Dear David Coleman: My daughter pulls her hair and has big bald patches now. She tries so hard to stop
Clinical psychologist David Coleman offers parenting advice in his weekly column.
Q. My 15-year-old daughter has been suffering with trichotillomania (pulling out her own hair) for two years and has been wearing wigs for over a year, because of the bald patches she now has. She is a happy, social child, who loves hanging out with her friends. It's heart-breaking to see her go through this. We find at times she seems to be doing well (she's had several therapists) and the hair starts to grow back, then she reverts back and more damage is done. She explains that she tries but it's so hard to stop. What can we do to help her?
David replies: The benefit of having been to several therapists is that you, presumably, have a very clear understanding of your daughter's condition, including the name, trichotillomania. Others who may be reading this, however, may not be so familiar with the condition.
Estimates suggest that trichotillomania affects between one and four people in every 100. A typical onset of the type that you describe is amongst youngsters aged between 12 and 15 years. Your daughter pulls at the hair on her head, but for others, the hair pulling could be on any part of their body. Eyebrows or eyelashes are the most common other places.
There is no definitive explanation for why some children develop trichotillomania, although most psychological and behavioural theories suggest that it is a response to stress or anxiety, or an indicator of some kind of mental health problem. Some even include it as a form of self-harm, where the act of hair-pulling may serve to relieve some kind of emotional distress or may reflect some kind of self-loathing.
Interestingly, from what you describe, your daughter doesn't seem to suffer from any kind of mental health issues, and seems to be quite happy, with a full social life and generally good mood. That suggests that the typical explanations for why trichotillomania develops don't fit for your daughter.
In other cases, hair-pulling can develop at a much younger age, as a self-soothing behaviour. For example, many babies will twirl, curl, stroke or entwine their fingers in their mother's hair while feeding. The intense comfort this brings can then transfer to playing with their own hair when they get older. Could your daughter's hair-pulling have developed in this way, becoming a strongly rooted behavioural pattern?
It does sound, from what you say, that her habit of hair-pulling is very strongly ingrained. If so, then a form of cognitive behavioural therapy (CBT), called habit reversal therapy (HRT), is likely to be the most effective.
There are several steps to HRT. The first is likely to have been completed in whatever therapies she has already been through, namely educating herself about her condition. The more she knows about it and the dynamic of how and why it might have developed, the better.
She then needs to become aware of when she pulls her hair. That will include noticing any particular times when it is more likely to happen, or any environments (like does it happen more at home or at school), or are there any triggers (like coming up to exams or any other points of stress or anxiety).
She then needs to learn to use some other kind of behaviour as an alternative, or as a distraction from the hair-pulling. So, any kind of behaviour that needs the use of her hands, like squeezing a stress ball, using embroidery threads (perhaps to make friendship bracelets), even just clenching her hands, keeps them occupied enough that the urge to hair-pull might pass.
Another option may be to wear a hat, such that she creates a physical barrier that simply doesn't allow her to pull her hair. Having a goal to aim for, in terms of needing a full head of hair (like a beauty make-over, or a trip to a really nice restaurant, or a special disco) might also be helpful to encourage her to avoid the hair-pulling.
Your daughter seems so aware of, and knowledgeable about, her condition. Bearing this in mind, and given her age, there may be little you can do, or need to do, to help her, since the motivation to stop must come from within her.
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