When a child begins pulling out their hair, the resulting patches of hair loss can be alarming for a parent. This behavior is relatively common in childhood and adolescence, affecting an estimated 1 to 2 in every 50 people at some point. It is generally recognized as a psychological behavior that acts as a coping mechanism for underlying feelings, not a sign of a serious medical or neurological problem. Addressing the issue with informed observation and a supportive attitude is the most constructive step toward helping a child overcome it.
Understanding Hair Pulling as a Body-Focused Repetitive Behavior
Hair pulling is formally categorized as a Body-Focused Repetitive Behavior (BFRB), a cluster of self-grooming actions where individuals pull, pick, or bite their hair, skin, or nails to the point of causing damage. The clinical term for chronic hair pulling that results in noticeable hair loss is Trichotillomania (TTM). This condition falls under the category of Obsessive-Compulsive and Related Disorders.
Parents should look for physical signs, such as uneven or patchy hair loss, which often appears in specific, unusual patterns rather than general thinning. While the pulling typically targets the scalp, it can also involve eyebrows, eyelashes, or other body areas. The hair in affected areas may show texture changes or appear broken off at different lengths, as the pulling is often done strand by strand.
The behavior is generally divided into two types: focused and automatic pulling. Focused pulling is a conscious act often done to relieve tension, followed by a feeling of relief or gratification. Automatic pulling happens without the child’s full awareness, often while they are engaged in sedentary activities like watching television or reading. Younger children are more likely to engage in this unconscious, automatic pulling, which serves as a form of self-soothing.
Common Triggers and Underlying Reasons
The behavior is frequently rooted in emotional regulation and a child’s response to internal or external stimuli. Stress is a common psychological trigger, often stemming from significant life changes like a new school, family conflict, or academic pressure. The act of pulling offers a momentary sense of distraction or control when the child feels overwhelmed or powerless.
Emotional and Sensory Triggers
Anxiety and uncomfortable feelings, such as frustration or loneliness, often precede pulling episodes. The compulsive action provides a temporary release of built-up tension. Conversely, pulling can also be triggered by under-stimulation, such as boredom or inactivity. In these moments, the hands naturally seek something to do, and the hair becomes an accessible target. For some, there is a distinct sensory-seeking component, where the child enjoys the feeling of a certain hair texture or manipulating the pulled hair afterward. This sensory input can be inherently soothing.
Neurobiological Factors
While environmental and emotional factors are primary drivers, a neurobiological component is also suggested. The behavior appears to have a genetic predisposition, increasing the risk if a close relative also has the condition. Evidence suggests that neurotransmitter imbalances, such as those involving serotonin, may play a role, linking the behavior to other conditions like anxiety or depression.
Recognizing When Professional Help is Needed
While some hair pulling in young children is transient, professional consultation is warranted if the behavior persists beyond a few weeks or intensifies over time. A consultation with a pediatrician or dermatologist is the first step to rule out any underlying medical causes for the hair loss.
A specialist consultation with a mental health professional experienced in BFRBs becomes necessary under several conditions:
- The hair loss is significant, resulting in noticeable bald spots that the child attempts to hide.
- The behavior is accompanied by emotional distress, such as shame, embarrassment, or anxiety about their appearance.
- The child begins avoiding social activities, playdates, or school due to distress over their appearance.
- Co-occurring behaviors, like skin picking (excoriation disorder) or severe nail biting, are present.
- The child has made repeated, unsuccessful attempts to stop the pulling on their own.
- Pulling episodes are prolonged, lasting for hours at a time.
Treatment Options for Children
The most effective treatment approach for hair pulling in children is behavioral therapy, often done in conjunction with the parents. The recognized standard for Body-Focused Repetitive Behaviors (BFRBs) is Habit Reversal Training (HRT), a form of Cognitive Behavioral Therapy (CBT). HRT focuses on increasing the child’s awareness of their pulling behavior.
Habit Reversal Training (HRT)
The process begins with awareness training, where the child learns to identify the thoughts, feelings, and sensations that happen immediately before a pulling episode. This allows them to recognize the urge before the action becomes automatic. The next step is developing a competing response—a physical action incompatible with pulling that the child performs when they feel the urge. A common competing response involves clenching the fist, sitting on their hands, or holding a small object until the urge passes. Parents are also encouraged to help modify the child’s environment to minimize triggers, such as providing fidget toys for sedentary times.
In certain cases, especially when the hair pulling is severe or occurs alongside significant anxiety or depression, medication may be considered. Selective Serotonin Reuptake Inhibitors (SSRIs) may be prescribed by a physician to support the primary behavioral therapy.