Dear Eddie; I have a daughter who has trichotillomania, very low self-esteem and anxiety. She has been like this for three years.
She was assessed by CAMHS (Child and Adolescent Mental Health Services) this year, they found no diagnosis, and she is no longer attending.
She was given techniques to use to help with her anxiety, but doesn’t find them useful.
I bring her for sacral cranial therapy, but I don’t think she gets much from it.
She has managed to make a few friends, but she still finds it hard to mix socially outside of school.
She likes very little about herself, and the loss of her hair is now a huge source of anxiety.
She fears that it may never come back and ironically the anxiety caused from the lack of hair, only brings on urges to continue to pull.
Her school work is suffering badly now, interest in school and other activities is poor, she is finding ways to avoid school.
She has always been strong academically, a high achiever, so this present attitude is completely out of character.
Home life is suffering also. Life is very stressful. I feel that if she could get her hair back then her confidence would improve, and she might be less stressed.
Dr Eddie, I’m running out of solutions, and I don’t know where to turn next.
All I do know is that I’m watching a bright, healthy girl ruining her own life.
Thanks, Mary, Cork
Dr Eddie says: Dear Mary, I can feel your stress. There is a lot going on for your daughter, which seems to stem from her fears.
Too often when children don’t hit certain clinical thresholds, they are deemed unsuitable for CAMHS.
In my view that threshold is too high. We need a one stop shop where children and families are supported when they hit times of struggle.
Firstly, research trials have found insufficient evidence to support ANY specific therapeutic effect of craniosacral therapy.
What is Trichotillomania?
Trichotillomania, otherwise known as ‘Trich’ is often not discussed due to embarrassment. People who have Trich pull out hair from their scalp, eyelashes, eyebrows or other areas. It can result in noticeable bald patches or no eyelashes.
This differs from Alopecia where people lose their hair involuntarily.
Future research may bring more understanding about what causes the Trich disorder.
It affects one to two people in every 100.
It does appear to affect more women than men but some men may just be more embarrassed to seek help. It often develops in early adolescence.
What Can Be Done?
With appropriate treatment Trichotillomania is manageable. Many people with Trich lead active and fulfilling lives.
Cognitive Behavioural Therapy (CBT) with a particular focus on the behaviour part is important. Given the present of anxiety and self-esteem issues, cognitive strategies are important as well.
It is important for the person with Trich to check out a CBT therapist’s knowledge of this presentation.
Not all people who say that they use CBT are properly trained or fully understand Trich and the appropriate treatments.
I myself do not do this treatment.
Psychologists or behavioural therapists use habit reversal training and stimulus control techniques as the evidenced based approach.
There are good resources on www.ocdireland.org with some interesting upcoming public lectures around Trichotillomania.
Dr Eddie Murphy runs a psychological and counselling service in Portarlington, Co Laois. If you are organising a speaker or training for school, community, voluntary, sporting or work groups, call Dr Eddie on 087 1302899 or go to www.facebook.com/ dr.eddie.murphy.psychologist