Anxiety Disorder, Trichotillomania Treatment & Management

  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Sep 23, 2009
 

Medical Care

After a diagnosis of trichotillomania is confirmed through a workup, take the following actions:

  • Determine whether symptoms represent a short-term childhood habit.
  • Determine whether the symptoms indicate a more serious psychological problem through consultation and collaboration with a psychiatrist, developmental-behavioral pediatrician, or licensed clinical psychologist. Consultation is recommended and may be required for choosing various treatment options.
  • Recognize that children with presenting symptoms of trichobezoars may require further evaluation via ultrasonography and/or MRI and/or CT scanning.
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Surgical Care

Consider removal of trichobezoars in the stomach and intestines.

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Consultations

Consult with psychiatry, psychology, or developmental-behavioral pediatrics specialists.

  • As suggested by several studies, the first line of treatment in children who present with hair pulling is behavioral treatment and intervention.
  • Effective behavioral strategies in the treatment of trichotillomania in children include the following:
    • Habit reversal: This is a set of procedures taught to a child, which include the following components: increasing the child's awareness of the habit; teaching the child a competing response to practice when they feel the urge to engage in the habit, in situations where the habit historically occurs or for 1 minute following the occurrence of the habit; practicing stress/anxiety reduction procedures on a daily basis; and support and encouragement from parents.
    • Self-monitoring: Self-monitoring involves systematically observing and discriminating when the behavior occurs, recording the responses, and evaluating one's own behavior.
    • Competing reaction training: Competing response or reaction training is one component of habit reversal, which is occasionally used alone. A child is taught a socially appropriate alternative behavior or response, which they are encouraged to practice on a daily basis when they feel the urge to engage in the habit, in situations where the habit historically occurs or for 1 minute following the occurrence of the habit.
    • Relaxation training: Relaxation training involves helping children to identify their own bodily sensations associated with tension and then to use procedures designed to induce relaxation. Typically, this approach is individualized and may include such procedures as deep-breathing strategies and systematic muscle tensing and relaxation.
    • Psychotherapy: Psychotherapy is a process that involves direct communication between a therapist and a child, mainly in the form of talking, using various techniques to help solve behavioral and other psychological problems. One of the most popular forms of psychotherapy is cognitive behavioral therapy.
    • Hypnosis: Hypnosis is a process of controlling physiologic responses by focusing attention on specific mental images for therapeutic purposes, typically to gain more control over behavior, emotions, or physical well-being. Hypnotic procedures often involve having the child visualize an experience to facilitate induction, during which time they concentrate intensely on a specific thought, memory, feeling, or sensation while blocking out distractions. In this state, the child is more open than usual to suggestions (provided by the hypnotist) for subsequent changes in behavior.
    • Elimination of a comorbid behavior: In cases where two seemingly different behaviors occur together (eg, trichotillomania and thumb sucking), a treatment to reduce or change one behavior may also result in a change or reduction in the comorbid behavior.
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Diet

A child with trichotillomania requires no special diet.

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Activity

No activity limitations are suggested for a child with trichotillomania. However, if the hair-pulling behavior is associated with a specific activity, that specific activity may require close monitoring. As indicated in a study of individuals with trichotillomania, the following are possible activities during which patients with trichotillomania may engage in hair pulling:

  • Watching television
  • Reading
  • Talking on the phone
  • Lying in bed
  • Driving
  • Writing or doing paperwork
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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.

Specialty Editor Board

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.

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

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.

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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A close-up picture of typical trichotillomania shows a combination of newly growing young hair, broken shafts, comedolike black dots, empty orifices, and vellus or intermediate hairs.
Typical geometric shape of trichotillomania in a 7-year-old boy. Smooth baldness of the scalp surface at this age is rare.
 
 
 
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