Emotion regulation in trichotillomania (hair-pulling disorder): the role of stress and trauma

[摘要] Introduction: Trichotillomania (hair-pulling disorder, or TTM) is characterized bypathological hair-pulling, repeated unsuccessful attempts to stop the behaviour, and significantdistress. Various affective states (e.g. tension, stress or pleasure) occur before, during or afterhair-pulling, and difficulties in regulating these have been noted in TTM. When applied toTTM, the emotion regulation (ER) model is based on the argument that pulling serves toregulate emotions. However, this appears to be an arduous relationship. For example, stressmay increase hair-pulling as a way to assuage feelings of extreme anxiety and depression,whereas hair-pulling and its sequelae may also increase stress levels. There is also evidence tosuggest significantly greater severity of childhood trauma in individuals with TTM comparedto controls. However, the relationship between stress, childhood trauma and ER in TTM is notyet known. This study aimed to address this gap in our knowledge, by firstly comparing therates of these variables in TTM with matched healthy controls. A second aim was to investigatewhether there was a relationship between hair-pulling severity and difficulties in ER. A thirdaim was to investigate whether there was a relationship between stress, childhood trauma, andER difficulties in TTM, while controlling for the presence of mood and anxiety disorders.Methods: The majority of the data included in the study formed part of a larger ongoingstudy. Fifty-six adults with TTM and 31 sex- and age-matched controls were included.Participants in this study completed a battery of questionnaires, which included the PerceivedStress Scale (PSS), the Childhood Trauma Questionnaire (CTQ) and the Difficulties inEmotion Regulation Scale (DERS). The data were analysed using the Statistical Package forthe Social Sciences (SPSS v. 22).Findings: Stress (p = .03), childhood trauma (p = .03), and difficulties in ER (p < .01)were all significantly increased in TTM patients compared to the healthy controls. Second,there was no statistically significant relationship between hair-pulling severity and difficulties in ER. Last, a combination of stress and childhood trauma explained 28.7% of the variance inER difficulties in TTM [F (2.51) = 7.00, p < .01). However, stress was the only variable thatsignificantly correlated with difficulties in ER in TTM (ß= .47, p < 0.001).Conclusion: As one of the first studies to explore ER in TTM in-depth, the studyfindings suggested significantly increased stress, childhood trauma, and difficulties in ER inindividuals with TTM. While individuals with TTM had greater difficulty in regulating theiremotions compared to healthy controls, the data showed no significant relationship betweenTTM severity and ER difficulties. In keeping with the ER model, one would expect thatincreased pulling could be used as an attempt to regulate emotions – however this data did notsupport this hypothesis. Rather, increased stress in TTM individuals significantly explaineddifficulties in ER. It may be argued that stress and difficulties in ER seem to be more closelyrelated than hair-pulling and difficulties in ER. This suggests that the ER model may not be thebest model to explain the phenomenon of pathological hair-pulling. Further research into theunderlying mechanisms and dynamics of stress, trauma and ER in TTM may assist in findinga more appropriate explanatory model. In the clinic, emphasis should be placed on theassessment of difficulties in ER in patients with TTM and on addressing modifiable features(such as stress) associated with such difficulties, in addition to reducing hair-pulling.

[发布机构] Stellenbosch University