Trichotillomania

Hi,  I have a ten year old daughter that has a diagnosis of depression, conduct disorder,ADHD, and violent rages.  She now has developed a behavior that consists of a picking if you will.  She does not do this constantly, but it is happening more and more.  Mostly in private.  She picks everything hair from all parts of her body.  legs, arms, eyebrows and pubic hairs as well.  When I ask her why is she doing this she tells me she doesn't want the hairs there at all.  I tell her that as she gets older, she will have even more to grow she just says yeach!and makes a face.  She will spend several times a day doing this picking in the bathroom.  I have let her do this as long as 30 mins. before just to see how long she would do this. If I didn't tell her she had to leave the bathroom, I swear she would stay there for hours. I have discussed this with her Doctors they are keeping tract of this.  I have offered her an alternative pick item if you will. she picks this stuffed animal for a short time then she goes back in the bathroom and today I noticed alot of hair on the floor.  When I asked her what was doing she hung her head and told me she pulled it out. Do you have any suggestions for us please?

[Kevin Kennedy, Ph.D.]

Dear Karen,

Trichotillomania is an impulse control disorder and is often not subject to much improvement via conventional outpatient therapy. Sometimes behavior modification interventions, if the child is old enough to cooperate with them, can make a difference.

However, there is some indication in your description that your daughter's behavior may indicate Obsessive-Compulsive Disorder. She may be experiencing obsessive thoughts and the hair picking is the compulsive bbehavior that eliminates the anxiety. I'd speak with her clinicians about this possibility, so they can evaluate the situation. For most types of OCD, a combination of medication (e.g., Luvox) and cognitive-behavioral treatment is the recommended intervention.