Q. We have become very concerned about our daughter who is just 13 years old. She had become quite moody and argumentative as well as secretive and is spending lots of time in her room. We put it down to her becoming a teenager and we’re dealing with it as such. However, a few weeks ago I noticed that her hair had become thin in various places and that she had been going to great lengths to hide this. She got upset and admitted that she sometimes pulls her hair out in her room but “did not know why she did it”. It seems to coincide with when she is stressed or upset about something. We took her to see the GP, who said he did not think there was a physical cause and that it might be trichotillomania, which means she has got into a habit of pulling her hair out when upset.
She also seems to sometimes do it unconsciously at home – I see her starting to pull at her hair when she is absorbed in reading or watching TV. Overall, she is very upset about the habit as it is starting to leave unsightly gaps on her head. I feel very sorry for her and want to get the best help for her. What causes trichotillomania and what can you do to stop it?
A. Trichotillomania is a compulsive habit that causes a person to pull out their hair either from their scalp, eyebrows or other parts of their bodies. As a problem, it often starts in adolescence, is more common in girls and can affect up to four in 100 people to varying degrees.
Essentially, trichotillomania has many parallels to other body-based or somatic habits such as nail-biting, whereby people do something physical to their body as a means of reducing tension or distracting themselves. Like biting your nails, such behaviours develop over time, become habits that are often done unconsciously and can increase in frequency when a person is nervous or distressed.
In addition, the severity of such habits can vary greatly, with some people being only mildly affected while others develop a severe habit. Trichotillomania has the additional problem of leaving thinned-out hair and bald patches in severe cases. This can be particularly distressing to young people who are naturally concerned about their appearance and this can result in shame, embarrassment and guilt.
Supporting your daughter
The first step in overcoming trichotillomania is to break the silence surrounding it. It is great that your daughter has spoken to you about what is going on for her so you can be there to support her. It is likely that your daughter has experienced shame and upset about the problem and it will be a great relief to her when you show you understand and don’t judge her. At least she does not have to hide the problem from you and the two of you can work together to overcome it.
One of the advantages of having a label for the problems is the realisation for your daughter that she is not alone, that many people develop this habit and that it can be overcome with support and hard work.
Breaking the habit of trichotillomania
Like many other somatic habits, trichotillomania is usually broken in stages.
1. Learn about the condition, how it develops and how it can be changed.
2. Become aware of when and why your daughter pulls her hair out – it can be helpful to observe with your daughter the exact specifics of the habit over a couple of days. What are the triggers? What is she feeling before? In what situations does it happen?
3. Also observe any times when the habit is less or situations when your daughter resists the urge to pull her hair. This will give you and your daughter clues to strategies that she can build upon to reduce the habit. It might be helpful to keep a journal with your daughter so you can understand patterns.
4. Help your daughter learn new responses when she feels the urge to pull her hair out – for example, squeezing her fingers, stretching her hands, or simply taking a moment to breathe and relax.
5. Create barriers that prevent your daughter from pulling her hair out – for example, get her to wear a hat if she usually pulls hair from her scalp or hold something in her hands at trigger situations such as watching TV.
Helping as parents
As parents you can be very helpful to your daughter in overcoming the habit by encouraging any progress you see and being supportive and empathetic during setbacks. You can also help her by watching out for the trigger situations and reminding her of agreed alternative strategies. To avoid this becoming unhelpful nagging, it can be helpful to agree a code word in advance such as “hands” or a subtle gesture to remind her of alternative strategies in the moment.
In addition, it is a good idea to teach your daughter relaxation or mindfulness strategies that she can use as a means of becoming aware of and diverting her hair- pulling behaviour as well as reducing her stress levels generally. Perhaps you could attend a relaxation class together to support her.
Seek further support
Many people with trichotillomania find it helpful to get professional support to overcome the problem. You could ask your GP to make a referral to your local adolescent mental health or primary care service or seek the support of a private psychologist or mental health professional. Good professional help could support your daughter through the steps of breaking the habit and help you work as a team together.
There is also a great deal of good online support and information that includes details of many success stories in which people share how they overcome the problem. Have a look for websites that are particularly relevant for young teenagers and then view these with your daughter. A good place to start is www.trichotillomania.co.uk or www.nhs.uk/conditions/trichotillomania.
Dr. John Sharry, Irish Times Newspaper, July 2013. John writes in the Irish Times Health+Family every Tuesday.