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Repetitive Hair-pulling

​By Rachele Merk, Ph.D., Licenced Psycologist, Boys Town Behavioral Health Clinic, Nevada

Hair Pulling

​​​The expression “I'm so stressed, I could pull out my hair" may be more than just a statement made when feeling overwhelmed. Repetitive hairpulling that is difficult to stop is referred to as trichotillomania (trik-o-til-o-may-nee-uh) and can involve pulling hair from one's scalp, eyebrows, eyelashes or other areas of the body. Hairpulling can often leave patches on one's scalp, reduced hair on one's eyebrows and eyelashes, and can significantly impact self-esteem and overall functioning. Additionally, people who repetitively pull out their own hair may have to work hard to cover up the hair loss.

Studies indicate that one or two in 50 people experience significant hairpulling during their lifetime. This behavior usually begins in late childhood to early adolescence and affects girls and boys equally when occurring during childhood. However, if this behavior persists into adulthood, approximately 80-90% of the reported cases are in women. Doctors and researchers who work with people with this disorder find that many cases of problematic hairpulling are chronic and improve little without treatment.

Signs of trichotillomania may include:

  • Recurrent hairpulling that results in hair loss.
  • Repeated and unsuccessful attempts to decrease or stop the behavior.
  • Elevated levels of distress or discomfort from the behavior.  
  • A sense of tension or discomfort prior to pulling or when resisting the urge to pull.
  • Relief or pleasure following pulling one's hair.
  • Rituals/behaviors following pulling one's hair such as playing with the hair or rubbing it across the face or lips. Studies indicate that 5-20% of people swallow their hair following the hair being pulled. This behavior can cause problems internally and should be reported to a medical doctor to assess for complications.

Hairpulling may occur in a variety of situations and may include hairpulling that is purposeful or goal-directed (e.g., pulling specific hairs or a certain number of hairs) and non-purposeful (i.e., lack of awareness of the behavior). Some individuals report experiencing a combination of hairpulling that occurs intentionally and unintentionally.

Other concerns that are similar to hairpulling and may warrant behavioral treatment include:

  • Skin Picking Disorder 
    This disorder (also referred to as excoriation) is picking of one's skin that causes infection, scarring or damage. 
  • Nail Biting Disorder 
    This disorder (also referred to as onychophagia) causes people to bite their nails past the nail bed and chew on cuticles until they bleed, leading to soreness and infection.

​​Why is my child pulling their hair?
Youth pull their hair for many reasons and it is important to understand that reasons differ for each person. However, common reasons include:

  • Children and adolescents may engage in hairpulling to relieve stress or other negative sensations (e.g., anxiety, boredom, discomfort).
  • Additionally, research indicates that individuals with hairpulling or similar behaviors (e.g., nail biting and skin picking) may have a relative with a similar behavior due to genetic influence.

What can I do to help my child?
Recently published research shows that behavior therapy is the most effective treatment. Cognitive behavior therapy (CBT) is an approach that focuses on the individual's feelings, thoughts and behaviors, which results in improved control over the behavior. Evidence-based treatment includes a specific cognitive-behavioral therapy called habit reversal training (HRT), which teaches people to be aware of hairpulling, nail biting and skin picking behaviors, and to use alternative strategies to alleviate stress or discomfort. Additionally, some persons may benefit from medications in combination with behavioral therapy. (For additional information and resources, please visit the TLC Foundation for Body-Focused Repetitive Behaviors website: https://wwww.bfrb.org/learn-about-bfrbs.)

To read more about how to help your child manage anxiety, take a look at our Guide to Anxiety.