Psychologist Treating Trichotillomania 

The TLC Foundation for Body-Focused Repetitive Behaviors

Trichotillomania and Children

Dr. Steven Pence is an anxiety specialist treating Trichotillomania for both children and adults. His office is centrally located near Bloomfield Hills, Birmingham, and Troy in Oakland County, Michigan. Dr. Pence treats Trichotillomania with evidenced-based cognitive behavior therapy with emphasis on body-focused repetitive behaviors and habit reversal training (HRT) for both weekly therapy and intensive outpatient treatment programs. Trichotillomania is a type of impulsive control disorder in which the person has an irresistible hair pulling urge from your scalp, eyebrows, or other areas of their body. Most individuals tend to start pulling their hair during childhood or adolescence, but it can start at any age including infant or in pre-school. It may affect as much as 4% of the population and women are four times more likely to be affected than men. A stressful event can be associated with the onset such as change of schools, abuse, family conflict, or death of a parent. Early detection is the best form of prevention and leads to early treatment. Symptoms usually begin before age 17. Body-focused repetitive behavior is a general term that refers to an repetitive self-grooming behavior such as pulling, picking, biting, or scraping of the hair, skin, or nails that results in damage to the body.

 Symptoms of this disorder may include:
Inability to resist hair pulling urges
Patchy bald areas on the scalp or other areas of your body
Sparse or missing eyelashes or eyebrows
Chewing or eating pulled-out hair
Playing with pulled-out hair
Rubbing pulled-out hair across your lips or face
Denying the hair pulling
In severe cases, they avoid social contacts

Common parts of the body that people pull from:
Pubic area

Physical problems sometimes associated with hair pulling:
Trichobezoars, hairballs which can block the intestinal track
Repetitive strain injuries such as neck, back, and shoulder problems or tendonitis
Eye irritations and infections
Dental problems

While the underlying biology is not clearly understood this time, we do know that people with trichotillomania generally have a neurologically based predisposition to pull their hair as a self-soothing mechanism. The pulling behavior serves as a coping mechanism for anxiety and other difficult emotions. There may be a relation to other illnesses such as symptoms of obsessive-compulsive disorder that include counting, checking, or washing. Depression may occur with trichotillomania or other associated behaviors such as nail biting, thumb sucking, head banging, or compulsive scratching. There is a strong emotional impact on individuals such as painful feelings of shame, helplessness, isolation, and frustration and can suffer ridicule, anger, and insensitivity.

A combination of education, medication, and behavior therapy tend to be the most effective forms of treatment. The most important part of the behavioral therapy includes habit reversal training (HRT), which is designed to increase the person’s awareness into the triggers, and create competing responses to interrupt the pulling response. The individual learns a structured method of keeping track of the symptoms and associated behaviors allowing increased awareness of the pulling to reverse the habit. The individual also learns how to utilize alternative behaviors in response to these situations and events. Internal triggers can trigger a body-focused repetitive behavior and refers to sensory experiences, thoughts, and feelings. External triggers refer to identifying the environment or activities that lead to behavior and finding ways to reduce the behavior. Stress can cause hair pulling to get worse. Stress management helps reduce the hair pulling, because stress may increase the compulsive behavior. Medications help people temporarily, but symptoms are likely to reoccur when medication stops unless behavioral therapy is incorporated in the treatment plan. Children who start pulling hair early (before the age of 6) tend to do better with treatment than those who start later. Mindfulness and emotional regulation techniques are helpful in the treatment process.

 Children & Adolescence:

​The treatment approach is the same concept of cognitive behavior therapy with emphasis on habit reversal training in adults, however techniques are tailored for age appropriateness based on developmental stages. The peak age of this disorder's onset can appear between 9-13, but may be present at the infantile stage. The parental education and support are imperative in the treatment process due to dependency children have with their parents. Education of the disorder and environmental structure are important in the treatment and progress.