A student twists a strand of hair during a spelling test. Another child has a small bare patch near the crown that wasn’t there last term, or eyelashes that seem to be thinning. For teachers and school staff, noticing trichotillomania at school can bring up a mix of concern and uncertainty. Should you say something? Will it embarrass the student? What can you actually do during a busy school day?
This guide is written for teachers, aides and school counselors who want practical, respectful ways to support a student who pulls their hair, eyebrows or eyelashes. School staff are not there to diagnose or treat. Your role is something different and just as important: creating a classroom where the student feels safe, supported and free from shame, and working as a team with the school counselor and the family.
What Trichotillomania at School Can Look Like
Trichotillomania is a body-focused repetitive behavior (BFRB) that involves recurrent pulling of hair from the scalp, eyebrows, eyelashes or other areas. At school, it often shows up quietly. Many students pull without fully realizing it, especially when they are concentrating, bored, tired or feeling stressed.
Things classroom staff might notice include:
- Twisting, touching or pulling at hair, eyebrows or eyelashes during seatwork, reading or tests
- Small patches of thinner hair, gaps in eyebrows or missing eyelashes
- Hair collecting on the desk, floor or in the student’s lap
- Hats, hoods, headbands, bangs or makeup used to cover affected areas
- Reluctance to take part in activities like swimming, PE or class photos
- Hands frequently moving to the head or face during quiet, still moments
None of these signs alone confirms anything. What matters is that you notice with curiosity and care, and share your observations with the school counselor rather than with the class.
How to Respond in the Moment
When you see a student pulling, your first instinct may be to stop it. Pointing it out in front of others, however, can increase embarrassment and stress, which may make the urge stronger. A calm, low-key response protects the student’s dignity and keeps learning going.
What helps
- Stay neutral. Your tone and facial expression matter as much as your words.
- Use a quiet, private cue the student has agreed to, such as a light tap on the desk or a gentle hand signal.
- Redirect the hands rather than the behavior. Offering a task that uses the hands (“Could you hand out these papers for me?”) is often easier than “Stop pulling.”
- Check in privately later, at a moment when no peers are nearby.
A private check-in can be short and kind. For example: “I’ve noticed things seem a bit stressful lately. I’m here if you ever want to talk, and our school counselor is a great person to talk to as well.” Then leave it there. The goal is to open a door, not to push the student through it.
What not to say
Well-meaning comments can easily land as criticism. Try to avoid:
- “Stop pulling your hair” or “Hands down,” said in front of the class
- “Why do you keep doing that?” (most students can’t explain it, and the question can feel like blame)
- “You’ll go bald if you keep that up” or any comment about appearance
- “Just try harder to stop,” which suggests the behavior is simply a choice
- Taking away recess or using consequences for pulling
Hair pulling is not misbehavior. Treating it as a discipline issue tends to add shame, and shame rarely helps a student feel more in control.
Discreet Classroom Supports
Small, thoughtful adjustments can make the school day easier without drawing attention. Ideally, these are planned with the school counselor, the family and the student, so the student has a say in what feels comfortable.
Fidgets and competing-response items
Keeping the hands busy is one of the simplest supports. Items that give the fingers something to do, especially something with texture, can offer an alternative when the urge to pull comes up. Options might include a textured strip stuck under the desk, a soft stress ball, putty, a smooth stone or a fidget ring. Offer a few choices and let the student pick, and consider making fidgets available to the whole class so no one stands out.
Seating and movement breaks
- Seat the student where they feel comfortable, perhaps away from high-traffic areas, without making the move feel like a consequence.
- Build short movement breaks or classroom jobs into long periods of sitting.
- Agree on a discreet break pass the student can use to step out briefly, such as getting a drink of water or visiting the counselor.
Hats, head coverings and accessibility
Some students feel much more comfortable when they can cover affected areas. If your school has rules about hats, hoods or bandanas, talk with the school counselor or administration about whether an exception or accommodation is appropriate under your school or district policy. Where a student has a formal support plan, such as a 504 plan, these details may be included there. Handle any exception quietly so the student isn’t singled out or questioned by peers.
Protecting Privacy and Preventing Teasing
A student’s hair pulling is personal health information. Share it only with staff who need to know, and follow your school’s guidelines on confidentiality. Avoid discussing the student in the staff room or within earshot of other students.
Teasing about appearance can be especially painful for students who pull. Classroom staff can help by:
- Building a classroom culture where comments about bodies and appearance are clearly off-limits
- Responding promptly and calmly to unkind remarks, and following up privately with the students involved
- Teaching general lessons on kindness, differences and “everyone has something they’re working on,” without ever naming or pointing to an individual student
- Keeping an extra eye on less structured times like recess, lunch and PE locker rooms
If peers ask direct questions, a simple, neutral answer works well: “Everyone’s body is different, and it’s kind to keep comments about other people’s bodies to ourselves.” If the student wants to explain their hair pulling to classmates, that should be their choice, planned with the counselor and family.
Working Together: Teachers, Counselors and Families
Students do best when the adults around them share a consistent, calm approach. Each person brings something different to the team.
The teacher or aide
Classroom staff see the student across the whole day, which makes their observations valuable. Notice when pulling seems more likely: during tests, silent reading, after recess, or late in the day. Share those patterns factually with the school counselor, without labels or guesses about causes.
The school counselor
The school counselor can meet with the student, explore what feels supportive, and help coordinate a simple plan with classroom staff. Counselors can also support coping and emotional regulation skills, connect with the family, and help decide whether outside support may be helpful.
The family
Families often know a great deal about what helps at home and may already be working with a health professional. When reaching out, lead with care rather than concern about appearance. For example: “We’ve noticed your child seems to twist and pull at their hair when things feel stressful in class. We’d love to work with you on ways to help them feel comfortable at school.” Ask what they’ve found helpful at home.
When to Refer to Outside Clinical Support
School-based supports are helpful, but they are not treatment. The school counselor and family may consider a referral to an outside professional, such as a psychologist or therapist with experience in body-focused repetitive behaviors, when:
- Pulling seems to be increasing or is causing noticeable hair loss
- The student appears distressed, withdrawn or anxious about it
- It is affecting learning, friendships or participation in school activities
- There are signs of other emotional concerns that need further attention
Clinicians who specialize in this area often use behavioral approaches such as habit reversal training or the Comprehensive Behavioral (ComB) model. In general terms, these approaches help a person become more aware of when and why pulling happens and develop alternative responses and supports. School staff don’t need to deliver these approaches, but knowing that specialized help exists can make conversations with families more hopeful.
If a student ever shares thoughts of self-harm or seems unsafe, follow your school or district’s safety protocol right away and involve the school counselor or administrator.
Supporting the Student’s Self-Esteem
Students who pull often feel embarrassed and may be hard on themselves. The way adults respond can quietly shape how a student sees themselves. Helpful approaches include:
- Focusing on the whole student: their strengths, interests, effort and kindness
- Giving genuine, specific praise that has nothing to do with appearance or hair pulling
- Offering leadership roles and classroom jobs that build confidence and connection
- Noticing when the student uses a coping tool, without making it a big deal (“I saw you grab the putty. Nice job looking after yourself.”)
- Remembering that progress is rarely a straight line, and responding to setbacks with the same patience
Picture a student who knows their teacher will never call them out, has a fidget waiting in their pencil case, and has a quiet way to step out when things feel overwhelming. That sense of safety is something every classroom can offer.
Frequently Asked Questions
Should I tell a student to stop pulling their hair?
It’s usually more helpful to avoid direct instructions like “stop pulling,” especially in front of others. A private, pre-agreed cue or a gentle redirection to a hands-busy task tends to feel less embarrassing and keeps the focus on support rather than correction.
Can teachers allow a student to wear a hat in class?
That depends on your school or district policy. Talk with the school counselor or administration about whether an accommodation is appropriate. If it is approved, handle it discreetly so the student doesn’t have to explain it to peers.
Should I contact the family if I notice hair pulling?
Share what you’ve noticed with the school counselor first. The counselor can decide the best way to connect with the family, often alongside the teacher, so the conversation is coordinated, caring and focused on how the school can help.
Are fidgets distracting for the rest of the class?
Quiet, small fidgets such as textured strips, putty or a stress ball are generally easy to use without disrupting others. Setting clear class expectations for fidget use, and making them available to everyone, helps the student who needs one blend in.
Is trichotillomania something school staff can treat?
No. School staff provide support, not diagnosis or treatment. Teachers, aides and school counselors can create a safe, shame-free environment and work with families, while outside clinicians with specialized training can offer assessment and treatment when needed.
Looking for practical, ready-to-use resources to support your work with students with body-focused repetitive behaviors? The All Therapy Resources Membership provides access to a growing collection of thoughtfully developed counseling activities, interactive games, and therapeutic tools designed to save preparation time while supporting meaningful, skill-focused learning.
