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Hair pulling and skin picking: How to help your child stop body-repetitive behaviors (UC Davis MIND Institute)
Also known as hair pulling disorder, this condition leads to irresistible urges to repeatedly pull and/or twist hair from anywhere on the body leading to notable hair loss. It is commonly misdiagnosed as obsessive-compulsive disorder (OCD) due to the compulsive nature of the behavior. OCD usually involve persistent, intrusive thoughts (obsessions) leading to actions that satisfy those urges (compulsions). Trichotillomania usually lack the obsessional thoughts present in OCD and do not respond to standard OCD treatment. Most people pull hair from the scalp, eyebrows, and eyelashes but other body parts can be affected as well including the pubic area. Pulling from multiple sites is common and pulling episodes can range from minutes to hours.
What are the Symptoms of Trichotillomania?
- Recurrent pulling out of one’s hair, resulting in hair loss, bald spots, hair of different length
- Repeated attempts to decrease or stop hair pulling
- The hair pulling causes significant distress or impairment in social, occupational, or other important areas of functioning.
- The hair pulling or hair loss is not due to another medical condition (ex. a skin condition)
- The hair pulling is not better explained by the symptoms of another mental disorder (ex. attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)
This habit often occurs with other habits such as nail biting, skin picking, and lip biting.
Some children with hair pulling may also experience anxiety, mood disorders, and ADHD.
Studies show that negative emotions such as anxiety, sadness, frustration, and stress often trigger hair pulling and skin picking, and patients who engage in this behavior may do so as a means to escape or avoid these experiences. The temporary decrease in these emotions as they pull or pick may reinforce continuation of such behavior.
Treatment
Young children who twist or pull their hair often outgrow the behavior within 3-6 months, especially with consistent distraction from the behavior. Older children and teens may have a more difficult time overcoming it and may need further intervention. Try offering an alternative habit - ex. squeezing a stress ball or playing with a fidget toy. Help them to calm down, have periods of rest and relaxation during the day, and reduce obvious triggers if possible. Never punish a child for pulling their hair as this can exacerbate the stress they feel and lead to increased pulling.
Behavioral therapy and psychotherapy are considered first line treatment, and although evidence for their benefit is still small, it is promising. Specific types of behavioral therapy are habit reversal therapy (HRT), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT). Currently, there is no medication that has been approved for treatment of hair pulling or skin picking disorders. Results from one small double-blind, placebo-controlled study of adults showed olanzapine (Zyprexa) to be promising, but given the overall unfavorable side effects of such medications, the decision to use it will need to be carefully considered. Currently, there is no comparable data for use of olanzapine in children and adolescents.
Treatment of co-occurring conditions such as anxiety, depression, and ADHD may actually result in improvement of hair pulling and skin picking behavior.
If left untreated, most cases often become chronic although the severity of symptoms may wax and wane. When diagnosed early and treated appropriately, as many as 50% of individuals may experience symptom reduction for at least 3-6 months at a time. Continued booster therapy sessions may be necessary for longer reduction of symptoms.
Website for parents: www.trich.org
PL MD 3/2026, Behavioral Health Committee