Areas of Specialization - Children and Adolescents
Trichotillomania in Children and Adolescents
Similar to adults, children and
adolescents with trichotillomania
pull out the hair from their scalp,
eyelashes, eyebrows, or other parts
of the body resulting in noticeable
bald patches. Hair pulling commonly
occurs absentmindedly during sedentary
and contemplative activities as
children frequently pull their hair
at night when they are in bed trying
to fall asleep. Children and adolescents
may begin hair pulling from one
site and later start pulling from
another area. Commonly children
may pull hair from other people
or from pets and some may play with
or ingest the pulled hairs. Although
the majority of adults with trichotillomania
are women, the prevalence of hair
pulling in children is equally common
in boy as in girls. It has been
proposed that the majority of very
young hair pullers have a more benign
and transitory condition that does
not continue into older childhood.
Children with trichotillomania frequently
conceal or deny hair pulling to
their parents, friends, and clinicians.
Children and adolescents often wear
creative hairstyles and hats and
apply cosmetics or use crayons and
magic markers to camouflage bald
patches. Young children with trichotillomania
are typically less self-conscious
and embarrassed about their hair
pulling than older children, adolescents
and adults. However adult and peer
reactions to the hair pulling and
its cosmetic effects result in even
young children to feeling different
or strange. It is important to address
any negative feelings to prevent
the development of more serious
emotional problems, decreased self-esteem
and impaired social or academic
functioning.
Trichotillomania can have considerable
implications for the family as
parents are typically frustrated
and demoralized by the persistence
of their child's pulling. Parents
frequently become trapped in unhealthy
interactions with their child
around the issue of pulling as
their relationship can become
negative and punitive. Unfortunately,
parental criticism, anger and
punishments are not likely to
control or stop the hair pulling
and may increase the depression,
anxiety, shame, and low self-esteem
that are often associated with
trichotillomania. In fact, negative
emotions like anxiety, anger and
sadness may increase the child's
urge to pull hair. Thus the role
of the child's parents in treatment
is crucial. However the treatment
plan must be sensitive to child's
age and tailored to the child's
developmental level. Trichotillomania
in younger children requires directly
involving the parent in the implementation
of treatment strategies. In older
children and adolescents, parents
typically play less of a direct
role in the treatment yet they
may require specific guidance
in separating themselves from
the therapy. In general, cognitive
behavioral treatment for trichotillomania
in children and adolescents involves
a number of components. These
include educating the child, family
and possibly teachers about hair
pulling, minimizing stress; evaluating
relationships between the child
and family members, assessing
the child's motivation and capability
to commit to treatment, and creating
an individualized behavioral program
for the child or adolescent.
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