Trichotillomania In Childhood: Hair Pulling Disorder

Some people have an irresistible urge to pull out their hair or hair from different parts of the body. The immediate physical consequence is significant and noticeable loss of hair, which makes them have bald spots in different areas (head, eyebrows, eyelashes …). At an early age, childhood trichotillomania can be an especially bothersome disorder.

However, it is important to carry out a  differential diagnosis with some dermatological diseases (for example, with alopecia) or with other types of clinical problems that may explain the existence of these clearings in the hair or hair of the patient.

Clinical features in childhood

• It is estimated that the prevalence in children is between 0.6% and 6% ; although it varies depending on age.
• There is a higher incidence among children between two and six years old.

• The prognosis is better the lower the age of onset.
• The part most affected by plucking is usually the head, especially the combined temporal, frontal and parietal areas. But trichotillomania in childhood can also target other parts of the body, such as the eyebrows, eyelashes, armpits or even the pubis.
• When hair is plucked, children often play with it. Many choose to make little locks or balls to play with. Others put it in their mouths. Some break them into smaller hairs; while others just pile them up and then throw them away, for fear of being punished by their parents.
• However, on other occasions, this disorder is accompanied by trichophagia: eating the hair. This, in addition to adding gravity, can cause digestive complications of a very diverse nature. From severe obstructions to nausea and vomiting.

Age of onset

If it occurs in early childhood, it tends to be triggered before 2 years or from 3 or 4 years. During this stage of development, hair pulling is usually considered by the little one as simple habits, like thumb sucking. This is because they are unaware of their compulsion.

Moment of appearance

It is common for them to emerge in periods of family tension (parents in periods of separation, divorce proceedings, constant arguments …). Also when they are relaxed (in bed), bored or tired. For this reason and, among other things, it is so important to stimulate children, to prevent them from developing harmful automatisms for their physical and psychological health.

In adults, this disorder can be the result of a situation of tension, anxiety and stress. Or, according to the so-called “automatic” model , which accounts for 75% of the cases, occur in the face of fatigue, boredom, or in sedentary situations (watching television, driving, studying …).

Thus, depending on the degree of consciousness during hair pulling, one can distinguish between those patients whose acts are more conscious and have a more compulsive character in response to negative emotional states. Or those that do it automatically, without being aware, possibly during sedentary activities.

Causes of trichotillomania in childhood

There is no single cause that can explain this disorder. These are multiple, depend on each person and can encompass a set of psychological, genetic, biological or environmental factors.

Thus, it can occur in children whose parents have previously suffered from the disorder. Due to a shortage or an excess of a certain neurotransmitter. Or simply be the consequence of external variables, such as family tension, stress, depression or a state of affective deprivation, for example.

How to detect it

In any case, the presence of alopecia in certain areas of the scalp usually produces isolation in the child or a complex on its part. In addition, serious dermatological or infectious lesions in those sparsely populated areas that can become really worrisome if the disorder does not remit. That is why it is so important that parents know how to detect trichotillomania.

In addition to the uneven appearance of the hair, these children may have intestinal obstructions, discomfort or severe stomach pain. Likewise, the pulling or twisting of hair that they carry out is evident, while they deny that they are doing them. They tend to show increasing tension before pulling out hair and engaging in other self-injurious behaviors.

Treatment

Trichotillomania in childhood usually subsides before the child starts school. For this, it is essential to support parents and make them aware of their child’s condition, so that they can help and facilitate the abandonment of hair pulling.

If it does not remit, sometimes the treatment is pharmacological and psychological, mainly through cognitive behavioral therapies. The objective of the latter is to eliminate the habit, by strengthening other alternative behaviors incompatible with the disorder and much more adaptive and appropriate.