There doesn’t need to be an acute stressor to trigger the onset of hair pulling. On the other hand, sometimes the stressor is simply hard to identify, or it’s lots of little things that add up over time. If you watch closely, you may be able to identify a pattern in her hair pulling. For example, it might seem to happen more when she is less active, providing the opportunity for thoughts and feelings to come rushing in. Or it might happen after a particular kind of interaction that gives rise to upset feelings. It will be important for you to try and understand what these thoughts and feelings are and talk with your daughter about them. Putting words to her feelings not only gives her a vocabulary to express her inner world to you, it also lets your daughter know you understand and helps her feel less alone. The more she can feel soothed with you, the less she will feel the need to pull her hair.

What I am suggesting is not an easy task; if you haven’t seen an improvement after a month or so, you may need to seek out the help of a qualified therapist.