16 Things Parents of Children With Trichotillomania Need to Know

By the Trichotillomania Team

If you've noticed your child pulling out their hair, eyelashes, or eyebrows, you're probably feeling a mix of worry and confusion — and maybe you've been told to just wait it out. This guide is here to give you clear, accurate information and a calm plan for what to do next.

The good news up front: this is more common than you think, it's not your child's fault, there's genuinely effective treatment, and the way you respond as a parent makes a real, positive difference.

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First, what you're likely looking at

It's common for very young children (under about 7) to pull their hair, and this usually stops on its own without any lasting effect.

But if your child is older — roughly 8 and up — and you're seeing repeated pulling that leaves noticeable thin patches or missing lashes and brows, this is very likely trichotillomania (often shortened to "trich" or "TTM"), a recognised hair-pulling condition. Average onset is around ages 11 to 13, though it can start earlier or later.

Trichotillomania is classified as a mental health condition — it sits in the same diagnostic family as OCD in the current diagnostic manual (DSM-5), under "Obsessive-Compulsive and Related Disorders." That classification isn't something to be afraid of. It simply means it's a genuine, well-understood condition with established treatments, not a bad habit or a phase your child is choosing.

Some parents worry that words like "mental health condition" will frighten or stigmatise their child. What matters far more than the exact label is the message underneath it: this isn't your fault, lots of other people experience it, and it can be treated. Use whatever framing helps your child feel that.

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Important quick facts

1. Your child is not weird or unusual. Trichotillomania is fairly common — most estimates put it at around 1–2% of people, and among older teens and young adults the rate of at least occasional pulling is higher still. It's just not widely talked about, because most people who pull hide it well and stay silent out of shame. There's a good chance your child has never knowingly met another person who pulls.

2. There is effective treatment. The strongest evidence is for a behavioural therapy called Habit Reversal Training (HRT), usually delivered as part of Cognitive Behavioural Therapy (CBT). It teaches your child to notice the urge and the situations that trigger it, and to use a "competing response" — doing something else with their hands — in that moment. Many people see meaningful reductions in pulling, and earlier intervention is linked to better long-term outcomes.

3. The urge to pull is real and physically compelling. It's not attention-seeking or laziness. The urge often builds as a rising tension or an itchy, "needs releasing" sensation, with a feeling of relief once a hair is pulled. Some children pull automatically without noticing (often while reading or watching TV); others pull in a focused way to relieve that tension. Once an urge takes hold it can be very hard to think about anything else.

4. It usually needs support to overcome. Older children are unlikely to simply grow out of it on their own. That's not a reason to panic — it's a reason to get the right help, which for most families means finding a therapist trained in HRT.

5. Many doctors aren't familiar with trich, so you may need to advocate. Surveys show most people with trich feel their clinician didn't know much about the condition. Medication is not first-line: the evidence for drugs is limited and inconsistent, and no medication is currently considered a first-line treatment. A doctor may still be useful for ruling out other causes and, most importantly, for referring your child to a therapist experienced in HRT. (You may also come across the supplement NAC — evidence in children is mixed, so it's a conversation to have with a clinician, not a DIY step.)

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What to do when you first notice

6. Expect shame, and meet it with warmth. Your child is very likely feeling alone and embarrassed, and may not understand what's happening to them. The single most helpful thing you can offer is the steady sense that they are loved no matter what — nothing about this changes how you see them.

7. Don't be surprised if they deny it at first. Denial is usually about fear of judgement, not lying. Try not to react with anger or accusation. Pushing hard here tends to drive the behaviour further underground.

8. Name it gently and take the blame off them. Let them know there's a recognised condition that causes hair pulling, that it happens to lots of people, and that if they have it, it isn't their fault. You can frame getting help as matter-of-factly as you would a trip to the doctor for anything else.

9. Seek a therapist trained in HRT — that's the key step. Book a GP appointment and ask for a referral to a therapist experienced in Habit Reversal Training for hair pulling, or find one directly. It matters that it's someone with specific BFRB (body-focused repetitive behaviour) experience, not just any counsellor, because HRT is a specialised approach. For children and teens, good therapists actively involve parents — you'll be taught how to support the work at home, which improves outcomes.

10. Look for what might be underneath it. Pulling often ramps up around stress or change — starting a new school, friendship trouble, tension at home, pressure over grades. The trigger isn't always findable, but if you can spot one, you can address it. When you do, talk about the feelings and the situation rather than the pulling itself. Helping your child feel safe and heard around whatever is stressing them can take pressure off the urge.

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What not to do

11. Don't ignore it and hope it passes. Taking no action makes it more likely the pulling continues for years. You don't need to overreact — but do take a calm, deliberate next step toward getting help.

12. Don't tell your child to "just stop." The urge to pull works a bit like the build-up before a sneeze — a physical tension that demands release. Telling someone to stop doesn't remove the urge; it just adds guilt on top. The goal of treatment is to change how they respond to that urge, not to white-knuckle through it.

13. Don't draw attention to new pulling sites. Comments like "at least you're not pulling your eyelashes" can backfire by planting the idea and creating a new association in your child's mind. Pulling can then spread to areas they weren't touching before. Keep the focus off specific body parts.

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Things to remember

14. Keep the language kind and non-judgemental. Whatever words you use, your child should come away feeling that this is understood, treatable, and not a character flaw. Avoid anything that could make them feel "crazy" or at fault. Reassurance that it's common and beatable does a lot of quiet work.

15. Talk about feelings more than hair. Trich sits close to emotion regulation, so the most useful conversations are often the ones that aren't directly about pulling at all. The more your child feels secure, connected, and confident, the more room there is for the urges to settle. Praise the effort and the small wins along the way, not just the visible results.

16. Remind them they're not alone. Because so many people hide it, your child may genuinely believe they're the only one. They're not. Knowing the condition is common — and that you're in their corner — is often the first real relief they feel. Combined with early, HRT-based treatment and your steady support, the outlook is genuinely hopeful.

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If you'd like more structured guidance, the Parents' Guide — which has helped thousands of families — walks you through a practical, day-by-day approach to supporting your child through hair-pulling urges.

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Sources: DSM-5 (American Psychiatric Association); peer-reviewed reviews of trichotillomania prevalence and treatment; clinical guidance on Habit Reversal Training for body-focused repetitive behaviours.

This article is for general information and isn't a substitute for advice from a qualified health professional. If you're worried about your child, speak to your GP or a therapist experienced in treating trichotillomania.