Repeated hair pulling (trichotillomania) and repeated skin picking (skin picking disorder, also called excoriation disorder) are recognised mental health conditions, not simply bad habits. Hair pulling usually begins between the ages of 10 and 13 [1]. Many children feel ashamed and try to hide it. For hair pulling, the treatment with the strongest evidence is a form of behavioural therapy called habit reversal training [3], and the same approach is used for skin picking [2].
When to see a doctor promptly: if your child swallows or eats the hair they pull, arrange a medical review, because swallowed hair can form a hairball in the stomach that may cause serious illness [1]. See a doctor if skin wounds are not healing or look infected [2]. Hair pulling and skin picking are different from self-harm, but if you are unsure, or your child talks about wanting to hurt themselves, seek help urgently. In the UAE call 998 for an ambulance or 999 for the police [6].
What these conditions look like
Hair pulling (trichotillomania)
Children with trichotillomania feel a strong urge to pull out hair, most often from the scalp, eyebrows or eyelashes. Many describe a build-up of tension before pulling and a sense of relief afterwards. For others, pulling happens almost automatically, for example while reading, watching a screen or lying in bed, and they may not notice they are doing it [1].
Signs parents may notice include [1]:
- bald patches or thinning, sometimes in unusual shapes
- missing eyelashes or eyebrows
- hair found on the bed, floor or desk
- hats, scarves or hairstyles used to cover patches
- a child who seems embarrassed or upset when hair is mentioned
Skin picking
Skin picking disorder involves repeatedly picking at skin, often on the face, hands, arms or around the nails, to the point of causing wounds, scars or marks. Some children pick at spots or rough patches, while others pick at healthy skin. Triggers can include boredom and stress, and skin problems such as acne or eczema can make picking more likely [2].
How these conditions relate to others
Skin picking and hair pulling are related to obsessive-compulsive disorder (OCD) and to body dysmorphic disorder [2]. A child who pulls or picks may also have anxiety, low mood or other repetitive behaviours. Our articles on OCD in children and teenagers and body image and body dysmorphia in teenagers explain these conditions. An assessment can help to work out whether more than one condition is involved, which may change the treatment plan.
Why telling a child to “just stop” rarely works
Most children and teenagers with these conditions want to stop and have tried hard to do so. The urge is strong, and much of the behaviour happens without full awareness. Repeated reminders, punishments or comments about appearance tend to increase shame, which is already common [1], and can push the behaviour into hiding.
A calm, non-blaming approach makes it easier for a child to talk about what is happening and to accept help. It can help to describe it as something the child and the family will tackle together, rather than something the child is doing wrong.
Talking to your child about it
Many children feel relieved when a parent raises the subject gently, because it means they no longer have to hide it. Choose a quiet, private moment rather than mentioning it in front of siblings or friends. You might say something like: “I’ve noticed some of your hair is thinner. Lots of young people pull their hair when they’re stressed or bored, and it’s not your fault. Would it help to work on it together?”
Let your child describe what happens in their own words. Ask when it tends to happen and how they feel before and after. Avoid labelling it as disgusting or naughty, and avoid promising that it will stop quickly. Teenagers in particular may want more privacy and control, so agree together who else needs to know, such as a doctor or a trusted teacher.
Practical steps at home
The NHS suggests several self-help measures that can reduce pulling or picking, particularly while waiting for professional help [1][2]:
- Keep hands busy. A stress ball, fidget toy or something to squeeze during high-risk times such as homework or screen time.
- Add a barrier. Wearing a hat, covering areas with plasters, or keeping hair short can make pulling or picking harder.
- Notice the triggers. Keep a simple note of when and where the urge comes, and what your child is feeling at the time.
- Look after the skin. Ask your child’s doctor about treating any underlying skin condition, such as acne or eczema, that may be prompting picking.
These steps help many children, but on their own they are often not enough. If the behaviour continues, is causing visible damage or distress, or is affecting school and friendships, it is worth seeking an assessment.
Habit reversal training and other treatment
Habit reversal training
Habit reversal training is a structured behavioural therapy. It usually includes [1]:
- awareness training: recording when pulling or picking happens, often with a diary, so the child learns to notice the early signs
- identifying triggers: understanding the places, activities and feelings linked to the behaviour
- a competing response: practising an action that makes pulling or picking difficult, such as clenching the fists or holding an object, until the urge passes
- support: a parent or other trusted person encourages the child and praises progress
For skin picking, cognitive behavioural therapy that includes habit reversal is the main recommended treatment [2].
What the research shows
A 2020 meta-analysis of 24 randomised trials of treatment for trichotillomania, involving 857 participants, found that behavioural therapy with habit reversal training had the largest effect and the strongest evidence of all the treatments studied [3]. Most of these trials involved adults.
Evidence specifically in children is more limited. In one small randomised trial of 24 young people aged 7 to 17, eight weekly sessions of behavioural therapy led to 75 per cent of participants responding to treatment, compared with none in the comparison group, and the gains were maintained at a week-16 follow-up [4]. The study was small, so larger trials are still needed, but the findings are consistent with adult research.
Medication
Medication is not the first-line treatment. Antidepressants are not usually prescribed for trichotillomania [1]. A Cochrane review found insufficient evidence to confirm or rule out any medication as effective for trichotillomania, and the one trial in children and adolescents, which tested N-acetylcysteine in 39 participants, found little or no difference compared with placebo [5]. Some medicines have shown benefit in single, mostly adult, studies that still need to be repeated [3]. For skin picking, medicines are more often considered by a psychiatrist [2]. Any decision about medication for a child should be made with a child psychiatrist after a full assessment.
Supporting your child during treatment
Progress is often gradual, with good weeks and setbacks, especially at stressful times such as exams. It helps to praise effort, such as using a competing response or filling in a diary, rather than focusing only on how much hair or skin has recovered. If your child agrees, the school can help by allowing a fidget object in class or a hat where uniform rules permit. Keep the plan simple and agreed with your child, so that it feels like their plan rather than a list of rules imposed on them.
When to seek professional help
Consider booking an assessment if:
- hair loss or skin damage is noticeable, or keeps getting worse
- your child is distressed, ashamed, or avoiding school, sport or social events because of it
- home strategies have not helped after a few weeks
- there are signs of anxiety, low mood, OCD or worries about appearance alongside the behaviour
- your child eats pulled hair, or skin wounds are not healing, in which case see a doctor promptly
How BMMC can help
Beautiful Mind Medical Center’s children’s services provide assessment by child and adolescent mental health clinicians, cognitive behavioural therapy, behavioural therapy and parent support. An assessment can clarify what is driving the behaviour and whether anxiety, OCD or another condition is also present. If you would like to know whether a specific approach, such as habit reversal training, is available for your child, please ask the team when you book. Assessments can be carried out in Arabic or English.
To arrange an appointment, call +971 2 621 2230, email info@bmmc.ae, or use the booking form.
Author: BMMC Editorial Team
Medical reviewer assigned: Dr. Abdulnaser Arida, Consultant Psychiatrist and Director
Medical review status: Pending
Draft date: 14 November 2026
Last updated: Pending publication
Beautiful Mind Medical Center, Sultan Bin Zayed The First St, Al Muntazah – Zone 1, Abu Dhabi. MOHAP Licence XYRKN7C2-230725.
This article is for general educational purposes and is not a substitute for an individual assessment, diagnosis, or treatment plan from a qualified healthcare professional. If you are concerned about a child’s or adolescent’s safety, seek urgent professional help.
References
- NHS. Trichotillomania (hair pulling disorder). Page last reviewed 5 February 2024. nhs.uk
- NHS. Skin picking disorder. Page last reviewed 23 April 2024. nhs.uk
- Farhat LC, et al. Pharmacological and behavioral treatment for trichotillomania: an updated systematic review with meta-analysis. Depression and Anxiety. 2020;37(8):715–727. doi:10.1002/da.23028. PubMed
- Franklin ME, et al. Behavior therapy for pediatric trichotillomania: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2011;50(8):763–771. doi:10.1016/j.jaac.2011.05.009. PubMed Central
- Hoffman J, et al. Pharmacotherapy for trichotillomania. Cochrane Database of Systematic Reviews. 2021; CD007662.pub3. doi:10.1002/14651858.CD007662.pub3. University of Southampton repository
- The UAE Government portal. Handling emergencies. u.ae
