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Q: Are today’s “experts” sometimes guilty of impulsive diagnosis-dispensing disorder (DDD)?

That question came to mind in the wake of a column I wrote about a four-year-old girl who was pulling her hair out, producing large bald spots on her pretty little head. Her parents had tried “everything” to get her to stop, even sending her to a psychologist, during which time the hair-pulling got worse.

I recommended that they calmly but authoritatively inform their daughter that she could pull all the hair she wanted, but in the downstairs bathroom only, to which they would take her if she forgot the rule and began pulling elsewhere. This sort of paradoxical approach was once known as “reverse psychology.” Predictably, once the little girl was no longer able to occupy the center of a family cyclone, the hairpulling stopped.

Shortly after the column appeared, a representative of the Trichotillomania Learning Center, Inc. (TLC), sent me a letter accusing me of dispensing harmful, misleading information, and said that sending the little girl to the bathroom to pull her hair amounted to “shaming.” She also chastised me for not even mentioning “the name of the disorder, trichotillomania.”

Now I recognize that there is such a thing as obsessive-compulsive disorder, one of which is trichotillomania. Appropriate treatment for these disorders is available, including those offered by TLC.

However, as I told my caller, genuine disorders do not disappear in response to calm, authoritative instruction. Since the child in question stopped her hair-pulling after being told she could pull in the bathroom all she wanted, she clearly didn’t have a disorder. She “had” nothing, in fact. However, she was surely developing a habit that could have developed into a genuine compulsion.

Another TLC associate told me that the little girl might have stopped only temporarily. Indeed, the symptoms of a truly diagnosable disorder may wax and wane, in which case professional intervention is certainly called for. However, this girl’s parents told me later that their daughter “is a much happier little girl these days, not to mention that our family is much calmer. She even laughs about it now.

“One day, she put her hand up to scratch her head and said, ‘Don’t worry, Mom, I’m not pulling my hair out, I’m just scratching bugs.’ ” (She has no infestations, by the way, so please, no letters from Lice-Busters, Inc.) What about TLC’s assertion that my recommendation amounted to shaming?

My question is, How can being told that you can pull all the hair you want, as long as you pull it in the bathroom, result in shame? Being permitted to do something within certain benign boundaries is not shameful. It is liberating. In this case, it liberated the little girl from the habit of hair-pulling.

Unfortunately, too many parents of hair-pulling children do try to shame and/or scare their kids into stopping by telling them how awful they look, spanking them, telling them their hair will never grow back, and so on. It is axiomatic that shaming a person who is engaging in compulsive behavior will only exacerbate the problem. But as this case illustrates, shame is not the only alternative to professional treatment.

As I told the TLC executive director, “Behavior alone does not a disorder make.” Nonetheless, one must wonder how many “disorders” have been manufactured out of nothing more.

Family psychologist John Rosemond is the director of the Center for Affirmative Parenting in Gastonia, North Carolina. For information about his talks and workshops, contact Elizabeth Stevens at 919-403-8712.

Living With Children

by John Rosemond
From the July 2007 Signs