Trauma and trichotillomania: A tenuous relationship

Some have argued that hair pulling in trichotillomania (TTM) is triggered by traumatic events, but reliable evidence linking trauma to TTM is limited. However, research has shown that hair pulling is associated with emotion regulation, suggesting a connection between negative affect and TTM. We investigated the associations between trauma, negative affect, and hair pulling in a cross-sectional sample of treatment seeking adults with TTM (N=85). In the current study, participants' self-reported traumatic experiences were assessed during a structured clinical interview, and participants completed several measures of hair pulling severity, global TTM severity, depression, anxiety, experiential avoidance, and quality of life. Those who experienced trauma had more depressive symptoms, increased experiential avoidance, and greater global TTM severity. Although the presence of a trauma history was not related to the severity of hair pulling symptoms in the past week, depressive symptoms mediated the relationship between traumatic experiences and global TTM severity. These findings cast doubt on the notion that TTM is directly linked to trauma, but suggest that trauma leads to negative affect that individuals cope with through hair pulling. Implications for the conceptualization and treatment of TTM are discussed.