Anxiety Disorder, Trichotillomania Treatment & Management

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.

Consider removal of trichobezoars in the stomach and intestines.

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.

A child with trichotillomania requires no special diet.

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