Hair pulling

Parents usually describe finding it rather than being told. A patch at the crown that was not there last month. Eyebrows thinned on one side. Eyelashes gone. A child wearing a cap indoors, or keeping her dupatta up at home, with an answer ready for the question.

Adults describe the same thing from the inside and with more embarrassment: a hand that goes up without a decision being made, while reading, on the phone, in traffic. Many describe searching for a particular hair by feel and the relief of finding it. Others describe it as deliberate — a private half-hour in front of a mirror at the end of a difficult day.

Around either version people describe the same three things. The concealment: the parting moved, the eyebrow pencil, the seat with its back to the room. The promises, made sincerely and broken by the following evening. And the shame, which is heavier than the hair loss.

Some pick at skin or bite nails alongside it, and many describe years of it in silence.

Recognising yourself, or your child, in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess anyone, and there is nothing here for you to score against.

Twisting or pulling at hair now and then, at a desk or in an exam, is ordinary and is not what brings people to a clinic.

What a clinician pays attention to is frequency, visible loss, distress and cost. Pulling that has continued for months. Hair loss that is visible, or concealed. Distress that comes not from the pulling but from trying to stop. A life arranged around it — swimming avoided, a haircut put off, a photograph refused.

Two things worth saying plainly, and both are medical rather than psychological. Hair loss has physical causes too — scalp conditions, thyroid difficulty, iron deficiency, some medicines — and a doctor ruling those out is sensible. And more urgently: if hair is being swallowed, tell a doctor. Swallowed hair can collect in the stomach and cause a blockage that needs treatment, and that should not wait for an appointment with us.

Only a qualified clinician can tell you what is going on. What a page like this can tell you is that it is described far more often than people assume, and that nobody here will be shocked by it.

PHC is an assessment-first practice. Before therapy begins there is an initial session, and its job is to work out what is actually happening rather than to start treating it.

1. An initial sessionWe ask what has been going on, for how long, when it happens, and what it is costing. Nobody is asked to show anything. Nothing is administered before this conversation.
2. Emotional assessment and symptom screeningA structured screening of emotional functioning and what you are presenting with, using internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need. It also looks at what is sitting alongside: anxiety, low mood and self-esteem are commonly described with this.
3. A psychologist matched to what the assessment foundAssignment is based on speciality, the presenting needs and clinical fit, never on availability — and for a child, on age as much as anything else.
4. Therapy, reviewed as it goesFor older children, teenagers and adults the modality most often indicated is Cognitive Behavioural Therapy (CBT), alongside the behavioural approaches our clinicians are trained in. For younger children the same work is usually done through play therapy, with the parents closely involved. Sessions are 50 minutes, in clinic at our DHA clinic or in PECHS, or online.

We would rather be straight with you than fill this space with a name.

No clinician on our team names hair pulling, trichotillomania, skin picking or any related body-focused behaviour in the areas of practice they have given us. So there is no card on this page. Putting one here would mean promoting somebody into a speciality they have not claimed, and on something people have spent years not telling anybody, you deserve to know what you are walking into.

In practice: contact us, describe what is going on, and we will tell you whether PHC is the right service. If we are, you are matched at the initial session on what the screening finds. If we are not, we will say so and refer you elsewhere.

Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.

• OCD
• Anxiety
• Low self-esteem
• Emotional assessment
• CBT at PHC