R…. (now 7) has had sm since recognized in kindergarten two years ago. Her first grade year she received counseling, but this year we do not have insurance and we cannot go. The teachers are very understanding and we do not focus this as a problematic pattern, however I feel there is something else underlying here…she is now pulling out her eyelashes and eyebrows (there is NOTHING left). she claims she “can’t help it”. Are you familiar with this situation…Self mutilation does not seem SM to me, Do you think it is an imbalance of some sort. Help please.


What you are describing is called Trichotillomania. Like SM this is a form of anxiety. Hair loss is caused by compulsive pulling and twisting of the hair until it breaks. The hair may be lost in round patches or diffusely across the scalp. The effect is a moth-eaten appearance. Children with this disorder often pull out their eyelashes, eyebrows and other facial hair. This is another manifestation of anxiety. Just as children with SM do not speak in select social settings, children with trichotillomania pull out their hair. This disorder is actually a manifestation of OCD, and is treated very similarly. I recommend finding a physician or therapist that specializes in anxiety to help you determine the etiology for your child’s severe anxiety, and to help develop a treatment plan for your child.

Dr. Elisa Shipon-Blum