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It’s not always easy to watch your child struggle with habits that cause harm, especially when they seem linked to stress. Many parents worry when they notice their child pulling out their hair, unsure whether it’s just a phase or a sign of something more serious. This guide will help you understand why your child pulls their hair, and how you can support recovery.
Key takeaways
- Trichotillomania is a stress-linked mental health condition where kids repeatedly pull out hair from the scalp, eyebrows, or eyelashes, often without full awareness.
- Causes involve brain impulse control differences, emotional stress triggers, and personality traits like perfectionism or difficulty expressing emotions.
- Diagnosis requires recurrent hair-pulling causing noticeable hair loss, distress, or functional problems, assessed by a qualified mental health professional.
- First-line treatment is Habit Reversal Training (HRT), supported by mindfulness/ACT, and sometimes medications like SSRIs, clomipramine, or N-acetylcysteine.
- Other treatment options include microneedling with minoxidil for hair regrowth and neuromodulation (tDCS) for improving impulse control in resistant cases.
Hair pulling is linked to the mental health condition—trichotillomania
Trichotillomania is a mental health condition where children repeatedly pull out their hair, often without fully realizing it. This can happen from the scalp, eyebrows, eyelashes, or other areas. While it may look like a simple habit, it is a recognized body-focused repetitive behavior, often linked to emotional stress.
Signs and symptoms of trichotillomania in children
- Repeatedly pulling out hair from the scalp, eyebrows, eyelashes, or other areas
- Noticeable hair loss or thinning
- Spending time alone to pull hair
- Feeling tense before pulling and relief or pleasure afterward
- Avoiding situations where hair loss might be noticed, such as swimming or windy days
Why is my teenager pulling their hair out?
There’s no single cause. Children may develop this condition for a mix of biological, emotional, and environmental reasons.
Brain circuitry differences and impulse control
One study found that differences in the brain’s cortico-striatal-thalamo-cortical loops — areas that help regulate impulses — can make it harder for children with trichotillomania to manage their urges.
These loops act like communication highways between brain regions involved in decision-making and self-control. When signals travel less smoothly, a child’s natural “brake system” for stopping a behavior may lag, making it easier for the urge to pull hair to slip through.
Emotional stress
Research shows that stressful events, from family conflict to academic pressure, often precede symptom onset in children. In these cases, hair-pulling may serve as a form of emotional release.
The act can temporarily soothe intense feelings, offering a quick way to manage distress. Over time, this link between stress and pulling can become automatic, making it harder for the child to break the cycle without new coping skills.
Personality traits and emotional regulation challenges
Certain personality traits, such as perfectionism, difficulty expressing emotions openly, and alexithymia (difficulty identifying emotions), appear more common in children with trichotillomania. These traits can make it harder to process stress in healthy ways.
For example, perfectionism can heighten self-criticism, while alexithymia can trap feelings inside. Without effective emotional outlets, children may turn to repetitive behaviors like hair-pulling for relief.
How trichotillomania is diagnosed
Kleptomania often shows up differently in teens than in adults. The symptoms can sometimes be mistaken for typical misbehavior, such as shoplifting or rule-breaking. Here are some signs to look out for:
Who makes the diagnosis
- Qualified mental health professionals, such as child psychologists or psychiatrists.
- Pediatricians may identify early signs and refer the child for specialized assessment.
Tools or assessments used
- Structured clinical interviews focused on hair-pulling behavior.
- Behavioral checklists completed by parents, teachers, or the child.
- Direct observation and discussion about patterns and triggers.
Required symptom duration
- Hair-pulling behavior must be recurrent and cause noticeable hair loss.
- The behavior must lead to distress or interfere with daily functioning.
- Symptoms should persist over an extended period, not just in isolated short phases.
Early diagnosis improves treatment outcomes and helps families begin adequate support sooner.
Treatment for trichotillomania in children
There is no single “one-size-fits-all” approach to managing trichotillomania in children. The most effective plans are tailored to each child’s needs, taking into account the severity of symptoms, co-occurring conditions, and the child’s developmental stage.
Use habit reversal training (HRT) as the first step
A randomized clinical trial found that HRT significantly reduced hair-pulling frequency in pediatric cases. HRT involves a set of structured techniques designed to interrupt the automatic nature of hair-pulling and replace it with healthier actions. To practice techniques used in HRT:
- Track progress together: Keeping a simple, non-judgmental log helps identify patterns, celebrate small wins, and adjust strategies when necessary.
- Teach awareness skills: Sit with your child during calm moments and help them notice what happens right before they pull, where their hands are, what they’re feeling, or what’s happening around them. This way, they build the habit of catching the urge early and can take action before pulling begins.
- Practice competing responses: The child learns to perform an alternative, physically incompatible action like squeezing a stress ball, clenching fists, or playing with a textured object until the urge subsides.
Support emotional regulation with mindfulness and ACT
Mindfulness and Acceptance & Commitment Therapy can help children tolerate stress without resorting to pulling. Parents can make these skills practical by weaving them into daily life:
- Practice grounding exercises: Sit with your child and slowly count breaths together, or have them describe five things they can see, four things they can touch, three things they can hear, two things they can smell, and one thing they can taste. This anchors them in the present and calms the nervous system.
- Name feelings out loud: During everyday situations, model labeling your own emotions (e.g., “I’m feeling a bit nervous before my meeting”). Encourage your child to do the same, helping them connect physical sensations to emotional words.
- Encourage non-judgmental awareness: Teach your child that having an urge doesn’t mean they have to act on it. You might say, “You can notice the feeling and let it pass, just like watching a cloud move across the sky,” then guide them through a short pause before shifting to a different activity.
Pharmacotherapy
Pharmacotherapy aims to reduce the intensity and frequency of urges, often working best alongside therapy and supportive strategies:
- N-acetylcysteine: An amino acid supplement that has shown strong results in adults but less consistent benefits in younger patients.
- SSRIs and clomipramine: These medications can help manage co-occurring anxiety or obsessive-compulsive symptoms, which may in turn reduce hair-pulling behaviors.
- Atypical antipsychotics: Options like olanzapine or aripiprazole may be considered in severe or complex cases, typically when other treatments have not been effective.
These medications should always be prescribed and monitored by a qualified clinician, with ongoing evaluation to balance benefits and potential side effects.
Adjunctive hair and scalp care approaches
A 2022 study found that dermatologic treatments can be effective when paired with therapy, offering both psychological and cosmetic benefits. This approach aims to reduce the urge to pull while also supporting hair regrowth:
- Topical minoxidil: Applied after microneedling to promote hair regrowth and improve appearance, which can boost self-esteem and motivation for recovery.
- Microneedling: A minimally invasive procedure that stimulates the scalp and may help decrease pulling urges by altering sensory feedback.
Neuromodulation
Neuromodulation is a non-invasive way of gently stimulating specific areas of the brain to alter the way they communicate. For trichotillomania, the goal is to improve impulse control and reduce the urge to pull hair. In more resistant cases, it has shown promise in improving symptoms. This treatment targets specific brain areas to help regulate impulses and reduce pulling behaviors:
- Transcranial Direct Current Stimulation (tDCS): A non-invasive method that delivers mild electrical currents to the dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA), brain regions involved in impulse control.
- Symptom improvement: Regular sessions have been linked to reduced hair-pulling frequency and better control over urges in clinical studies.
Sources
- Alizadehgoradel, J., Pouresmali, A., & Taherifard, M. (2023). Safety and Efficacy of an Intensified and Repeated Transcranial Direct Current Stimulation Targeting Supplementary Motor Area and Dorsolateral Prefrontal Cortex in Trichotillomania (Hair Pulling Disorder): A Case Report. Clinical Psychopharmacology and Neuroscience, 22, 188 – 193. https://doi.org/10.9758/cpn.23.1082.
- Romanov, D., Michenko, A., Romanova, I., & Lvov, A. (2021). Trichotillomania (Hair Pulling Disorder). Psychodermatology in Clinical Practice. https://doi.org/10.1007/978-3-030-54307-5_16.
- Hamid, N., Bordbar, M., & Marashy, S. (2022). The effectiveness of habit reversal training with cognitive behavior therapy on quality of life and symptoms of trichotillomania patients. Medical Journal of Tabriz University of Medical Sciences. https://doi.org/10.34172/mj.2022.021.
- Christensen, R. E., Schambach, M., & Jafferany, M. (2022). Microneedling as an adjunctive treatment for trichotillomania. Dermatologic Therapy, 35(10), e15824. https://doi.org/10.1111/dth.15824
- Alizadehgoradel, J., Pouresmali, A., & Taherifard, M. (2024). Safety and efficacy of an intensified and repeated transcranial direct current stimulation targeting supplementary motor area and dorsolateral prefrontal cortex in trichotillomania (hair pulling disorder): A case report. Clinical Psychopharmacology and Neuroscience, 22(1), 188–193. https://doi.org/10.9758/cpn.23.1082