My teenager has trich and tourettes. She has outgrown her tics 90 % but since puberty, pulling has escalated. She pulls her eyebrows and lashes. Everytime she has progress she falls hard and does so much damage in 10 minutes that take 5 months to grow back. Her triggers are viruses and stress. We have been working on behavior modification, trigger distractions, nutritional supplements. I noticed her triggers are worse during December and January when vitamin d levels are low, magnesium is low and also after corn consumption is high.  

I feel helpless and get terribly depressed when she comes down the stairs and see hair missing. I just want to cry or hide. If I mention it, she gets upset but if I dont mention it, she wont even try to work on impulse therapy suggestions.  She walks around in denial and acts like people dont notice but everyone asks me things like does she have cancer, is she in chemo, what is wrong with her eyes, is she depressed, Is she sick. If I tell her that would feel worse but she genuinely thinks nobody notices.  I just feel hopeless and ashamed that I am failing her as a mother, I'm not finding a therapist who works. She is beautiful and smart but I think kids avoid being her friend because they find it scary. Having sparse eyebrows and no upper lashes distorts her face.  As a mom, it's heartbreaking seeing her look different and knowing she is doing this herself.  I cant sleep and avoid group outings bbecause answering questions is difficult.  The doctors tell me never to punish or reprimand but sometimes I wonder if I that is best. Wouldn't taking away cell phone give motivation to  harder and work on therapists ssf suggestions. I can only imagine how terrible this is for her but I it's not easy for loved ones either. Feeling hopeless.