Trichotillomania in Teenagers: A Guide for Parents

If your teenager has started pulling out their hair, eyebrows or eyelashes, you may feel worried, confused, or even a little frustrated. Many parents first search for something like “my teenage daughter pulls her hair” or “my son is pulling out his eyebrows”. You’re not alone, and neither is your child. Trichotillomania in teens is common: it’s most likely to start in the early teenage years.

Trichotillomania (trich) is a condition where someone repeatedly pulls out their own hair and finds it very hard to stop. It isn’t a bad habit, attention-seeking or self-harm. This guide covers why it so often begins around puberty, how to bring it up, how to help without taking over, and how to find support that suits a young person.

Why does trichotillomania often start around puberty?

Nobody knows exactly, but a lot changes at once in the early teens. The UK’s NHS lists changing hormone levels during puberty as one possible factor, alongside stress, brain chemistry, genes, and the way pulling can become a habit that feeds itself. Trich also tends to run in families.

Teenage life brings new pressures too: exams, friendships, a changing body, and more time alone. Mayo Clinic, a large US medical centre, notes that boredom, being alone and privacy all make pulling more likely.

Trich most often starts in the early teens, when school, friendships, bodies and sleep are all changing at once.

The way people pull also changes with age. Young children mostly pull automatically, without noticing, while older young people and adults more often pull in a focused way, to ease an urge or tension. So a teenager may know they’re pulling and still find it very hard to stop. That isn’t a lack of willpower.

One thing that doesn’t cause trich is bad parenting. Nothing you did or didn’t do made your child pull.

What does hair pulling look like in a teenager?

Many teenagers hide pulling, so the first signs are often indirect. You might notice:

thin or patchy areas on the scalp
missing or uneven eyebrows or eyelashes, sometimes filled in with makeup or pencil
a new hairstyle, fringe, hat or hood that always covers the same spot
hairs on the pillow, desk, floor or bathroom sink
hands going to the head while studying, gaming, reading, scrolling or lying in bed
avoiding swimming, sleepovers, windy days or the hairdresser

Shame is a big part of teen hair pulling. A 2012 review of trich in young people found that guilt, shame and low self-esteem are common, and that many adolescents worry about classmates finding out. Hiding it is part of the condition, not a sign that your teenager is being sneaky with you.

How do I talk to a teenager about hair pulling?

Choose a calm, private moment, and lead with care rather than questions about their hair. Many teenagers find it easier to talk side by side than face to face: in the car, on a walk, or while cooking together.

Things that help:

Say what you’ve noticed, and that you’re on their side. “I’ve noticed you seem to pull at your hair when you’re stressed. I’m not cross. I’d just like to understand, and help if you want me to.”
Give it a name. Hair pulling has a name, it’s common, and it isn’t their fault. Many teenagers are relieved to hear that.
Ask, then listen. When does it happen? How do they feel about it? Let silences sit.
Let them lead on next steps. Offer options rather than insisting: reading about it together, seeing a doctor, trying a few strategies.
Keep it short. You can come back to it another day.

Things to avoid:

telling them to “just stop”, or pointing it out every time you see it
punishments, rewards tied to hair, or taking their phone away as a consequence
comments about how they look, or comparisons with siblings or friends
telling relatives, teachers or friends without their agreement

For more example phrases, and what to do if the first conversation doesn’t go well, see our guide to what to say to a child who pulls their hair.

How do I support my teenager without controlling them?

Be a steady ally in the background, and let your teenager own their progress. Teenagers need growing privacy and independence, and being watched or reminded often adds to the shame that drives pulling. The 2012 review notes that parents usually take part fully in assessment for younger children, but that older adolescents need them less, and that clinicians weigh up whether a parent’s involvement is helping.

Practical ways to help:

Agree a plan together. Ask what kind of help they’d like: a private signal, such as quietly handing them something to fiddle with, help setting up barriers, or nothing at all for now.
Make the environment easier. Put fidget toys and textured objects where they tend to pull, use a brighter bedroom light, and charge phones outside the bedroom if bedtime is a hard time.
Praise effort, not hair. Notice when they use a strategy, not whether a patch has grown back.
Expect ups and downs. Pulling often rises with stress, exams or big changes. A setback isn’t failure.
Look after the basics. Sleep, exercise, downtime and time with friends all help.
Respect their choices about covering up. Hats, makeup or a new hairstyle can help a teenager feel able to face school and friends.

Make the room easier and keep the door open. Watching and reminding tend to make pulling harder to talk about.

What treatment works for teenagers?

Behaviour therapy based on Habit Reversal Training (HRT) has the most research behind it in young people. Habit Reversal Training teaches someone to notice the early signs of pulling, change their surroundings so pulling is harder, and use a competing response: an action with the hands that can’t be done at the same time as pulling, such as making a fist.

What the research shows:

Approach	What was studied	What was found
Behaviour therapy (based on Habit Reversal Training)	24 young people aged 7 to 17, eight weekly sessions, compared with a group who had less contact	Pulling fell much more with behaviour therapy. A later review reported three in four responded, compared with none in the comparison group. Gains held for a further eight weeks.
Behaviour therapy plus ACT, by video call	28 teenagers aged 12 to 16, in a small pilot study	Pulling and distress fell, and improvements lasted through a year of follow-up.
NAC (a supplement)	39 children and teenagers aged 8 to 17, compared with a dummy pill	No better than the dummy pill.
Antidepressants called SSRIs	Reviewed across studies in young people	Not shown to help pulling in young people. The NHS says antidepressants are rarely prescribed for trich.

ACT (acceptance and commitment therapy) is a talking therapy that helps people make room for uncomfortable urges and feelings without acting on them.

These trials are small, but they point the same way: skills-based therapy helps many young people, and medicines play a smaller role. Always speak to a doctor or pharmacist before your teenager takes any medicine or supplement for pulling.

Our guide to Habit Reversal Training explains each step in detail.

What if my teenager seems low?

Keep an eye on mood as well as hair. Mayo Clinic lists shame, low self-esteem, anxiety and depression among the effects trich can have. Signs worth gentle attention include pulling away from friends, losing interest in things they used to enjoy, changes in sleep or appetite, talking about themselves harshly, or not wanting to go to school.

If you notice these, ask kindly how they’re feeling and let their doctor know. Low mood can be treated, and support for mood and support for pulling can go hand in hand.

If your teenager says they feel hopeless, or you’re worried about their safety, get help today.

In an emergency, call your local emergency number or go to your nearest emergency department.

Find a helpline (international directory) (findahelpline.com)

How do I find help for a teenager with trich?

Start with your teenager’s doctor, who can check for other causes of hair loss. Then look for a practitioner who already understands hair pulling, because many have never worked with it.

Your family doctor or your teenager’s paediatrician is a good first stop and can talk you through local therapy options for young people.

When you contact a practitioner, it’s worth asking:

Have you worked with teenagers who pull their hair?
What approach do you use, and does it include behaviour therapy?
How involved will I be as a parent?
Can sessions happen online?

Let your teenager have a say in who they see. Some find online sessions from home easier than a clinic.

Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory near you or for online sessions.

Our guide to finding someone who understands trich explains what to ask on a first call.

For the essentials every parent should know, read our guide to trichotillomania in children.

If you’d like a fuller plan for supporting your child at home, The Parent’s Guide to Trichotillomania is about understanding what your child is going through.

Questions people ask

Will my teenager grow out of trichotillomania?

There’s no way to know for sure. Pulling in toddlers often stops by itself, but pulling that starts around puberty is more likely to need support. The good news is that skills from behaviour therapy last: in studies of young people, improvements held after treatment ended, in one case for a full year.

Should I tell my teenager’s school?

Only with your teenager’s agreement. A teacher who knows may be able to allow a fidget in class, a hat, or a quick break when the urge is strong, and can look out for teasing. Let your teenager decide who is told and what is said.

Is trichotillomania a form of self-harm?

No. People with trich pull because it brings relief, satisfaction or calm, not to hurt themselves. It’s a body-focused repetitive behaviour. If you’re ever worried your teenager is hurting themselves in other ways, talk to them and to their doctor.

Can my teenager have therapy online?

Yes. In a small study, teenagers aged 12 to 16 had behaviour therapy by video call. Their pulling and distress fell, and the improvement lasted through a year of follow-up. Many teenagers also find it less awkward to talk from home.

Is it OK for my teenager to cover patches with makeup, hats or a new hairstyle?

Yes, if it helps them feel confident at school and with friends. Covering up is a personal choice. It can sit alongside getting help rather than replacing it, so there’s no need to discourage it.

Should I see the doctor on my own first?

You can, if you want to talk things through before involving your teenager. It usually works better to go together, with their agreement, so they hear the information first-hand and feel part of the decision.