Writer and broadcaster

I think my daughter is pulling her hair out. The Guardian

Dear Annalisa

My daughter is 13 and since the age of eight has had episodes of what I suspect is hair pulling. Lately this has become more evident and she now has patches of missing hair which are getting harder for her to hide. She has started to feel self-conscious and asks me if it is noticeable.

I have tried to talk to her about this but she becomes very defensive and upset and denies pulling the hair. She says it is alopecia. I don’t believe her but am at a loss as to my next move. I have done some online research into alopecia so I know that treatment is non-existent and am reluctant to take my daughter to my GP as I am certain that this is not the cause.

My daughter is intelligent and astute, and a high achiever at school, but with a tendency to what I think is slightly obsessive compulsive behaviour. I have suffered from anxiety most of my adult life and feel dreadful that she may have inherited this from me. I so want to help her and avoid what I think may be a lifetime of battling a hair-pulling compulsion but how can I if she will not accept that she does it? I don’t want to make things worse or make her feel bad by constantly checking and asking.


This must be a very upsetting situation for both of you, but it could be alopecia – imagine if it is and you don’t believe her? This will only add to her distress. I wonder what makes you so certain she’s pulling her own hair?

Please take her to your GP, where she can be assessed. She could then be referred to a dermatologist, who should be able to diagnose alopecia but if it’s not that, then ask your GP to refer your daughter for counselling.

I spoke to two people in relation to your letter, Dr Peter Congdon, a psychologist with experience of trichotillomania (hair pulling) and a volunteer from Alopecia UK who has had alopecia for two years.

To talk about trichotillomania first: the causes vary. It can be an impulse control disorder (a psychological condition where the person cannot stop doing it), or it can be a sign of a mental health issue – a form of self-harm.

Although no one is trying to diagnose your daughter by letter, Dr Congdon did go into more detail about self-harm which I think is worth repeating: “Self-harm can be a cry for help. When confronted with emotional difficulties, young children lack the complex thinking skills and life experience to enable them to work out alternative solutions. They are unable to verbally express their feelings and needs and are trapped in their own immaturity.

“This sometimes leads them to blame themselves for situations for which they are not responsible. In their confusion, they choose a way out of their predicament by diverting their attention to inflicting physical pain on themselves. The action of turning mental or emotional pain into physical hurt gives them a sense of control over their bodies at a time when they feel that they have no other kind of control over their lives.”

He recommends that if symptoms persist, your daughter should have a psychological assessment (either privately or via your GP).

Alopecia UK also recommends you take your daughter to your GP. They said that the “symptoms of alopecia can vary considerably. Some people suffer from bald patches that may occur but regrow. Patches may occur in the same place each time, or appear in other areas. A common theme we see is patches that start the size of a 10p coin and either gradually get bigger or maybe fill in again. But then some people can lose a lot quite suddenly from one large patch. Or people can experience general thinning all over.”

They went on to tell me that though there are some treatments available, how successful they are is another matter. “As the symptoms of alopecia and trichotillomania (hair pulling) are essentially the same – ie hair loss – it can be really difficult to diagnose but a dermatologist will see more cases of each than a GP.”

Please be careful not to let your own anxiety issues cloud what is happening and I think you need to listen to your daughter. If she’s telling you that it’s alopecia, yes, she may be lying to cover up her hair pulling but she may be telling the truth. Imagine how frustrating it must be to not be listened to.

Try to sit down calmly with her and listen reflectively. Don’t tell her how she must be feeling, or what’s happening. Ask how she is feeling and what is happening. Listen with your mouth closed. Let her know that no matter what, you love her and will be there for her and you can deal with this together.


First published in The Guardian Family on 10 January 2014.