Trait anger, anger expression, and anger control in trichotillomania: Evidence for the emotion regulation model

• Hair pullers express their anger inwards more than the normative population.
• Hair pullers have difficulty controlling or reducing inwardly directed anger.
• Anger expressed inwards is a predictor of hair pulling severity.
• Emotion regulation strategies may be beneficial in the treatment of hair pulling.

Researchers have proposed emotion regulation (ER) as one model of trichotillomania (TTM). This model suggests that hair pulling may function as a maladaptive coping mechanism given difficulty managing negative emotions such as anger. This study compared hair pullers versus the normative population on trait anger, anger expression, and anger control and explored whether there is a relationship between anger variables and hair pulling severity. 158 adult females with TTM or chronic hair pulling completed self-report measures of anger and hair pulling severity. Hair pullers reported significantly higher rates of inwardly directed anger and more difficulty controlling their inward anger. Frequency of inward directed anger was a significant predictor of hair pulling severity even after controlling for psychiatric illness, providing support for the ER model of TTM. These findings underscore the potential importance of understanding and addressing ER in TTM.