If your child nervously pulls their hair out when stressed, there may be an underlying reason for the behavior. Here are ways to help them.

Have you noticed a bald spot on your child’s head or that they’re missing hair from their eyebrows? They may be pulling out their hair.

Instead of reprimanding your child, it may be a good idea to ask yourself what could cause your child to pull their hair out.

Trichotillomania is a hair-pulling disorder that occurs when one repeatedly pulls hair from any part of their body, leading to visible hair loss. This disorder is different from alopecia, known as hair loss, which is a symptom of trichotillomania.

The disorder starts in childhood, and experts once believed it was rare. But, recent evidence suggests trichotillomania may be more common than initially thought.

A 2017 review cited an older survey that found that out of 2,534 students, 0.6% of them had the disorder, and it may also be significantly more common in females. According to newer data published in a 2020 study, 1.7% of a large sample of adults reported having trichotillomania.

The stigma of trichotillomania may lead people to hide it from loved ones since it can change the way they look. But taking the time to learn about trichotillomania and how to treat it can help lessen that stigma.

The exact cause of trichotillomania isn’t well understood.

Trichotillomania was once classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4). However, in 2013, the DSM-5 began classifying it as a condition related to obsessive-compulsive disorder (OCD).

Sometimes, trichotillomania can be a symptom of certain mental health conditions in children. It may also be a coping mechanism for your child to deal with stress.

Obsessive-compulsive disorder (OCD)

OCD is a mental health condition in which a person repeatedly has intrusive or distressing thoughts (obsessions) and rituals (compulsions). OCD may make you feel like you have no control over your life.

The DSM-5 groups trichotillomania as a condition related to OCD.

Hair pulling can be a symptom of OCD, but the two conditions are distinct from one another.

Many people with OCD pull their hair because it gives them a sense of gratification. But, a person with trichotillomania may not experience that same feeling when they pull out their hair, especially children.

Doctors don’t necessarily recommend the same treatment for both conditions. However, selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for both OCD and trichotillomania.

Anxiety and depression

People with trichotillomania often also receive a diagnosis of anxiety or depression.

Anxiety can be characterized as feelings of fear, dread, or uneasiness. Other symptoms of anxiety include:

  • sweating
  • restlessness
  • rapid heart rate

Some common symptoms of depression can be:

  • persistent feelings of sadness or hopelessness
  • not enjoying things you used to like
  • trouble focusing
  • irritability
  • changes in your appetite or sleep habits

According to 2019 research, it’s common for people with trichotillomania to have another mental health condition as well. The researcher found that 50% of people with trichotillomania also have depression, anxiety, or both. But only an estimated 26% have an OCD diagnosis.

Children with anxiety may subconsciously pull out their hair in response to feelings of anxiety. Often, they may not recall the actual pulling out of their hair.

Coping mechanism

There are indications that trichotillomania occurs because of the gratification felt from the activity. Others may simply have the urge to do it. But, another possibility is your child may be pulling their hair to cope with stress or worry.

Grooming disorder

Grooming disorders are common and include hair pulling with skin picking and nail-biting. These acts are repetitive and can harm the body.

Your child may have feelings of shame since they can’t control the behavior. But you may be able to help them avoid feelings of shame by explaining the instinct behind hair pulling.

Your child may also feel an urge to remove parts of their body and become triggered when they see hair growing in specific places on their body.

If they see hair as an imperfection, they may pull the hair as a way to groom. A sense of relief usually follows.

One 2009 study found that 1 out of 3 people with OCD has a grooming disorder. Additionally, if your child experiences trichotillomania, they may be more likely to pick their skin or bite their nails.

There are many treatment options to help children with symptoms of trichotillomania.

Reducing stress at home

Since trichotillomania can often be a stress response in children, consider making changes to your child’s environment to reduce stress.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is often considered a first-line treatment for trichotillomania.

Working with your child’s therapist, you can learn different interventions to try at home. Some examples may include:

  • placing a sock over your toddler’s hand to discourage the behavior
  • providing a fidget toy for the child and directing them to it when they start to pull their hair
  • placing bandages on their index fingers to increase their awareness of the behavior

Habit reversal training

Habit reversal training is a form of CBT that consists of three main parts:

  • Awareness. The child becomes aware of their hair pulling and their triggers.
  • Competing for the response. An action is identified to take the place of plucking their hair.
  • Social support. Loved ones around the child praise their positive behaviors and remind them to use their training.

Overall, this therapy is a low risk and effective treatment for trichotillomania.


Your child’s doctor may prescribe SSRIs for trichotillomania. But medication alone may not be enough to help your child manage their symptoms.

For maximum effectiveness, it’s best to supplement the medication with therapy.

Trichotillomania is a mental health condition that usually begins in childhood.

If you start to see signs that your child is pulling their hair out or experiencing unexplained hair loss, it’s a good idea to seek advice from a doctor as soon as possible. Treatment is much more effective when started early.

Help is out there for you and your child. To find a therapist, you can search via the Anxiety & Depression Association of America’s website or ask a pediatrician for a referral.

The most important thing to remember is never to shame your child for their behavior because that may worsen the hair pulling and make them more likely to hide the behavior. Love and support can go a long way in aiding their recovery.