I have a 9 year old client who has recently begun pulling out her eyelashes. Her parents and other family members have witnessed this but she is denying doing it. Does anyone have any experience in working with this behaviour specifically? I would assume it's a sign of anxiety.
Any help or direction to resources would be appreciated.
Leona in Calgary
First of all I don't have a great deal of experience with this disorder, but I also had a nine year old client who pulled out eyelashes. I read everything I could find on the subject known as tricholtillomania, which I found is a form of anxiety disorder and sometimes OCD, and is also a type of self-injurious behaviour. What we know about self-injurious behaviour is that it is a way the client has of coping with the emotional pain or anxiety they are experiencing. Our consulting Psychologist confirmed my findings and supported my strategies for working with the client.
This is what I did... I started out just
building the relationship with the client because the client initially
blocked anything that had to do with her presenting problem, so I felt,
as always, that I needed to develop that relationship and sense of trust
if we were to move forward. We did a great deal of get to know you
exercises, reading therapeutic stories, arts and crafts related to
feelings etc. When our relationship had reached the point where the
client was willing to explore her issues, I began to work on the
underlying causes of the anxiety (effects of witnessing family violence,
on-going issues with step-family, attachment issues with mom,
self-esteem issues). I also introduced an appropriate soothing behaviour
to substitute for the eyelash pulling. I gave my client 2 smooth shiny
stones (pinkish in colour because pink was my client's favourite colour)
and suggested that my client keep them by her bed (charting revealed
this is where she seemed to do the pulling most often) and keep them in
her hands, run them over her face and eyes whenever she felt the urge to
pull out her lashes. The rocks were very cool and smooth feeling on my
client's skin and seemed to be a soothing experience. This seemed to
work; however there were some set-backs when the rocks were misplaced
for a few days. The one thing I will stress is that scolding or
reprimanding the child for this behaviour, will only increase the
anxiety the child feels and will likely increase the behaviour.
Therefore, it is crucial that parents who are frustrated and worried by
this behaviour are aware of the detrimental effects of scolding. Parents
need to find other ways of addressing the behaviour such as charting it,
not to reprimand the child, but rather to determine the situations or
thoughts that trigger the behaviour, which will assist the CYW in
helping the client. It is also important to recognize that the parent/s
may need support for family issues too and that they get the help they
need. this in turn will enable them to be more supportive to their
I have been working in Ontario as a CYC for the past 17.5 years. In the last 5 years have specialized in working with adolescents who have eating disorders and their families. 5 years ago I came across my first case of this behavior with one of my anorexic clients. As you know, eating disordered kids often have many co-morbid disorders, and as I found out, this was one. It is called trichotillimania. It is quite possible that this young girl is unaware that she is doing it. Many sufferers describe going into "trance like" states or "zoning" out when they are doing it. Often they have no memory of doing it at all. There are many ideas about what causes it and how to treat it. There is some thinking that it is related to childhood chicken pox, as well as another school that is researching the disorder to levels of serotonin in the brain. It is often categorized as an anxiety disorder, or impulse-control disorder or as in the experience I have had with my client as a co-morbidity to her anorexia. Some people have been moderately treated with cycles of medications like prozac or paxil, but many have not found medication helpful. I have found relaxation exercises combined with cognitive behavioral approaches (modified for kids and teens) to be helpful. I would also be wondering about past trauma for this girl as well as querying what is going on in the family. There are some websites that have articles and links to support groups and other resources. Just search under trichotillimania. Because of my specialization in the past 5 years, I am curious about this little girls relationship with food and sense of body image/esteem. What is the family's attitude to food, appearance and body image? These are just a few of the thoughts I have. If I think of anything else, I will forward it.
Lynn in Ontario
I was the prime worker for a youth about 14 or 15 years old who pulled out her eyebrows and eyelashes when under stress. When she came to the group home that I was working at she had pulled out pretty much all her eyelashes. The behaviour seemed to stop for about six months, then began again for a short while. If I remember correctly, it was something we noted and discussed, but the underlying anxiety was more important than the behaviour itself.
I'm not sure what the actual reason behind this behaviour is, but I did the same thing around the ages of 7 or 8. Your theory of anxiety fits for me and my situation at that time. It was a passing phase (3-4 months), but I am not sure whether I stopped because the anxiety went down or if it was out of embarrassment from other children noticing the gaps in my eyelashes. Hope this at least helps you, and this child, know that they aren't the only ones to do this.
Thanks to everyone for their input into
this behaviour! Nice to have this wealth of information and experience
at our fingertips!