Abstract
BackgroundDespite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations.AimThe present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both.MethodsAdults (n = 98, aged 18–65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined.ResultsIn comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress.DiscussionPersonality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.
Highlights
Trichotillomania and skin picking disorder are characterized, respectively, by recurrent pulling and picking, resulting in hair loss or skin excoriations, as well as functional impairment or distress [1]
Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with body-focused repetitive behavior (BFRB) and show strong associations with a number of clinically relevant features of illness
No significant differences between trichotillomania and skin picking disorder cases were evident on these three measures
Summary
Trichotillomania and skin picking disorder are characterized, respectively, by recurrent pulling and picking, resulting in hair loss or skin excoriations, as well as functional impairment or distress [1]. Stanley and colleagues [2] assessed personality traits in people with trichotillomania (n = 8) and obsessive compulsive disorder (OCD) (n = 13), and found that adults with trichotillomania were more extraverted than OCD patients (using the Eysenk Personality Questionnaire). Using the Temperament and Character Inventory, Lochner and colleagues [3] assessed 54 participants with trichotillomania and 278 with OCD and found that those with trichotillomania scored significantly higher on novelty seeking, whereas those with OCD reported significantly greater harm avoidance. In one of the few studies of skin picking disorder (n = 21), Lochner and colleagues [4] found that people with skin picking disorder scored high (compared to published normative data) on measures of reward dependence and harm avoidance, but not on novelty-seeking, using the Tridimensional Personality Questionnaire. Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations
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