Affective regulation in trichotillomania: Evidence from a large-scale internet survey

https://doi.org/10.1016/j.brat.2009.04.004Get rights and content

Abstract

Trichotillomania (TTM), a repetitive hair-pulling disorder, is underrepresented in the clinical literature. The current project explores the relationship between affective regulation and disordered hair-pulling. Previous research suggests that cycles of emotional states are correlated with the disorder and may induce, reinforce, or otherwise contribute to hair-pulling behavior. We use anonymous internet survey responses from 1162 self-identified hair-pullers to address four questions about affective regulation in people with TTM: (1) Do hair-pullers experience greater difficulty “snapping out” of affective states than non-pullers? (2) Does difficulty with emotional control correlate with TTM severity? (3) Are subtypes identifiable based on the emotions that trigger hair-pulling behavior? (4) Does difficulty “snapping out” of an emotion predict whether that emotion triggers pulling behavior? The results showed a small-to-moderate relationship between affective regulation and problematic hair-pulling. In addition, individual patterns of emotion regulation were systematically related to emotional cues for hair-pulling as well as overall hair-pulling severity. These findings contribute to an understanding of the phenomenology of TTM and provide empirical support for treatments focused on affect regulation.

Section snippets

The Comprehensive Survey on Trichotillomania

As part of a larger study exploring hair-pulling, we conducted a large-scale survey. We designed the Comprehensive Survey on Trichotillomania and administered it using a web-based survey platform to self-reported hair-pullers. Many hair-pullers do not seek treatment, even those with a severe problem, because of the enormous shame associated with the condition. We investigated a non-referred population to benefit from a larger sample and to gain a better understanding of the putatively large

Completion rates

A total of 1671 people entered the survey website and chose one of the two versions of the survey. Duplicate responses, responses from people under 18 years old, and surveys with no complete sections were removed; otherwise, responses with missing items were accepted. 1468 started and 1162 people finished the Trichotillomania version of the survey, a completion rate of 78.5%. 203 people started and 175 people finished the No Trichotillomania version of the survey, a completion rate of 88.2%.1

Discussion

The current study tests the hypothesis that compulsive hair-pulling satisfies an affective regulation function for the people who engage in it. The data analyzed here suggest that pullers experience more difficulty with controlling their emotions than Non-Pullers. For pullers, the degree of self-reported emotional control is correlated with the severity of the disorder. Furthermore, reported difficulty with the regulation of particular emotions is predictive of the degree to which those

Acknowledgement

We owe thanks to: the Trichotillomania Learning Center, Harvard University Psychology Department, and Wesleyan Quantitative Analysis Center for funding; Emmanuel Kaparakis and Jennifer Rose for assistance with statistical procedures; and to Lacey Beckmann, Matthew Nock, Cary Savage, Caroline Sunshine, and Rebecca Rosenberg for discussion.

References (31)

  • M.A. Stanley et al.

    Nonclinical hair-pulling: affective correlates and comparison with clinical samples

    Behaviour Research and Therapy

    (1995)
  • D.W. Woods et al.

    A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania

    Behaviour Research and Therapy

    (2006)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • G.A. Christenson et al.

    Trichotillomania

  • G.A. Christensen et al.

    Trichotillomania: descriptive characteristics and phenomenology

  • Cited by (0)

    View full text