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Trichotillomania in Children

What is trichotillomania?

Trichotillomania (TTM) is an impulse control disorder. People who have this disorder pull out the hair from the scalp, eyelashes, eyebrows, or other parts of the body until they have bald patches.

What is the cause?

The cause of this disorder is not known. Experts think it may be caused by differences in the brain or nervous system. It might also be related to things such as child abuse or a family history of mental illness. It may be related to certain chemical messengers between the nerve cells in parts of the brain.

Hair-pulling may be a simple habit for a young child. It may be a sign of anger, depression, or stress. Often young children find it hard to put feelings into words. If your child starts pulling their hair out at school age, it may be school-related stress.

Often, younger children will outgrow hair pulling. For most, the hair pulling ends within 12 months. Children who start pulling hair before 6 years of age tend to do better than those who start later.

People often start compulsive hair-pulling around the ages of 12 or 13. It often seems to begin after a stressful event such as change of schools, abuse, family conflict, or the death of a parent.

What are the symptoms?

Symptoms may include:

  • Constant tugging and twisting of hair
  • Repeatedly pulling enough hair over a long enough period of time to have bald spots on the head, or missing eyelashes, eyebrows, or other body hair
  • Feeling very tense right before pulling out the hair or if they try to resist the urge to pull hair
  • Feeling pleasure or relief when pulling out the hair
  • Denying that they are pulling hair

People with TTM do not lose hair due to a skin or other medical condition. They pull hair on purpose.

How is it diagnosed?

A healthcare provider or a mental health professional will ask about symptoms and any drug or alcohol use. The person may have lab tests to rule out medical problems.

How is it treated?

It is important to find out if anger, stress, or depression may be related to the urge to pull hair. A mental health therapist can help you and your child to explore feelings and behaviors.

Cognitive behavior therapy (CBT) helps children learn about what thoughts go with their urges to act or think and how to control them. CBT also teaches specific skills for managing anxiety about symptoms.

If a child has severe symptoms, both behavioral therapy and medicine may be best. Your child's healthcare provider will work with you to carefully select the best medicine for your child.

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Published by RelayHealth.
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