Hair-Pulling Does Not Necessarily Serve an Emotion Regulation Function in Adults With Trichotillomania.

Christine Lochner,Dan J Stein,Martin Kidd,Bronwynè Coetzee,Salome Demetriou

doi:10.3389/fpsyg.2021.675468

Abstract

Background: Trichotillomania (TTM) has been associated with childhood trauma and perceived stress. While it has been hypothesized that hair-pulling regulate negative emotions, the relationship between childhood trauma, perceived stress, emotion regulation, and hair-pulling has not been well-studied.Methods: Fifty-six adults with TTM and 31 healthy controls completed the Childhood Trauma Questionnaire (CTQ), Perceived Stress Scale (PSS), and Difficulties in Emotion Regulation Scale (DERS). Hair-pulling severity was measured with the Massachusetts General Hospital-Hair Pulling Scale. CTQ, PSS, and DERS total scores were compared across groups using ANCOVA and the correlation between hair-pulling severity and emotion dysregulation was determined. Regression analyses were used to estimate the association of CTQ and PSS totals with DERS, and to determine whether associations between predictors and dependent variable (DERS) differed across groups.Results: TTM patients reported higher rates of childhood trauma (p <= 0.01), perceived stress (p = 0.03), and emotion dysregulation (p <= 0.01). There was no association between emotion dysregulation and pulling severity (r = −0.02, p = 0.89). Perceived stress was associated with emotion dysregulation in both groups (p < 0.01), and no association between childhood trauma and emotion dysregulation in either group. Perceived stress was the only significant predictor of emotion dysregulation in both groups (F = 28.29, p < 0.01).Conclusion: The association between perceived stress and emotion dysregulation is not specific to TTM, and there is no association between emotion dysregulation and hair-pulling severity, suggesting that key factors other than emotion dysregulation contribute to hair-pulling. Alternative explanatory models are needed.

Highlights

Trichotillomania is characterized by recurrent hair-pulling or -plucking resulting in hair loss, and repeated attempts to decrease or stop the behavior (American Psychiatric Association, 2013)
Individuals with TTM may have more difficulty constructively regulating their emotions than healthy controls (Shusterman et al, 2009; Arabatzoudis et al, 2017), and treatment strategies focused on emotion regulation (ER), such as dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT), may be efficacious for TTM (Woods et al, 2006b; Keuthen et al, 2012)
Emotion dysregulation was significantly higher in individuals with TTM (DERS mean total 79.71, SD 22.15 SE 2.1) compared to healthy controls (DERS mean total 65.55, SD 21.56, SE 4.03) [F(1, 84) = 0.03, p

Summary

Introduction

Trichotillomania (hair-pulling disorder, or TTM) is characterized by recurrent hair-pulling or -plucking resulting in hair loss, and repeated attempts to decrease or stop the behavior (American Psychiatric Association, 2013). The relationship between trauma/stressors and TTM may not be a direct causal one, but rather indirect, with hair-pulling acting as a maladaptive mechanism to regulate negative affect associated with traumatic or stressful events. Evidence for this model includes findings that childhood adversity is higher in TTM patients compared to healthy controls (Lochner et al, 2002; Gershuny et al, 2006; Özten et al, 2015), and that stressors are associated with hair-pulling (Grant et al, 2015). While it has been hypothesized that hair-pulling regulate negative emotions, the relationship between childhood trauma, perceived stress, emotion regulation, and hair-pulling has not been well-studied

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