Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample

Trichotillomania-psychopathological correlates and associations with health-related quality of life in a large sample

BACKGROUND

Relatively few studies have assessed the prevalence, correlates, and independent impact on quality of life (QoL) of trichotillomania (TTM) in large samples.

METHODS

Consecutive participants (N = 7639) were recruited from a cross-sectional web-based study. Sociodemographic data were collected and several validated self-reported mental health measures were completed (Minnesota Impulsive Disorders Interview, Hypomania checklist, Fagerström Test for Nicotine Dependence, Alcohol Use Disorders Identification Test, Early Trauma Inventory Self Report-Short Form, and the Symptom Checklist-90-Revised Inventory). Health-related QoL was assessed with the World Health Organization QoL abbreviated scale (WHOQOL-Bref). Multivariable models adjusted associations to potential confounders.

RESULTS

The sample was predominantly composed of young females (71.3%; mean age: 27.2 ± 7.9 years). The prevalence of probable TTM was 1.4% (95% confidence intervals [CI]: 1.2-1.7), and was more common among females. Participants with probable TTM had a greater likelihood of having co-occurring probable depression (adjusted odds ratio [ORadj] = 1.744; 95% CI: 1.187-2.560), tobacco (ORadj = 2.250; 95% CI: 1.191-4.250), and alcohol (ORadj = 1.751; 95% CI: 1.169-2.621) use disorders. Probable TTM was also independently associated with suicidal ideation (ORadj = 1.917; 95% CI: 1.224-3.003) and exposure to childhood sexual abuse (ORadj = 1.221; 95% CI: 1.098-1.358). In addition, a positive screen for TTM had more impaired physical and mental QoL.

CONCLUSIONS

TTM was associated with a positive screen for several psychiatric comorbidities as well as impaired physical and psychological QoL. Efforts towards the recognition and treatment of TTM across psycho-dermatology services are warranted.

Gender Differences in Psychological Symptoms and Psychotherapeutic Processes in Japanese Children

Gender differences have been documented in the prevalence of psychological symptoms. Tic disorders and autism spectrum disorder (ASD) are more common in male clinical samples, while selective mutism and trichotillomania are more common in female clinical samples. In a review of 84 published case studies of Japanese children, this study explored gender differences in the prevalence of four categories of symptoms and expressions made in therapy for tics, selective mutism, autism spectrum disorder (ASD), and trichotillomania. Case studies were evaluated using both qualitative coding and statistical analysis. The findings were mostly consistent with epidemiological surveys and empirical research on adults. The gender differences in symptom prevalence and their expression could be summarized as differences in more direct aggression for boys versus indirect aggression for girls. The objective and progress in the therapy were to control impulsive energy for boys and to express energy for girls.

Comprehensive Behavioral Therapy of Trichotillomania: A Multiple-Baseline Single-Case Experimental Design

Despite rapidly increasing knowledge about Trichotillomania (TTM), no gold-standard evidence-based psychological intervention has been identified. In the current study, we evaluated the potential efficacy of an eight-session psychological intervention for TTM, namely the Comprehensive Behavioral Model (ComB) treatment, using a multiple-baseline single-case experimental design with three Italian women with TTM. The study included three phases: baseline, intervention, and 3-month follow-up. We assessed the intervention using daily self-monitoring of number of hair-pulling episodes, number of pulled hairs per episode, degree of resistance to pulling urges, and degree of associated distress. We also assessed for reliable improvement in general distress from baseline to post-intervention. All participants completed treatment and showed improvements on those symptom measures that were most relevant to their individualized case conceptualization. However, no participants recovered completely or demonstrated reliable improvement in general distress. Our results provide initial evidence for the utility of the ComB treatment for TTM in an Italian clinical setting. Furthermore, they support the delivery of individualized and flexible psychological treatments when treating TTM.

The Beliefs in Trichotillomania Scale (BiTS): Factor analyses and preliminary validation

OBJECTIVES

The role of cognitions and beliefs in trichotillomania (TTM; hair pulling disorder) has been the subject of only limited investigation. This study aimed to develop and validate the Beliefs in TTM Scale (BiTS).

METHODS

A pool of 50 items based upon themes identified in previous research was administered online to 841 participants with and without self-reported problematic, non-cosmetic hair pulling behaviours.

RESULTS

Exploratory and confirmatory factor analyses conducted in randomly split-halves of the sample supported retention of 14 items comprising three factors: negative self-beliefs, low coping efficacy, and perfectionism.

CONCLUSIONS

The BiTS demonstrated satisfactory psychometric properties and all three subscales significantly correlated with greater hair pulling severity. Negative self-beliefs predicted hair pulling severity over and above mood symptoms, suggesting the importance of addressing self-construals in psychological treatments for TTM. Validation in a clinician diagnosed sample is required.

PRACTITIONER POINTS

Research supports cognitive therapies for treating trichotillomania (hair pulling disorder), although studies investigating the nature and role of cognitions and beliefs in this disorder have been lacking. This study developed and validated a self-report measure of three styles of beliefs most relevant to trichotillomania: negative self-beliefs, low coping efficacy, and perfectionism. Negative self-beliefs predicted the severity of trichotillomania symptoms over and above depression and anxiety, suggesting such cognitions may not necessarily be due to comorbidities. Future research should validate the new measure in a clinician diagnosed sample, and therapies for trichotillomania may be enhanced by targeting shame specifically.

Affective correlates of trichotillomania across the pulling cycle: Findings from an Italian sample of self-identified hair pullers

Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers.