Abstract
Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8.6). Hierarchical factor analysis was used to identify a common latent factor and the multiple indicators and multiple causes (MIMIC) modelling was applied to test the predictive effect of borderline personality disorder symptoms, impulsivity, distress and self-esteem on pathological grooming. Pearson correlation coefficients between TTM, SP and NB were between 0.13 and 0.29 (p < 0.01). The model yielded an excellent fit to the data (CFI = 0.992, TLI = 0.991, χ2 = 696.65, p < 0.001, df = 222, RMSEA = 0.030, Cfit of RMSEA = 1.000), supporting the existence of a latent factor. The MIMIC model indicated an adequate fit (CFI = 0.993, TLI = 0.992, χ2 = 655.8, p < 0.001, df = 307, RMSEA = 0.25, CI: 0.022–0.028, pclose = 1.000). TTM, SP and NB each were loaded significantly on the latent factor, indicating the presence of a general grooming factor. Impulsivity, psychiatric distress and contingent self-esteem had significant predictive effects, whereas borderline personality disorder had a nonsignificant predictive effect on the latent factor. We found evidence that the category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting. This latent underlying factor is not better explained by indicators of psychopathology, which supports the notion that the urge to self-groom, rather than general psychiatric distress, impulsivity, self-esteem or borderline symptomatology, is what drives individual grooming behaviours.
Highlights
IntroductionEven in adulthood, bite their nails, twirl their hair or scratch their skin in moments of stress
Many people, even in adulthood, bite their nails, twirl their hair or scratch their skin in moments of stress
We found evidence that a category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting
Summary
Even in adulthood, bite their nails, twirl their hair or scratch their skin in moments of stress. These become pathological grooming disorders when they are repetitive and intentional acts of habitual behaviours that result in apparent physical harm and shame due to the inability to control the behaviour [1]. A recent survey of 1618 people from the United States found that one out of three people met the clinical diagnosis of at least one grooming disorder [2] This is greater than the prevalence of depression, anxiety or alcohol abuse [3, 4]. Human studies usually report findings from clinical, treatment-seeking populations; symptom manifestation in nontreatment-seeking individuals is relatively unknown
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