Trichotillomania Blog

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How to Identify Trich in Children

Compulsive hair pulling can be difficult to identify in children. It causes frustration, embarrassment, and shame not only for the child but also for the parent.

When does it start?

The typical age of onset for trichotillomania in children tends to coincide with the onset of puberty. Since the internal hormonal changes can be difficult to detect, a child could start puberty as early as 8 years old, which is why the typical age of onset for trich tends to be between ages 9 and 13. Some research links trichotillomania onset and severity with sex hormones, especially in girls which means the changing levels of estrogen, progesterone, and adrenocorticotropic hormone can create an environment ripe for developing trich or other BFRBs.

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Brain Study Sheds Light on Trich Changes Over Time

Anecdotal evidence suggests that trich follows a fairly predictable course over one’s lifetime. Most symptoms start around middle to late childhood with the onset of puberty and increases in severity during adolescence and twenties. However, most people experience lower symptom severity in their 30s and 40s. The changes later in life may result from a variety of factors including changing hormones, improved sense of self or learning to manage pulling behaviors through therapy. However, neurology points to something else.

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Experiential Avoidance and Triggers in Trich

One of the first things that occur in therapy for trichotillomania involves increasing awareness about pulling behaviors. The goal is to help a person become more aware of the triggers, both internal and external, that get the behaviors started. Once those triggers become known, then the person can make an informed choice about whether to pull or do something else.

This summary is a simplistic view of the beginning stages of habit reversal therapy, which is one of the most widely used evidence-based therapeutic interventions for trich. However, sometimes it is not as easy as identifying triggers.

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Trichotillomania Research Update

Good old-fashioned psychotherapy remains the most effective treatment for trichotillomania. A recently published evaluation of the research suggests that pharmacological treatments lag behind behavioral and cognitive-behavioral therapies.  

The Research Says

A meta-analysis looks at all the available research conducted within a subject area to determine if broader conclusions can be made. In the case of this meta-analysis, the researchers looked for psychological and pharmacological interventions for trichotillomania used with children under age 18. Although they found 129 studies conducted, only 6 met the criteria of being a well-designed study.

Should you try alternative therapies for trich?

The reason alternative therapies are called “alternative” is that they do not have the support of the medical community or approval by the Food and Drug Administration. Does that mean they don’t work? No, it just means they have not been subjected to rigorous research, which would determine if it works as intended or does not work as intended. Before you try an alternative therapy, consider some of the following tips and suggestions.


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Trich and Comorbid Disorders

What other conditions are most closely related?

In an effort to understand the risk factors for trichotillomania, researchers continue to look for genetic links between trich and other disorders. As a member of the obsessive-compulsive disorder (OCD) diagnostic family, there are many similarities between the disorders. One of the most common reasons for misdiagnosis is that trich looks very much like OCD. This blog article from the archives offers a refresher on the differences.

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Peer Support Retreat for Trich May Be as Effective as Therapy

Treatments for trichotillomania run the gamut with cognitive-behavioral therapies such as habit reversal training and acceptance and commitment therapy ranking high for level of effectiveness. However, a study conducted in Australia presents another form of treatment modality using peer support that shows promise.

Holistic Recovery

During treatment, people with trich learn to manage behaviors, but they also work through the emotional toll of pulling. Many people with trich feel embarrassment, shame, and guilt because the disorder affects appearance, which increases social judgment. Therefore, addressing those feelings as well as anxiety, stress, depression, trauma or other mental health issues that accompany trich is an essential part of therapy. Often, social support in the form of groups or connecting with others further along in recovery gives people a boost. However, one challenge with compulsive hair pulling is its chronic, episodic nature which means a person can feel like recovery is a success and then experience a lapse.


Embrace Vulnerability

Trichotillomania is a hard thing. The multiple layers of thoughts, feelings, and behaviors can be difficult to wade through, so sometimes it’s easier to ignore it. Hide it. Hope that nobody else notices. 

However, pretending is exhausting and only reinforces shame. One Trichstop forum member described her experience as shiny and successful on the outside, “But under the surface, I felt I had no sense of self-worth or value, I felt incredibly lonely, and I was just frustrated with myself.” Rachel courageously shared her story in her post, serving as an example of the power of vulnerability that helped her recovery.


Online Test for Trichotillomania

Find Out The Severity of Your Hair Pulling With This Free Online Test