Trichotillomania in Children: More than hair loss

Hair Loss In TTM


Trichotillomania (TTM) is an impulse control disorder that is associated with the pulling of one’s own hair. Usually the scalp hair is pulled but eyebrows, eyelashes and body hair can also be pulled or even represent the only area of pulling.

In children, other comorbidities need to be assessed. Nail biting, eating of one’s hair (trichophagia) and a variety of psychiatric and emotional issues may be present. These include anxiety, depression and obsessive compulsive disorders. Attention deficit hyperactivity disorder (ADHD) may also be present.

A recent study examined the clinical findings in 38 children with trichotillomania. 21 were girls and 17 boys. The activities during which the participants state that they mostly pull out hairs were the following: while doing homework and learning, working on PC, in the toilet, and watching TV. Nail biting was seen in more than a half of children. In nearly 60 % of children, one or more comorbid disorder was identified, of which ADHD (16 %) and tics (13%) were most common. Eating of hair (trichophagia) was found in 5 % of children. More than two thirds of children isolate themselves during hair pulling and half of them try to hide consequences.


The proper evaluation of TTM requires a detailed evaluation of a variety of co-occurring factors. Focus only on the hair without attention to other issues does little to help many children with TTM.


Klobučar A, et al. Clinical Characteristics and Comorbidity of Pediatric Trichotillomania: the Study of 38 Cases in Croatia. Psychiatr Danub. 2018.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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