DEAR DR. GOTT: I have a nine-year-old granddaughter who HAD long, beautiful, thick blonde hair. Her parents recently got a divorce and she has been pulling her hair out to the point her scalp bleeds. She says she can’t help herself bit it is really embarrassing to her and us as well. She has to wear a cap at times to cover the bald spots. We tried her on a small dose of Prozac which only made her not care how she looked. We took her off the drug and she got better for a while but she continues to pull her hair out. Please tell us if we can help her in any way. We have tried some counseling but she swears she cannot help the urges to pull it. Thank you.
DEAR READER: Your granddaughter is suffering from a condition known as trichotillomania (hair-pulling disorder).
The condition is marked by a strong urge to pull the hair which is followed by feelings of relief afterward. Other symptoms may include repeated pulling out of the hair from the scalp, eyebrows, or other areas of the body, chewing or eating the hair, bald patches on the scalp or body, sparse or missing eyebrows or eyelashes, and playing with or rubbing the torn hair across the face and lips.
Most sufferers perform this act in private. Some are aware that they are doing it and develop elaborate rituals to accompany the intentional maneuver. Others do it unintentionally. Depending on the situation and mood of the sufferer, both intentional and unintentional incidents may occur.
The cause is unknown but is thought to be a combination of environmental and genetic factors. Abnormalities in the brain chemicals serotonin (required for proper nerve and brain function such as regulating body temperature, attention and behavior) and dopamine (a chemical messenger that affects brain functions that regulate emotional responses, movement and the ability to experience pain and pleasure) may play a role in this complex disorder.
Risk factors include a family history; age (it occurs most commonly between the ages of 11 and 13); negative emotions such as feeling anxious, stressed, lonely, frustrated or fatigued; and having other disorders such as depression, an actual anxiety disorder, obsessive compulsive disorder, or an eating disorder.
Given that this started around the time of your granddaughter’s parents’ divorce, I would assume it was related. You don’t say how long she has been doing this, but trichotillomania is often a life-long condition. The good news is that it can be managed and techniques can be learned to prevent most pulling episodes.
Treatment may involve medication such as an antidepressant; however, in many cases behavioral therapy and counseling will provide the best results. One of the most commonly used is habit reversal therapy that uses a variety of techniques such as clenching the fists when an urge to pull is felt and recognizing situations which might trigger pulling urges in order to take preventive steps.
Some alternative treatments include hypnosis and various relaxation techniques such as deep breathing, meditation and more. You, your granddaughter, and her parents may also wish to joint a support group. This may help your granddaughter to feel less alone in her disorder and will allow her to interact with others of a comparable age who are also sufferers. You can find more information about this disorder and locate a support group on the Trichotillomania Learning Center’s website, www.trich.org.
