How to stop child from pulling out eyelashes

A Mini-guide to Trichotillomania in Children and Adolescence

Tasneem Abrahams
Jun 23rd, 2016

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Trichotillomania is the medical term for a disorder that involves a recurrent and irresistible urge to pull out hair from the scalp, eyebrows, eyelashes and other parts of the body, typically resulting in noticeable bald patches. It is estimated to affect 1-2 percent of the population (about 4-11 million Americans) and the disorder can affect people of any age, but it often begins in childhood and adolescence. For some children, trichotillomania may mild, but for others the compulsive urge to pull hair is overwhelming, which leads to significant distress and can interfere with social functioning. The majority of children who have been diagnosed with the disorder often pull out their hair one strand at a time and they will often inspect or play with the strand of hair after pulling it out, and about half of those with trichotillomania put the hair in their mouth after pulling it.

Signs & Symptoms of Trichotillomania

It is often easier to recognize trichotillomania in teenagers and young adults than in children and adolescents, because it is common for young children to pull at their hair during a tantrum. So, it is essential to distinguish between hair pulling that is a tantrum and a comforting habit. In order for a children to be diagnosed with trichotillomania they must meet certain criteria, which includes:

• repeatedly pulling out hair that results in noticeable hair loss
• repeated attempts for them to stop pulling out their hair
• the hair pulling causes additional distress at school or in social situations, and
• the hair loss is not due to another skin or medical condition, or the symptom of another mental disorder.

For children and adolescents with trichotillomania, hair pulling is focused and/or automatic. When it is focused, the children who pull their hair intentionally do so as a way to relieve distress or tension. For example, they will pull their hair out as a relief for their overwhelming urge to pull hair and they may develop a ritual for hair pulling, such as finding the right hair to pull. When hair pulling is automatic, children will pull out their hair without even realizing they are doing it. For example, pulling hair while reading, watching television or when bored. Children may also do both focused and automatic hair pulling, depending on their situation and their mood.

Do I Have Trichotillomania?

Most children who have trichotillomania will also bite their nails, chew their lips, pick their skin and they may pull hair from dolls/toys and pets or pick at clothes and blankets in search of hairs. They typically pull hair in private and usually try to hide it from parents, friends and other family members. Other signs and symptoms of trichotillomania usually includes:

• Increased tension just before pulling or when they try to resist pulling
• A noticeable sense of pleasure or relief after hair pulling
• Repeatedly pulling out hair, especially from the scalp
• Thinned, bald or shortened areas of hair on the scalp and/or missing eyebrows or eyelashes
• Biting, chewing or eating pulled-out hair-pulling
• Playing with hair that is pulled out or rubbing it across their lips or face

Problems Relating to Hair Pulling

One of the primary concerns when determining the cause of hair pulling in children is to rule out any other problems that may be related to or the cause of hair loss. For example, medical conditions, such as tinea capitis and alopecia areata are first ruled out. The child's physician will also question and test how the child is functioning from both parents and teachers, in order to determine if the hair playing is related to stress. Hair pulling in children often includes the following features, which also helps to determine if the hair pulling is a habit:

• Babies aged 1 month to 2 years-hair pulling during this age is typically a self-comforting habit and it usually goes along with thumb sucking. The child will find this relaxing and typically engages in the behavior before falling asleep or when they are distressed.
• Toddlers aged 2 to 5 years-if a child has been pulling their hair since infancy, at this age they will be in the habit of doing it without thinking. When they are about the age of three, the child can tell when their parents are reacting to what they are doing, so if the parent becomes upset or worried, the child will learn to do this as a way of getting attention for their behavior.
• School aged 5 to 12 years- trichotillomania at this age may be a simple habit or a sign that the child is anxious or under stress. When children start pulling their hair at this age, there is typically other causes for the problem, which may be school-related stress and/or an indication that something is worrying the child. It is often difficult for children at this age to put their feelings or troubles into words so they may pull hair as a form of relief for their stresses. They often pull eyebrows or eyelashes at this age and they usually become more secretive about pulling out their hair.
• Adolescence aged 12 to 18 years- trichotillomania in adolescence is often similar to another childhood behavior known as obsessive compulsive disorder (OCD), which can cause the teenage to develop rigid rituals. It may also be part of their struggle for independence, a symptom of anxiety or an expression of rebellion.

Treatment

Trichotillomania is a chronic disorder and without treatment the symptoms can vary in severity over time. For example, in young adult women, the hormonal changes of menstruation may worsen the symptoms. For most children/adolescents, if not treated, the symptoms can come and go for weeks, months, even years at a time, but rarely does hair pulling end within a few years after starting. Some treatments used for trichotillomania may include:

• Psychotherapy, which is a form of habit reversal thinking. This form of therapy helps the child learn how to recognize situations where they are likely to pull hair and substitute other behaviors instead.
• Cognitive therapy, which is designed to help the child challenge and examine their distorted beliefs they may have in relation to the hair pulling.
• Medications are not prescribed specifically for the hair pulling act, but may be prescribed for symptoms and/or other conditions relating to the hair pulling. For example, anti-anxiety medications may be prescribed for children who also display symptoms of anxiety. Antidepressants are sometimes used as well in order to relieve the symptoms of depression, which may lead to the acts of hair pulling.

Latest Research

In a recent study, 15 females and 8 males (23 children and adolescents) aged 6-18 years, with a diagnosis of trichotillomania were followed through an outpatient clinic. The study was used to determine if/what co-occuring (concurrent) or comorbid (one or more additional) psychiatric disorders may be associated with the trichotillomania diagnosis. 65.2 percent of those in the study reported precipitating stress factors before their trichotillomania symptoms had begun. Of the 23 children/adolescents, 19 suffered at least one psychiatric disorder, while 14 suffered from at least two psychiatric disorders. The most common comorbid disorders included:

Anxiety disorders (15)
Disruptive behavioral disorders (6)
Tic disorder (3)
Enuresis nocturna (3)

The study concluded that those participating were found to have high rates of comorbid psychiatric disorders also revealed that the scalp was the most commonly affected area and the average duration of the symptoms was 7 months.

It is important to understand that research on the treatment of trichotillomania is very limited and the exact cause of trichotillomania, especially in children is unclear. However, like most complex disorder, trichotillomania most likely is the result of other genetic and/or environmental factors. It is also essential to know that abnormalities in the natural brain chemicals dopamine and serotonin may play an important role in trichotillomania.

Tasneem Abrahams

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My daughter pulls out her eyelashes – The Irish Times

I'm a mother of two girls, who are 10 and eight. As with all kids, they are very different in many ways. Our elder girl will talk about her worries, but our eight-year- old daughter isn't as good. She likes to keep the peace more than her sister does, and doesn't like any confrontation.

I know she is getting better at opening up, but I still sometimes wonder what exactly is going on in her head. I was a worrier as a child too, so I know what it's like to have worries and to pretend to be okay.

Recently, I noticed that she seemed to have lost a few eyelashes in one area on her top eyelid. A few days later all the lashes were gone from that eyelid.

I had a word with her, saying: "You might have rubbed your eye a bit too hard recently because I think you've lost a few lashes; maybe just go easy and they'll grow back quickly. They're important for protecting your eye from dust." She didn't get upset but she didn't want to have any attention drawn to it, either.

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Now she has the other eyelid all pulled too. We had another chat and I'm happy enough that there isn't anything major going on at home or in school. I've sent a note to the teacher just to keep an eye on her during the school day.

I've encouraged her to wear a loose bobbin on her wrist at night and to pull on it as she's thinking or settling to sleep; I think pulling the lashes might have become a habit before falling asleep.

Like thumb-sucking and biting one’s nails, hair-pulling is one of many body-based habits that children develop as a means of distracting or relaxing themselves. Children can get into a habit of pulling hair from their eyelashes, as in your daughter’s case, or from their eyebrow or scalp. For most children, hair-pulling is a time-limited habit that they grow out of, though for others it can become a more fixed habit and, in these situations, it can be diagnosed as trichotillomania, which is grouped as an obsessive compulsive disorder (OCD) in mental health manuals.

Hair-pulling is common in children who are already prone to have somatic or body-based mannerisms or habits such as scratching, picking skin, nail-biting, thumb-sucking, and so on. It can be aggravated by stress and anxiety, though it is not usually started or caused by an anxious event.

Frequently, it starts out as a benign habit that developed from a sensory event, for example an itchy eyelash that your child gets into the habit of rubbing or pulling, even after the original itchiness is gone. Like all these habits, they are often done unconsciously and the child is not fully in control.

How to help your daughter

Your question shows that you are already doing many of the right things to help your daughter.

It is important to talk directly to your daughter about the habit in a supportive and non-blaming way. Some children are embarrassed about the habit and don’t want to talk about it and it is helpful to be matter-of-fact and supportive: “Lots of children get into habits like biting nails, but we can help you stop it.”

When talking about it, don’t expect that there is something at the bottom of the behaviour that your daughter needs to talk about, as this puts pressure on her and, most times, there is no specific cause.

While there could be stresses and worries that it might be useful for your daughter to talk about, these are likely to be separate from tackling the hair-pulling.

Try to find a time of day, such as bedtime or going for a walk with your daughter, when she is more open to talking about it.

Breaking the hair-pulling habit

Like many other somatic habits, hair-pulling is usually broken gradually over time. These are ways you can help:

Learning about the condition, and how it can be changed. Reading some good child-centred information online together might help to take the stigma out.

Becoming aware of when and why your daughter pulls her eyelashes: you have already noticed it is around bedtime and perhaps it is used as a habit around sleep. Can you identify with her other rituals she could develop to get to sleep, for example, holding a doll, squeezing her pillow or lying on her hand?

Help your daughter to learn new responses when she feels the urge to pull her eyelashes: for example, squeezing her fingers, stretching her hands, or simply taking a moment to breathe and relax. You have given her a bobbin to pull on her wrist, which is creative. Continue to explore new tactics with her until you find a few that work for her

Help your daughter to notice the trigger situations and remind her of agreed alternative strategies. To avoid this becoming unhelpful nagging, it can be helpful to agree a code word in advance, such as “hands”, or a subtle gesture to remind her of alternative strategies in the moment.

- It is a good idea to teach your daughter relaxation or mindfulness strategies that she can use as a means of becoming aware of, and diverting her hair-pulling behaviour, as well as reducing her stress levels generally. Perhaps you could listen to a relaxation tape together as part of her bedtime ritual.

Get further support if needed

As mentioned, most children’s hair-pulling habits fade over time, However, if it remains a problem or gets worse, do seek further help. You could ask your GP to make a referral to your local child mental health or primary care service or seek the support of a private psychologist or mental health professional.

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Your child psychologist Daughter tearing her eyelashes (trichotillomania)

Several questions came to the “Ask a psychologist a question” column again. Pleased with your trust in this blog and your desire to help your child. Slowly I sort out life's "tasks" in order.

Irina

Hello! My oldest daughter is 6.5 years old. She tears out her eyelashes. Scolded, explained - it's useless. The eyes are already almost "bald"! What to do!

Tatyana Egorova

Irina, hello.

The desire to tear one's eyelashes belongs to the group of obsessive-compulsive disorder neuroses. Experts regard this as a disease called trichotillomania .

Be warned, it is serious and requires psychotherapeutic and/or medication treatment, which can be done by a psychotherapist. Try to find a good child psychotherapist who will see your daughter, talk to her and you, and prescribe special treatment. nine0003

Why is this necessary?

To begin with, let me explain a little, what is trichotillomania .

In the medical literature, this term is understood as compulsive pulling of hair, eyebrows, eyelashes . Basically, it occurs in girls and women, and there are no age restrictions here, i.e. This disease affects both children and adolescents equally, and even the elderly.

Many, having been ill since childhood, continue to live with this obsessive condition, slowly depriving themselves of hair, eyebrows, eyelashes. When there is nothing left to tear out, they wear wigs and false eyelashes. Thus, if you do not work with this problem, it remains for life. nine0003

Unfortunately, no requests, explanations or reproaches will help here. For one simple reason, that this desire is not controlled by the consciousness of . A person tears his hair, eyelashes or eyebrows purely automatically, getting satisfaction from the process, which he is not able to explain. It's like a drug. That is why it is called "obsessive" state.

What causes trichotillomania?

Trichotillomania does not arise from scratch.

In rare cases, there may be gene disorders , but so far research is underway in this direction and nothing can be specifically stated.

Another reason. Children are naturally curious . They can spy on their mother, as she plucks her eyebrows for the sake of beauty, experiment on themselves and ... continue, because they "liked it." Later there is an addiction.

But this occurs as an exception to the rule.

In reality, very often trichotillomania is preceded by some kind of emotional shock, experienced stress . In children, it may occur in response to psychic trauma received in the family or outside the family. A child may experience a feeling of rejection in his own family for various reasons (here it is necessary to specifically clarify the key points in a conversation with parents and a child), may fear that they do not like him, do not appreciate that he interferes with someone. Or something happened to the child outside the home (in the kindergarten, on the street, at a party, etc.)