Trichotillomania In Children: Symptoms, Causes & Treatment

Several genetic or environmental factors may cause this OCD. Medications with CBT may help.

Medically reviewed by Dr. Pooja Parikh, MBBS, DCH, DNB Dr. Pooja Parikh Dr. Pooja ParikhMBBS, DCH, DNB facebook_icontwitter_iconinsta_icon Specialty: PediatricsExperience: 11 years
Written by Dr Bisny T. Joseph
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Trichotillomania (Hair Pulling Disorder) In Children

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Trichotillomania in children is a psychological disorder, which causes an uncontrollable desire to pull one’s scalp hair. Trichotillomania (TTM) is also known as a hair-pulling syndrome, hair-pulling disorder, or pathological hair-pulling.

The behavior may vary from plucking a single strand of hair at a time to pulling out a bunch of hairs at once, resulting in bald patches. A person with the syndrome may also pull hair from other parts of the body, such as eyebrows and eyelashes.

Children as young as two years old may show symptoms of the condition. Seek medical help if you suspect your child to have trichotillomania since it is easier to change the hair-pulling habit when the child is younger.

Keep reading to learn the various causes, risk factors, symptoms, and treatments for trichotillomania in children.

Causes Of Trichotillomania In Children

The exact cause for trichotillomania is not yet known. Multiple factors, including genetic and environmental factors, may play a role in the onset of the disorder. Some studies state that hair-pulling behavior can be due to changes in the brain regions that control habitual behavior and suppress inappropriate habits (1). More research is needed to determine how precisely these brain regions play a role in trichotillomania.

It is also believed that trichotillomania is an offshoot of obsessive-compulsive disorder (OCD). An imbalance in brain chemicals due to OCD may trigger the hair-pulling disorder. It is not entirely known how these chemicals trigger trichotillomania in children (2).

Risks For Trichotillomania In Children

Hair-pulling may begin in adolescence in many children. The following factors and situations may affect the risk of trichotillomania in children (3) (4).

  • Genetic predisposition, such as when a family member of the child has the condition.
  • Obsessive-compulsive disorder (OCD) may increase the risk.
  • Stress may increase compulsive behavior, such as hair-pulling.
  • Some children may pull hair when they are relaxed or calm.

Some children may have periodical changes in trichotillomania, such as symptoms that can be worsening or less at a particular time. Some may not pull hair for some time and have a recurrence.

Signs And Symptoms Of Trichotillomania In Children

The symptoms often appear before the age of 17 years. The following are the symptoms seen in children with trichotillomania.

  • Hair-pulling is the main symptom; you may notice bald patches on the scalp, eyelashes, eyebrow, and other parts of the body.
  • Skin irritation or tingling sensation experienced on the bald patches.
  • Uneven length of hair at the affected area due to constant hair-pulling.
  • Repeated scalp infections due to hair pulling
  • Habit of tugging or twisting the hair constantly. The child may also count their hair and play with their hair often.
  • Restlessness before hair-pulling and a sense of relief after the action.

Some children may have a tendency to swallow the pulled hair, a condition known as trichophagy. It may lead to additional symptoms, such as abdominal pain, nausea, vomiting, anemia, and bowel obstruction.

You may also notice the following body-focused repetitive behavior in children with trichotillomania.

  • Scratching
  • Nail-biting
  • Gnawing (always biting something)
  • Cracking knuckles
  • Pricking skin

A few children with trichotillomania may have coexisting psychiatric disorders, such as OCD and other anxiety disorders, ADHD, and depression that could have their symptoms. If you suspect your child is pulling their hair repeatedly, seek medical care.

Diagnosis Of Trichotillomania In Children

Bald patches and hair-pulling behavior may lead to the suspicion of trichotillomania. Your child’s doctor may perform tests to rule out other reasons for hair loss, such as infections or disorders that cause hair loss, such as monilethrix and alopecia areata. Parents could be asked for the detailed medical history of the child.

If your child is suspected of having trichotillomania, then parents could be asked details about the child’s general cognitive development. Other questions could be about the presence of any obsessive-compulsive behaviors in the child and any family history of trichotillomania or OCD and anxiety-related conditions.

Treatment For Trichotillomania In Children

Children may require referrals to pediatric neurologists, psychologists, or dermatologists for evaluation and treatment. The treatment of the condition could involve psychotherapy and pharmacotherapy. Psychotherapy, such as cognitive-behavioral therapy (CBT), may help change the emotions and thoughts that trigger hair-pulling behavior.

CBT which includes habit reversal therapy is generally used as first line. Habit reversal encompases awareness training (self monitoring for hair pulling), stimulus control (putting speed breakers on the way to hair pulling) and competing response training (engaging in a behavior that is physically incompatible with hair pulling until the urge subsides like art and craft).

Pharmacotherapy includes the following medications (5).

  • A tricyclic antidepressant, such as clomipramine, inhibits neurotransmitter, serotonin reuptake in the brain
  • N-acetyl cysteine influences the transmission of the neurotransmitter glutamate
  • Antipsychotic medication olanzapine acts on the neurotransmitter dopamine

These medications change the release of neurotransmitters in the brain that help modify the child’s behavior. N-acetyl cysteine is the most tolerated medication since it has less risk of adverse effects. The treatment may vary in each child. Discuss medications and their potential side effects thoroughly with the pediatric neurologist or doctor.

Frequently Asked Questions

1. Do children grow out of trichotillomania?

Trichotillomania doesn’t resolve on its own. In most cases, a child with trichotillomania would need support from medical experts and family to outgrow this problem (5).

2. How can I help my child with trichotillomania?

Getting your child a short haircut, providing them with a stress/squeeze ball, and making them wear a tight-fitting hat are a few ways to reduce the chances of the child pulling and damaging their hair (6).

3. Are there different types of trichotillomania?

Trichotillomania is of two types — automatic and focused. Automatic hair pulling is when an individual does not realize they are pulling their hair. Focused hair pulling is when an individual pulls their hair intentionally (7).

4. What seven areas of the body do people with trichotillomania most commonly pull hair from?

An individual with trichotillomania commonly pulls hair from their scalp. Other sites and hair types include eyebrows, eyelashes, pubic area, arms, underarms, and legs (3).

Genetic factors and the presence of anxiety or OCD may be responsible for causing hair-pulling or Trichotillomania in children. The child may be aware of his hair-pulling behavior or subconsciously doing it. Children with Trichotillomania may deny their actions or show restlessness if asked to stop pulling or twisting their hair. If untreated, Trichotillomania may cause bald patches and scalp infections. Consult a pediatrician if you suspect your child pulls their hair as early diagnosis and treatment with behavioral therapy and medications may help manage the condition.

Key Pointers

  • The exact cause of trichotillomania is not identified, and it is suggested to be due to various genetic and environmental factors.
  • Hair pulling, bald patches in the head, uneven hair length, and repeated scalp infections are some common signs.
  • Psychotherapy such as cognitive behavioral therapy is one of the effective treatments for this condition.

References

1. Trichotillomania; University of Auckland, New Zealand
2. Trichotillomania; The National Organization for Rare Disorders (NORD)
3. Trichotillomania: Risk Factors; Child Mind Institute
4. Trichotillomania; U.S. National Library of Medicine
5. Trichotillomania (hair-pulling disorder); St. Clair Hospital
6. Trichotillomania; Sydney Children’s Hospitals
7. What Is Trichotillomania?; Child Mind Institute
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Dr. Pooja Parikh
Dr. Pooja ParikhMBBS, DCH, DNB
Dr. Pooja Parikh is a pediatrician with 11 years of experience in the field. Her medical journey has taken her from Rajkot (PDUMC) to Vadodara (SSGH) to Mumbai (Hinduja & Breach Candy Hospital). Currently, she is actively involved in critical, intensive, and general care of 0 to 18-year-olds in the port town of Gandhidham, where she was born and brought up.

Read full bio of Dr. Pooja Parikh
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