When a child or adolescent is displaying hair-pulling behaviors that indicate the possibility of trichotillomania, early identification of symptoms and pursuing effective treatment with family support will set them on the right path.
The first step in any good treatment plan is to get a thorough assessment to understand the nature of an individual’s challenges and determine the best fit of treatment for the client’s goals. When the possibility of trichotillomania is a concern, the clinician should take care to make sure that hair-pulling behaviors and hair loss are not better attributed to a different medical disorder, and to ask questions about any possible medical risk that could be present from hair eating after pulling. If there are medical issues to be addressed, this should be done first to ensure the client’s safety. The clinician should also take care to ask the client questions about their thought patterns and motivations around hair pulling, to see if the behavior can be better attributed to a different mental disorder, as this would change the intended course of treatment. Finally, the clinician should also assess for the presence of other mental disorders, like depression, anxiety, and substance use, so that treatment can incorporate addressing these symptoms as well.
Following an assessment, if the individual is diagnosed with trichotillomania, a common recommendation for treatment is a behavioral therapy called Habit Reversal Therapy. Habit Reversal Therapy (HRT) was first developed for the treatment of tics, repetitive movements or sounds that an individual finds difficult to control and is often associated with stress. HRT has been proven effective for the treatment of trichotillomania and incorporates a series of behavioral interventions to target the hair pulling behavior and resulting distress.
HRT focuses on self-monitoring hair-pulling behaviors, building the skill of awareness to thoughts and sensations that precede and follow hair pulling, developing relaxation skills, training competing and incompatible responses, and developing stimulus control for the environment to reduce the frequency of hair pulling. The main idea is to bring the behavioral patterns that lead to and maintain hair pulling into the client’s awareness, and then to support the client in adjusting their responses to identified cues in a way that doesn’t allow the client to pull at their hair in that moment (e.g., doing something else with their hands that physically will not allow them to touch their hair). HRT can be delivered in both individual and group settings and often takes anywhere between 4-22 sessions on a weekly basis.
For children and adolescents, parent involvement is recommended so that caregivers can learn how to support their child in the treatment of trichotillomania. There is great progress to be made for children who are supported by caregivers that are interested in learning about trichotillomania and are willing to engage in treatment with the clinician and child.
At this time, there isn’t a medication that can be identified as a first-choice treatment for trichotillomania, but studies are underway to make progress in this line of care. HRT is a widely known effective treatment for trichotillomania and it facilitates great improvement across the majority of clients without any assistance from medication. The family unit can work as a team with their clinician to better understand their child’s needs and challenges, and to make effective change and progress together.
Want to learn more?
- Watch our free trichotillomania webinar
- Read Learn About Trichotillomania: The “Hair Pulling” Disorder
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