulling.
3. Support your chilld unconditionally. It is vital to support, love and validate your child without blame, judgment or criticism. When hair-pulling occurs, it can be easy to focus on the pulling. Hair-pulling is only one part of your child, and remember to also focus on what is going well and what are your child’s strengths.
4. A slip is a possibility. If you child’s hair pulling reduces or stops, rejoice! However, know that a slip is possible and prepare your children for it. Children with perfectionistic traits may challenge themselves by setting goal such as, “I am not going to pull at all today” and thought they have “failed” if they pull just one hair. As a result, they may think there is no reason to try to control their hair-pulling for the rest of the day or week, and increase pulling (or “binge pulling”) can occur. Recovery from hair-pulling is a process–not an on-off switch–focus on the successes.