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The Informed Parent

Pulling Out One’s Hair

by Peter W. Welty, M.D., F.A.A.P.
Published on Feb. 28, 2000

Ten-year-old Susy came into the office one day, accompanied by her anxious mother. It seems that Susy had developed an unusual habit. She had been pulling her hair out, one strand at a time. It began at the top of her head, and now she was working on the front.

Mom had begged, pleaded and threatened to punish her, but Susy continued this habit. "She always says she will stop. I even made her wear a necklace with a large bauble on it, and I told her to play with that when she felt the urge to pull her hair...She lost the necklace."

Susy had beautiful long hair. And now she was going bald. She was a pretty well-adjusted girl in a school program for gifted children, and she was beginning to go through puberty. Nothing in particular seemed to be bothering her.

This condition is called trichotillomania. It is a disorder where there is an inability to resist the impulse to pull out one's own hair. There is a sense of gratification in the person when pulling out the hair, followed by agitation until the hair-pulling begins again. It is classified as an "impulse control" disorder.

The areas commonly involved in trichotillomania are the scalp, eyebrows, eyelashes and in adults, the beard. It is more common in girls than in boys. It's cause is unknown, and may be related to the need to express anxious or aggressive feelings. In children, the major areas of stress occur at home and at school. Children in programs for the academically gifted have their own set of pressures. It would be important to try examining with Susy where she may be experiencing such difficulties.

The course of trichotillomania is usually chronic, and the condition may wax and wane over time. Treatment for this condition consists primarily of exploring and eventually eliminating the areas of stress. Susy may need a complete mental health evaluation and perhaps a referral for psychotherapy.

Medications have also been used in addition to psychotherapy, and many of them have been successful. Hypnosis and biofeedback are other options that have been used.

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