Trichotillomania in Children: Why Kids Pull Hair Out

The exact cause of trichotillomania isn’t well understood.

Trichotillomania was once classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4). However, in 2013, the DSM-5 began classifying it as a condition related to obsessive-compulsive disorder (OCD).

Sometimes, trichotillomania can be a symptom of certain mental health conditions in children. It may also be a coping mechanism for your child to deal with stress.

Obsessive-compulsive disorder (OCD)

OCD is a mental health condition in which a person repeatedly has intrusive or distressing thoughts (obsessions) and rituals (compulsions). OCD may make you feel like you have no control over your life.

The DSM-5 groups trichotillomania as a condition related to OCD.

Hair pulling can be a symptom of OCD, but the two conditions are distinct from one another.

Many people with OCD pull their hair because it gives them a sense of gratification. But, a person with trichotillomania may not experience that same feeling when they pull out their hair, especially children.

Doctors don’t necessarily recommend the same treatment for both conditions. However, selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for both OCD and trichotillomania.

Anxiety and depression

People with trichotillomania often also receive a diagnosis of anxiety or depression.

Anxiety can be characterized as feelings of fear, dread, or uneasiness. Other symptoms of anxiety include:

  • sweating
  • restlessness
  • rapid heart rate

Some common symptoms of depression can be:

  • persistent feelings of sadness or hopelessness
  • not enjoying things you used to like
  • trouble focusing
  • irritability
  • changes in your appetite or sleep habits

According to 2019 research, it’s common for people with trichotillomania to have another mental health condition as well. The researcher found that 50% of people with trichotillomania also have depression, anxiety, or both. But only an estimated 26% have an OCD diagnosis.

Children with anxiety may subconsciously pull out their hair in response to feelings of anxiety. Often, they may not recall the actual pulling out of their hair.

Coping mechanism

There are indications that trichotillomania occurs because of the gratification felt from the activity. Others may simply have the urge to do it. But, another possibility is your child may be pulling their hair to cope with stress or worry.

Grooming disorder

Grooming disorders are common and include hair pulling with skin picking and nail-biting. These acts are repetitive and can harm the body.

Your child may have feelings of shame since they can’t control the behavior. But you may be able to help them avoid feelings of shame by explaining the instinct behind hair pulling.

Your child may also feel an urge to remove parts of their body and become triggered when they see hair growing in specific places on their body.

If they see hair as an imperfection, they may pull the hair as a way to groom. A sense of relief usually follows.

One 2009 study found that 1 out of 3 people with OCD has a grooming disorder. Additionally, if your child experiences trichotillomania, they may be more likely to pick their skin or bite their nails.