My daugh­ter pulls her hair and has big bald patches now. How can we help her?

Irish Independent - Health & Living - - PARENTING -

? TMY 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

HE 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 child, who loves hang­ing out with her friends. It’s heart­break­ing 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?

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 self­harm, 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 hair­pulling.

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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