This is a very strong and complex habit. Even though it may not always seem so, your child truly wants to be able to stop. However, most children get easily frustrated when previous attempts to stop pulling have not been successful. In addition, it takes its toll on parents as well. In most cases, if children could have easily stopped pulling their hair, they would have already done so.

Hair pulling is not always a clinical problem. Tactile exploration is a normal part of development. If your child is hair pulling for a brief period of time (less than 3 months), or if your child is a preschooler and has not caused a great amount of damage, or if this is a new behavior, waiting may be the best approach in order to determine if a problem does indeed exist.

Generally speaking, trichotillomania waxes and wanes over long periods of time. There are several signs to look for in order to determine if your child’s hair pulling is a clinical problem. Ask yourself the following questions:

• Has you child’s hair pulling been consistent for more than three months?
• Is your child experiencing negative peer attention and/or is she bothered by the hair pulling?
• Has your child done considerable damage that is difficult to camouflage?
• Has hair pulling been incorporated into increasing numbers of activities?
• Has your child expressed a desire to stop hair pulling and been unable to?

If you answered "yes" to one or more of these questions it is time to seek out help from a knowledgeable, professional source.

As of yet, no single medication has been discovered that can reliably eliminate or even reduce hair pulling on a permanent basis.

This does not mean that drugs are useless for helping, however. While the search goes on for medications or combinations of medications that provide targeted relief of trichotillomania, a number of different varieties of drugs have been reported to be helpful for some people who pull their hair. Typically, these medications help when they improve other conditions that may impact on hair pulling. Thus, medication can help when it reduces other problems (depression, anxiety, hyperactivity, etc.) that make hair pulling more severe.

As with any medication used to affect mood or behavior, it is extremely important to see a psychiatrist who is experienced in prescribing these medications and can anticipate and manage some of the potential side effects.

For the majority of children who pull their hair, medication use is not necessary. Many children respond extremely well to a comprehensive, well monitored behavioral program, such as we are describing in this book.

Ask your child what she would like people to know. This information may range from the truth to a fabrication of the truth in order to maintain some personal privacy. If your child is comfortable letting people know about the hair pulling, a short and simple explanation is best. "My child has developed the habit of pulling out her hair and we’re getting help for it," is usually sufficient. If your child would like to maintain some privacy around this information, agreeing upon a plausible "explanation" would be most useful. Common explanations for hair loss include: allergy problems, skin conditions, or dermatological problems, etc.

If you feel that you need support as a parent who is struggling with a difficult parenting challenge, choose one or two close friends to confide in. Speaking with other adults and giving out additional information should be done only after discussing it with your child.

NO! Just as you cannot take credit for your child’s ability in ballet or inability in say, soccer, you cannot take responsibility for you child’s difficulty with hair pulling.

Some children have a genetic predisposition to hair pulling and through some unique set of circumstances end up pulling out their hair. Other children who should have a genetic predisposition to hair pulling never pull their hair. Other children have no genetic history at all and pull out their hair anyway. Most children that we have treated do not have parents who have had trichotillomania.

So, let yourselves off the hook! There was nothing that you could have or should have done differently to have avoided your child’s difficulty with hair pulling. The most important thing that you can do not is to learn how you can best help your child.