eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Anxiety Disorder, Trichotillomania: Follow-up

Author: Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Coauthor(s): Holly Jean Roberts, PhD, Assistant Professor, Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center; Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town
Contributor Information and Disclosures

Updated: Sep 23, 2009

Follow-up

Further Outpatient Care

  • Consult mental health professionals for further assessment and possible treatment modalities.
  • A record of hair pulling and/or the saving of plucked hairs may be required to confirm a diagnosis of trichotillomania. However, use caution when depending on patient self-reporting and/or records from children, because some may engage in trichophagia and consume pulled hairs or pluck hairs in privacy to hide the severity of the disorder.

Complications

  • Treating trichotillomania in children may be difficult because of the low reliability and validity of self-report.
  • Children often pull their hair in private.
  • Trichotillomania can result in alopecia, hair abnormalities, and, if the pulled hair is ingested, trichobezoar formation with associated medical complications (see Clinical).

Prognosis

  • Trichotillomania can become a chronic and persistent condition of hair pulling. Specifically, symptoms of trichotillomania can persist for weeks to decades. Therefore, comprehensive treatment planning is critical and may require consultations with mental health professionals.
  • Hair pulling that occurs in young children may be described more accurately as a short-term habit disorder.

Patient Education

Miscellaneous

Special Concerns

  • Assess symptoms of trichotillomania in children throughout a period of several months to confirm a correct diagnosis. Children can acquire a short-term habit of hair pulling that closely resembles trichotillomania. Therefore, several visits may be required to confirm a true trichotillomania diagnosis.
 


More on Anxiety Disorder, Trichotillomania

Overview: Anxiety Disorder, Trichotillomania
Differential Diagnoses & Workup: Anxiety Disorder, Trichotillomania
Treatment & Medication: Anxiety Disorder, Trichotillomania
Follow-up: Anxiety Disorder, Trichotillomania
Multimedia: Anxiety Disorder, Trichotillomania
References
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References

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  2. Franklin ME, Flessner CA, Woods DW, Keuthen NJ, Piacentini JC, Moore P, et al. The child and adolescent trichotillomania impact project: descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr. Dec 2008;29(6):493-500. [Medline].

  3. American Psychiatric Association. DSM-IV: Diagnostic & Statistical Manual of Mental Disorders. 4th ed. 2000:674-7.

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Further Reading

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Keywords

trichotillomania, childhood habit disorder, impulse-control disorder, hair pulling, obsessive-compulsive disorder, OCD, trichophagia, trichobezoars

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Contributor Information and Disclosures

Author

Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Holly Jean Roberts, PhD, Assistant Professor, Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center
Holly Jean Roberts, PhD is a member of the following medical societies: Autism Society of America, National Association of School Psychologists, and Psi Chi
Disclosure: Nothing to disclose.

Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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