Trichotillomania: How can I stop my daughter pulling her hair out?

hairQ. I’m a mother of two girls, who are 10 and eight. As with all kids, they are very different in many ways. Our elder girl will talk about her worries, but our eight-year- old daughter isn’t as good. She likes to keep the peace more than her sister does, and doesn’t like any confrontation.I know she is getting better at opening up, but I still sometimes wonder what exactly is going on in her head. I was a worrier as a child too, so I know what it’s like to have worries and to pretend to be okay.

Recently, I noticed that she seemed to have lost a few eyelashes in one area on her top eyelid. A few days later all the lashes were gone from that eyelid. I had a word with her, saying: “You might have rubbed your eye a bit too hard recently because I think you’ve lost a few lashes; maybe just go easy and they’ll grow back quickly. They’re important for protecting your eye from dust.” She didn’t get upset but she didn’t want to have any attention drawn to it, either.

Now she has the other eyelid all pulled too. We had another chat and I’m happy enough that there isn’t anything major going on at home or in school. I’ve sent a note to the teacher just to keep an eye on her during the school day.I’ve encouraged her to wear a loose bobbin on her wrist at night and to pull on it as she’s thinking or settling to sleep; I think pulling the lashes might have become a habit before falling asleep.

A. Like thumb-sucking and biting one’s nails, hair-pulling is one of many body-based habits that children develop as a means of distracting or relaxing themselves. Children can get into a habit of pulling hair from their eyelashes, as in your daughter’s case, or from their eyebrow or scalp. For most children, hair-pulling is a time-limited habit that they grow out of, though for others it can become a more fixed habit and, in these situations, it can be diagnosed as trichotillomania, which is grouped as an obsessive compulsive disorder (OCD) in mental health manuals.

Hair-pulling is common in children who are already prone to have somatic or body-based mannerisms or habits such as scratching, picking skin, nail-biting, thumb-sucking, and so on. It can be aggravated by stress and anxiety, though it is not usually started or caused by an anxious event.

Frequently, it starts out as a benign habit that developed from a sensory event, for example an itchy eyelash that your child gets into the habit of rubbing or pulling, even after the original itchiness is gone. Like all these habits, they are often done unconsciously and the child is not fully in control.

Talking to your daughter
Your question shows that you are already doing many of the right things to help your daughter. It is important to talk directly to your daughter about the habit in a supportive and non-blaming way. Some children are embarrassed about the habit and don’t want to talk about it and it is helpful to be matter-of-fact and supportive: “Lots of children get into habits like biting nails, but we can help you stop it.”

When talking about it, don’t expect that there is something at the bottom of the behaviour that your daughter needs to talk about, as this puts pressure on her and, most times, there is no specific cause. While there could be stresses and worries that it might be useful for your daughter to talk about, these are likely to be separate from tackling the hair-pulling. Try to find a time of day, such as bedtime or going for a walk with your daughter, when she is more open to talking about it.

Breaking the hair-pulling habit
Like many other somatic habits, hair-pulling is usually broken gradually over time. These are ways you can help: 

– Learning about the condition, and how it can be changed. Reading some good child-centred information online together might help to take the stigma out.

Becoming aware of when and why your daughter pulls her eyelashes: you have already noticed it is around bedtime and perhaps it is used as a habit around sleep. Can you identify with her other rituals she could develop to get to sleep, for example, holding a doll, squeezing her pillow or lying on her hand?

Help your daughter to learn new responses when she feels the urge to pull her eyelashes: for example, squeezing her fingers, stretching her hands, or simply taking a moment to breathe and relax. You have given her a bobbin to pull on her wrist, which is creative. Continue to explore new tactics with her until you find a few that work for her

Help your daughter to notice the trigger situations and remind 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.

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 listen to a relaxation tape together as part of her bedtime ritual.

Get further support if needed
As mentioned, most children’s hair-pulling habits fade over time, However, if it remains a problem or gets worse, do seek further help. You could ask your GP to make a referral to your local child mental health or primary care service or seek the support of a private psychologist or mental health professional.

Dr. John Sharry, Irish Times Newspaper, April 2015. John writes in The Irish Times Health+ every Tuesday.