10-year-old child pulls her hair out and has started wetting herself during the day.

[Joh3]

My daughter's friend, age 10, lost her mother 9 months ago. Her mom was sick for quite a while with cancer, during which this little girl pulled out all her eye lashes. Now that her mother has passed, she has pulled out most of her hair, except for a 3 inch patch on the crown of her head where she keeps her  hair tied in a long pony tail. She wears a bandana over the rest of her head. Recently, she has started wetting her pants continually throughout the day, having to change sometimes in the office at school. She comes home with us once a week so I can take her and my daughter to dance. She keeps her wet clothes on, even though I offer to wash them. The odor is unbearably, and I am surprised she's not getting teased at school. She just told me her pediatrician says her "leaking" is from stress. She is seeing a psychiatrist every other week, but she seems to be spiraling downward. What causes this incontinence? Could it be a physical problem rather than psychological. And either way, what can I do to support this child and make her more comfortable. She is becoming more trusting in her conversations with me lately.

[Kevin Kennedy, Ph.D.]

To be frank, there is little you can do directly beyond providing her with attentive, supportive, understanding influence. Yes, it could be that she has a physical problem that causes the enuresis, bit I assume the pediatrician has ruled that out. Under strressful conditions, children often do display regressive behavior. Her daily enuresis and trichotillomania demand intensive intervention. It is likely that twice-monthly menatl health contact is not sufficient. Do you happen to know if she is prescribed any medication? Are you friendly with her father (or other guardian)? You would be helping her by suggesting that more intensive help be sought. An example of more intensive help would be a so-called partial hospital or day program. She would stay overnight at her home, but attend the day program instead of school for as long as needed to achieve stability.

[Joh3]

Yes, I do believe she is taking 2 medications. She says one is for her "itchy" scalp, so she won't pull out more hair (I assume some form of antidepressant to stop the ocd behavior) and something she takes at night (and I'm assuming it's a sleep aid).

I am friendly with her dad, but frankly I suspect the dad has a form of asperger's syndrome. He is very lacking in social skills and it takes him a long time to even talk to someone (when he used to call me about dance pickup times, sometimes he was too afraid to speak, even though on caller ID I could see it was him, I would then have to initiate conversation, and he would speak haltingly). Family friends have told me to leave messages on their home answering machine, so that the dad can "digest" the question or information. My latest voice mail to him has been about whether I could give his child feminine pads for her day wetting, but he has not called back about that yet. Anyway, I will carefully explore whether it would be an option for her to do more intensive therapy. Right now, like I said, they seem to go every other week.