Trichotillomania Among Children During Pandemic Times.

Trichotillomania and Other Mental Health Issues Increased During Pandemic Times.

Trichotillomania is a hair pulling disorder whereby children pull their own hair. Underlying depression and anxiety is common among children with TTM as is obsessive compulsive disorder.

It is well accepted that the COVID pandemic has impacted a wide variety of mental health issues in adults and children. For those with current trichotillomania, the pandemic has had a negative impact.

Several studies to date have reminded us of the impact of pandemic on those with trichotillomania.

In July 2020 Pathoulos et al surveyed a total of 460 individuals with a self-reported Body-focused repetitive behaviors (BFRB) including those with repetitive hair pulling (trichotillomania), nail biting, and skin picking (excoriation disorder). 67.2 % of surveyed patients felt their BRFR’s worsened during the pandemic. 37% of those who were in active treatment had to interrupt treatment in the early days of the pandemic. 40 % of those who were not treatment wanted to enter into treatment.

In 2021, Oner from Turkey reported 3 adolescent females with trichotillomania. They were aged 12, 13 and 14. It was felt that the social isolation from inability to attend face to face learning negatively impacted their mental health.

Wang & Zhang 2022

A new study by Wang and Zhang reports a 13 year old male with trichotillomania. The authors proposed that his long-time separation from his parents coupled with his lack of outdoor activity during the COVID-19 pandemic were likely contributing factors. could be the cause. After 4 weeks of behavior modifcation therapy in the Psychology Clinic, the patient’s alopecia achieved full remission.

Trichotillomania in a 13 year old male during the COVID pandemic. Behavioural therapy lead to complete resolution. SOURCE: Wang et al. Trichotillomania occurs during the COVID-19 pandemic in an adolescent. World J Pediatr. 2022 Feb 28;1-2. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic

COMMENT

The COVID pandemic has proven very challenging to children. A recent study in JAMA Pediatrics by Saunders and colleagues showed a very significant increase in pediatric mental health services during the pandemic. Their study was a population-based cross-sectional study and examined changes in utilization of physician-provided mental health services for 2.5 million children and adolescents aged 3 to 17 years in Ontario, Canada. From March 2020 through February 2021, the researchers found a rapid and sustained 10% increase in outpatient mental health service utilization by children and adolescents compared with prior rates. The largest increases in service utilization were noted for mood and anxiety disorders (74.7%), psychosis (73.2%), substance use (83.6%), social problems (64.6%), and neurodevelopmental disorders (69.8%).

These findings are consistent with other studies. In fact, a 2021 meta-analysis by Racine and colleagues found a 2-fold increase in the global prevalence of depression and anxiety for children and adolescents, with higher rates for adolescents and girls.

MAIN REFERENCE

Wang et al. Trichotillomania occurs during the COVID-19 pandemic in an adolescent. World J Pediatr. 2022 Feb 28;1-2.

ADDITIONAL REFERENCES

Pathoulas et al. Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic. J Am Acad Dermatol. 2021 Mar;84(3):771-773.

Saunders NR et al. Utilization of Physician Based Mental Health Care Services Among Children and Adolescents Before and During the COVID-19 Pandemic in Ontario, Canada. JAMA Pediatr . 2022 Apr 1;176(4):e216298.

Racine  N, McArthur  BA, Cooke  JE, Eirich  R, Zhu  J, Madigan  S.  Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis.   JAMA Pediatr. 2021;175(11):1142-1150.

Öner Ü. Children with trichotillomania in COVID-19 outbreak. J Cosmet Dermatol. 2021;20(7):1967–8.