Teen Trichotillomania Treatment

Teen trichotillomania is a condition that causes teens to compulsively pull out or manipulate their hair. While it most often affects hair on the head or face, it can involve hair found nearly anywhere on the body. Rather than being strictly behavioral, trichotillomania is an impulse control disorder and/or mental health condition. Teens who suffer from it are usually unable to stop, even if they experience pain, loss of hair coverage, or balding.

Research shows that females are much more likely to suffer from trichotillomania than males. They’re also far more likely to pull hair from regularly visible zones are on the face, such as the eyebrows, eyelashes, and  hairline. Trichotillomania is about much more than just hair removal; in most cases, it is a negative coping method used to assuage intense or difficult emotions like stress, depression, and anxiety. In some cases, it can also be a form of self-harm.

What Does Teen Trichotillomania Look Like?

  • Trichotillomania suffers obsessively pull hair out, pulling or twisting to remove it. The most commonly targeted areas include the eyelashes, eyebrows, hairline, and scalp.
  • Teens often experience a rush of adrenaline after they pull hair, which can be very pleasurable. This rush can become addictive.
  • Trichotillomania is a stress-modulated disorder, meaning teens are more likely to pull hair to cope with stress. In some cases, it may also manifest alongside chewing or skin picking behaviors.
  • It is common for teens suffering from trichotillomania to develop bald patches, irritated skin, minor infections, and scarring. Rashes may also occur, as well as stomach upset if teens eat hair.

Signs of Trichotillomania

Teen Trichotillomania Treatment

Obsessively pulling or twisting body hair

Teen Trichotillomania Treatment

Frequently denying their behavior

Teen Trichotillomania Treatment

High levels of stress leading to pulling

Great sense of humor

Feeling relief after pulling hair

Stomach upset due to ingested hair

Shaking, trembling, or high heart rates

Self-harming behaviors, such as skin-picking

What Causes Trichotillomania?

Mental health issues – There is a link between trichotillomania and other mental health disorders like depression, manic-depressive disorder, and obsessive-compulsive disorder. Anxiety-mediated illnesses are much more likely to be associated with hair pulling.

Stressful circumstances – Trichotillomania behaviors are closely tied to, and often directly correlated with, increased stress. Teens who experience trauma, extreme academic or performance pressure, or trouble at school and home are much more likely to develop trichotillomania as a negative coping mechanism.

Age and gender – It is far more common for younger teens, preteens, and sometimes, young children, to develop a hair pulling disorder than older teens and adults. Being female also significantly raises the risk for developing trichotillomania at all ages. Gender risk is, however, evenly split across children 12 years of age or under.

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Teen Trichotillomania Treatment


of all Americans suffer from trichotillomania


year-old children have the highest risk for trichotillomania


of trichotillomania sufferers are female, especially in teens

How Can I Help My Teen with Trichotillomania?

Encourage the use of healthier stress relief – Because trichotillomania is a stress-mediated disorder, stress reduction is extremely important to relieving symptoms. Teens need guidance on how to cope with negative emotions and difficult situations like dating, relationships, bullying, school pressure, and puberty. Helping your teen find new ways to manage stress in a healthy manner is critical to helping them stop pulling hair during the early phases of teen trichotillomania treatment. It will also increase their chances to remain free from trichotillomania long-term after they graduate and return home. Be your teen’s partner in overall wellness, helping them find activities and strategies (like yoga or meditation) they find enjoyable and relaxing.

Talk to your teen about support groups – Trichotillomania is associated with significant stigma; sufferers are very often bullied or picked on by their peers. Physical side effects, like loss of hair, can strip down self-esteem and even cause teens to become agoraphobic. Teens also frequently fear judgement if they express how they feel. Support groups provide a safe space where they can share and discuss their experiences with people who already understand where they’re coming from – no judgement involved.

Encourage a healthy lifestyle – Living a healthy lifestyle is so important in reducing the symptoms of trichotillomania. This includes eating a healthy diet, staying hydrated, getting enough exercise, and sleeping according to a regular schedule, all of which are immensely beneficial to overall mental health. In teens, these core components are even more important because they’re growing into adulthood; the habits they set now last for life.

How Teen Trichotillomania Is Treated

Teen trichotillomania treatment starts with diagnosing secondary mental health conditions, like anxiety and depression. Teens must be helped to find healthier ways to reduce negative emotions associated with these illnesses and general stress or pressure. If trichotillomania is obsessive in nature, then teens will also need to break the cycle and stop pulling hair even if they experience intrusive or difficult thoughts. It is important to note that there is no specific cure for trichotillomania, but patients can and often do find solutions that help them live healthy, amazing lives without pulling for years at a time.


Some teens may benefit from treatment with antidepressants and atypical antipsychotic medications. These drugs alleviate the symptoms of trichotillomania by lessening anxiety, depression, and feelings of stress. They may also help to reduce obsessive or compulsive thoughts and behaviors, too. However, there is no medication-based “cure” for trichotillomania. Teens must still work to address other contributing factors, including comorbid mental health illnesses and lifestyle concerns.

Habit Training

Teens who suffer from trichotillomania may benefit from habit reversal training. This treatment is a form of behavior therapy that helps teens learn to identify, respond, and cope with triggering situations or experiences that drive them to pull hair. The techniques and strategies taught in habit reversal training empower teens to recognize when their behavior is heading towards pulling so they can stop before they become stuck in a negative feedback loop. While it isn’t necessarily a cure, it can significantly reduce episodes.

Cognitive Therapy

Cognitive behavioral therapy, also known as talk therapy, gives teens the opportunity to explore their feelings and experiences in a safe, judgement-free space. Therapists guide teens on how to reduce intense emotions while also showing them how to view their struggles from an objective point of view. The goal is to reduce cognitive distortion and negative self-talk to help teens manage their symptoms logically and rationally. CBT can also help teens to better identify triggers so they can avoid them, or cope with them, in the future.

Helping Teens with Trichotillomania at Paradigm San Francisco

Paradigm’s staff work hard to treat every teen individually. Especially when it comes to trichotillomania, we recognize that every teen’s story is unique. What drives one teen to pull hair may be totally different from another. It is important to us to pay attention to outward behaviors, physical symptoms, and shared experiences as a whole. This includes judging whether hair pulling behaviors are driven by the need to self-harm, which is very common, or by associated disorders like OCD.

Every teen starts with an initial psychiatric evaluation to ensure we don’t miss any concomitant disorders, like depression or anxiety. Treatment plans are specifically designed to address your teen’s unique symptoms and experiences, rather than a generalized approach.

Individualized Treatment at Paradigm

When teens come to Paradigm, they have instant and constant access to a variety of effective  teen trichotillomania treatments. Options like talk therapy, behavioral therapy, one-on-one counseling, group therapy, and sometimes, medication, help teens find new ways to get and stay well for life. Talk therapy sessions focus on helping teens identify triggers and address what drives them to pull and/or eat hair in the first place, letting teens understand the connection between body and mind and how it influences their behaviors.

Counselors provide a safe, objective space in which teens are given time to self-acknowledge their behavior without feeling abandoned, alone, or without support. Cognitive behavioral therapy techniques give us the ability to teach teens how to dissociate from obsessive or compulsive behaviors, like hair pulling, so they can acknowledge and confront how it impacts their own lives and the lives of people they love. A big part of this process is providing teens with resources and strategies to help them cope with stress, which may include helping them explore their interests or even discover new activities they enjoy. This positive-focused approach lets teens build confidence at their own pace.

Treatment in the Long-Term

Early therapy for trichotillomania often focuses on teaching improved impulse control, but teaching teens how to cope and adapt is also important. Continued cognitive therapy over several months, and potentially, even for life, can help teens continue to separate themselves from their actions so they can decide how to react logically. This is critical for long-term success in teen trichotillomania treatment.

Parents should know that teen trichotillomania treatment isn’t easy or quick. Effective treatment takes time, and patience is critical to your teen’s success, especially in older teens who may be more resistant to our efforts. For this reason, it’s best to seek help as early in your child’s disorder as possible. No matter how bad things are, we can always help.

Paradigm was the first program that did extensive psychological testing and helped our daughter identify and deal with a serious trauma that we had been unaware of as a family. She came home to us happy, healthy and free of the need for any medication. Our daughter's time at Paradigm was the first step for our entire family to heal.

– Bethany S.

Frequently Asked Questions About Teen Trichotillomania Treatment

Does my teen need treatment to stop pulling out her hair?

In almost all cases where hair pulling is compulsive or obsessive – yes. Because trichotillomania is compulsive, teens can’t just decide to stop. In fact, trying to force them to stop can actually be detrimental and even damaging, causing them to regress and develop worsening symptoms. Teens who are judged harshly or “called out” may begin to feel deeply ashamed; they will naturally begin to pull more hair to cope with these emotions. Seeking treatment early, and often, is the best way to help your teen overcome this issue.

How common is trichotillomania?

Pulling one’s hair, or even eating it afterward, is surprisingly common, especially in teens under 15 years of age. It isn’t clear just how many people suffer from this troubling behavior in the United States, but most experts agree it is a relatively common experience for teens who express stress through self-harm.

We do know that around 0.5% to 4% of all Americans suffer from trichotillomania at any given time. While this may seem low, that’s approximately 1,635,000 to 13,080,000 people (roughly the population of Phoenix, AZ, on the lower end, or twice the population of New York City, on the high end). While all genders experience trichotillomania in even numbers before age 12, females are inordinately more affected in the later teen years. However, some of this may be due to the fact that women who pull hair are often more stigmatized.

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