Emotion regulation in individuals with and without trichotillomania

- Emotion dysregulation and distress intolerance were worse in individuals with trichotillomania even after controlling for depression.
- Focused hair-pulling was associated with poor emotional and clarity, and difficulty engaging in goal-directed behavior when distressed.
- The role of comorbid depression in trichotillomania requires ongoing investigation.

Emotion regulation difficulties in trichotillomania (TTM) have been documented in past studies. However, the potential conflation of relationships due to comorbid affective symptoms means that the relationship between TTM symptoms and emotion regulation constructs requires further investigation. In addition, the relationship between different hair pulling styles (focused vs. automatic) and emotion regulation constructs has received only limited empirical attention. This study investigated relationships between emotion regulation constructs and TTM, controlling for depression, in 20 adults with self-reported TTM symptoms compared to 43 non-symptomatic participants. All participants completed structured clinical interviews. The results revealed that individuals who endorsed TTM symptoms had significantly more difficulties regulating emotions and poorer distress tolerance compared to the non-symptomatic group, even after controlling for depression. While automatic hair-pulling was not associated with any emotion regulation constructs, focused hair-pulling yielded moderate-to-strong significant correlations with several emotion regulation facets. These findings support suggestions that emotion dysregulation is core to the phenomenology of TTM (specifically, the focused hair-pulling style) and is not simply a result of comorbid depression. Future research is required to examine the impact of comorbid depression on treatment outcomes, and to determine the clinical utility of differentiating between focused and automatic hair-pulling styles.