Understanding and Treating Trichotillomania in Teens

If your teen pulls her hair out, she may have trichotillomania. Although not very common, trichotillomania has been well studied and there is help available for this condition.

Overview

Trichotillomania is a condition in which the person pulls out, twists off or breaks off his or her own hair. This hair pulling is not for cosmetic reasons (like shaping eyebrows by tweezing) and often causes distress. Currently, it is thought that approximately 1 to 3% of college-aged individuals in the United States have trichotillomania. It can begin at a young age (under 5 years old), but the child often grows out of it when it starts this early. When the hair pulling starts later in life, in the preteen or teen years, it can be more persistent and last into adulthood.

People with trichotillomania will pull out head hair, but they will also pull out eyelashes, eyebrows, and/or hair on other parts of the body, such as the underarm, pubic, chin, chest or leg areas. The hair pulling may be unconscious or intentional. According to The TLC Foundation for Body-Focused Repetitive Behaviors, this is a condition that can come and go; the hair pulling can stop for days or even months but then reoccur. There is even evidence that someone can pull hair out while sleeping. It is a complicated problem that can manifest itself differently depending on the person.

Causes

The short answer is that no one knows for sure what causes this kind of hair-pulling, although there seem to be biological forces as well as behavioral, learning, and psychological components to its development.

Having a family member or relative with trichotillomania increases the risk for the condition, which suggests that there may be a heritable component to the condition. One twin study suggested a heritability estimate of 76.2%, indicating that genetics plays a significant role.

Sometimes trichotillomania occurs in kids who have anxiety, major depression, obsessive-compulsive disorder, or Tourette's syndrome. Tourette's syndrome is a neurodevelopmental disorder characterized by repetitive motor movements, which may include sniffing, facial movements, coughing, and blinking.

Currently, trichotillomania is classified as one of the obsessive-compulsive and related disorders. Kids may have an uncontrollable need to pull out their hair, or they may pull it out unconsciously while doing other activities, such as watching TV.

Why Trichotillomania Is a Problem

The TLC discusses many reasons why trichotillomania becomes a problem for a teen. The hair pulling is often done in such a way that it leaves patches of hair missing. This is a cosmetic problem, and the teen can spend a lot of time and effort trying to cover up the missing hair. She may opt for elaborate hairstyles or hats to cover up patches of missing head hair. Sometimes mascara or even markers are used by teens to “color in” areas where hair has been pulled out.

Teens are often embarrassed by the problem and sometimes will deny the hair pulling and resist getting help. In addition, they may face teasing from their peers, which can further their shame.

Another rare issue—trichobezoars—can arise if the hair that is pulled out is eaten. If too much hair is eaten, these 'hairballs' must be removed with surgery. The hair pulling can also lead to infection of the skin that was traumatized by the pulling. In the end, the repeated pulling out or breaking off of hair can lead to permanent hair loss.

The hair pulling isn't only a problem for the teen that is doing it. It can cause problems in some families, as frustrated parents have resorted to punishing the teen for the behavior or even bribing them with gifts to stop it. Because what a parent does to stop it makes little difference with this disorder, you may feel powerless to help your child if they are struggling with this problem.

Getting Help

Because there isn't a clear cause for this disorder, it can be confusing for parents. Should my teen see a dermatologist? Their pediatrician? A psychiatrist?

If your teen has patches of hair missing, your pediatrician or family healthcare provider might be a great place to start. There are sometimes medical reasons for the missing hair, like ringworm of the scalp or traction alopecia, a form of gradual hair loss caused primarily by pulling or putting pressure on the hair.

If it is determined that the problem is trichotillomania, there are treatments available.

Cognitive behavioral therapy (CBT) undertaken by a qualified therapist is often effective. During therapy, the teen will learn about the disorder, as well as ways to manage the urge to pull the hair or avoid hair-pulling that goes on unconsciously.

Medications, particularly selective serotonin reuptake inhibitors (SSRIs), have also been found to be effective for trichotillomania, although they have not been rigorously tested in children or teens for this disorder.