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Trichotillomania-Associated Personality Characteristics
Abstract
Background: Patients with Trichotillomania (TC) have an irreversible urge to pull their hair. This self-mutilation behavior is associated with high level of tension before and a sense of gratification and relief after TC. Objective: To investigate the personality characteristics of patients suffering from TC. Method: The study was performed on 43 TC patients and 43 gender and age-matched non-psychiatric control individuals who were asked to complete a Persian version of the NEO Personality Inventory-Revised (NEO PI-R). Results: The TC patients had significantly higher scores on Neuroticism (p<0.0001) and Agreeableness (p<0.05) domains. The TC patients were high scorers in all Neuroticism sub-scales including anxiety, angry-hostility, depression, self-consciousness, impulsivity, and vulnerability to stress. The patient group had lower scores on the compliance scale, a sub-scale of Agreeableness. Conclusion: According to Costa and McCrae (founders of the NEO PI-R) suggestions, the picture of the personality traits or characteristics displayed by our data resembles borderline personality disorder.
... The first study (Christenson, Chernoff-Clementz, & Clementz, 1992) compared individuals with TTM to an age and gendermatched psychiatric control group and did not identify significant differences between the two groups in levels of personality disorders or traits. The second study (Hagh-Shenas, Moradi, Dehbozorgi, Farashbandi, & Alishahian, 2004) compared 43 individuals with TTM to an age-and gender matched non-psychiatric control group on personality and psychological variables assessed by the Persian version of the NEO Personality Inventory-Revised (NEO-PI-R). Results demonstrated that TTM participants scored higher on the anxiety, angry-hostility, depression, self-consciousness, impulsivity, and vulnerability to stress subscales and lower on the compliance subscale compared to the control group. ...
... Taken together, these studies identified specific comorbid symptoms and traits as potentially playing an important role in TTM, including anxiety, depression, agreeableness, neuroticism, openness, angry-hostility, self-consciousness, impulsivity, vulnerability to stress, and compliance. Two of the studies (Hagh-Shenas et al., 2004;Keuthen et al., in press), however, utilized the NEO-PI-R and NEO-FFI, which were not developed for use with individuals with psychopathology. Additionally, the NEO-PI-R and NEO-FFI lack validity scales, which are important in determining positive or negative response bias as well as general comprehension and consistency in responding. ...
... Of note, although significant differences were found between the TTM and control group with regard to the PAI scales, none of the scales were significantly elevated above the PAI norms indicating that the TTM group had no personality characteristics in the clinically severe range. Overall, the findings largely corroborate the results of other studies of personality and TTM (Christenson et al., 1992;Hagh-Shenas et al., 2004;Keuthen et al., in pres s) and provide valuable insight into TTM that may inform future research and treatment of this condition. ...
... In one of the few studies of skin picking disorder (n = 21), Lochner and colleagues [4] found that people with skin picking disorder scored high (compared to published normative data) on measures of reward dependence and harm avoidance, but not on novelty-seeking, using the Tridimensional Personality Questionnaire. In a study of 43 adults with trichotillomania and 43 controls using the NEO-Fave Factor Inventory, Hagh-Shenas and colleagues found that trichotillomania was associated with significantly higher scores on all neuroticism subscales and significantly lower scores on the compliance sub-scale of Agreeableness [5]. Finally, Keuthen and colleagues [6] examined personality factors in 164 adults with trichotillomania using the NEO-Five Factor Inventory and found that elevated openness, neuroticism, and less agreeableness were all associated with both greater pulling severity and that higher neuroticism was associated with less pulling control. ...
... This is in keeping with a previous study [6] in trichotillomania and extends those findings to skin picking disorder as well. Unlike previous studies [5,6], however, neither openness nor agreeableness were significantly different in those with BFRBs compared to controls. Having shown the large effect size association with neuroticism, the question remain as to what exactly is the relationship between neuroticism and these disorders? ...
Background:
Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations.
Aim:
The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both.
Methods:
Adults (n = 98, aged 18-65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined.
Results:
In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress.
Discussion:
Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.
... Trait sensitivity to punishment underlies the trait of neuroticism (Corr, 2004), individuals with TTM tend to be high in both traits (Hagh-Shenas et al., 2004;. ...
... Findings place TTM well within the overlap of impulsivity and compulsivity (Figure 1.2, and address the tension within this overlap by identifying that behaviours in TTM may be driven from differing levels; impulsiveness in TTM being driven from biological origins and compulsiveness from a psychological and social level. This interpretation supports previous findings of reward processing abnormalities (White et al., 2013), striatal structural abnormalities (Isobe et al., 2018) and personality traits in TTM (Hagh-Shenas et al., 2004;. ...
Compulsive hair pulling is a serious and debilitating psychological disorder lasting on average 20 years. Using multiple research approaches that included qualitative interviews, psychological measures, systematic literature review and functional brain imaging, a comprehensive picture of how reward and punishment drive the behavior of hair pulling was created. The model of hair pulling disorder developed in this research can guide the application of current treatments and inform the development of new ones. The implications of this research may be relevant to any health condition that features impulsive behaviors that are driven by the experience of reward.
... For both studies, urge strength correlated positively with neuroticism (emotionality); for Study 2, pulling frequency correlated positively with neuroticism as well. This is perhaps not surprising, given that neuroticism has correlated with trichotillomania consistently (Grant & Chamberlain, 2021b;Hagh-Shenas et al., 2015;Keuthen et al., 2015Keuthen et al., , 2016. ...
Measuring trichotillomania is essential for understanding and treating it effectively. Using the Situated Assessment Method (SAM ² ), we developed a psychometric instrument to assess hair pulling in situations where it occurs. In two studies, pullers evaluated their pulling in relevant situations, along with how much they experience factors that potentially influence it (e.g., external triggers, reduction in negative emotion, negative self-thoughts). Individual measures of pulling, averaged across situations, exhibited high test reliability, construct validity, and content validity. Large differences between situations in pulling were observed, along with large individual-situation interactions (with limited evidence distinguishing focused versus automatic pulling subtypes). In linear regressions for individual participants, factors that influence pulling tended to correlate with pulling as predicted, explaining a median 74%–83% of its variance. By identifying factors that predict pulling for each individual across situations, the SAM ² Trichotillomania Assessment Instrument (TAI) offers a rich understanding of an individual’s pulling experience, potentially supporting individualized pulling interventions.
... Increased hostility was found to be a predictor of hair pulling behavior in university students. In a parallel study, it was reported that patients with TTM had a general increase in the subscale scores of neuroticism and anger-hostility and a decrease in adjustment scores (Hagh-Shenas et al., 2015). It is known that individuals with hair pulling behavior have more interpersonal problems and describe themselves as cold, vindictive, oppressive, and authoritarian pullers, the rate of men was slightly higher than for women, which is not compatible with the literature, but may also be a finding showing that male sex is a risk factor. ...
To examine the prevalence of trichotillomania (TTM) and associated factors in a large non-clinical sample of Turkish university students. The population of the study comprised 862 university students, 596 (69.1%) females and 266 (30.9%) males, aged between 18 and 29 (21.3 ± 1.8) years. In addition to a sociodemographic form, the participants completed the Massachusetts General Hospital Hairpulling Scale and the Brief Symptom Inventory, and the Structured Interview Form based on the DSM 5 criteria for TTM. In the study, lifetime hair-pulling behavior was found in 18.9% of university students, current hair-pulling behavior was found in 10%, and a current diagnosis of TTM was found in 2.3%. The ratio of men to women among those diagnosed as having TTM was determined to be 1.8:1. Women mentioned more stressors that triggered hair-pulling behavior than men. Women showed hair-pulling behavior to reduce tension, whereas men reported that they experienced more pleasure sensations during hair-pulling. Finally, it was determined that those who met the TTM diagnostic criteria showed more persistent pulling patterns, felt more regret, and social avoidance, attempted to camouflage more, and thought their behavior was more likely to be a psychiatric illness than those who did not meet the TTM diagnostic criteria. Unlike the literature, the prevalence of TTM in Turkish university students was found to be almost equal in men and women, but it was determined that the hair-pulling patterns of men and women differed. Therefore, it is thought that rather than sex being a risk factor for TTM, it may differentiate approaches of men and women to hair-pulling and help-seeking behaviors.
... For both studies, urge strength correlated positively with neuroticism (emotionality); for Study 2, pulling frequency correlated positively with neuroticism as well. This is perhaps not surprising, given that neuroticism has correlated with trichotillomania consistently (Grant & Chamberlain, 2021b;Hagh-Shenas et al., 2015;Keuthen et al., 2015Keuthen et al., , 2016. ...
Trichotillomania (hair pulling disorder) is characterized by the recurrent and repetitive pulling of one’s own hair, often resulting in distress for the individual. Being able to accurately measure trichotillomania is essential for understanding hair pulling and developing interventions to decrease pulling. Most current assessment measures are unsituated, asking an individual to assess their pulling by abstracting across unspecified life situations to construct overarching impressions. This abstraction process can potentially lead to inaccurate judgements that ignore important sources of situational variance. We used the Situated Assessment Method (SAM²) to develop a situated psychometric instrument for assessing trichotillomania: the SAM2 Trichotillomania Assessment Instrument (SAM2 TAI). Using the SAM2 TAI, participants in two studies (n = 117 and n = 99) evaluated 52 situations for pulling frequency and urge strength, along with a set of processes known to influence pulling (e.g., external triggers, reduction of negative emotion, situational control, emotion regulation). As expected, large reliable individual differences emerged across these measures of trichotillomania, together with substantial situational effects and situation by individual interactions. High levels of construct and content validity were also observed, demonstrating that the SAM2 TAI provides meaningful assessments of constructs associated with trichotillomania. Prediction of trichotillomania at both the group and individual levels supported theoretical models of trichotillomania in the literature, while establishing individual prediction profiles that varied widely. Interestingly, the SAM2 TAI was only moderately related to a well-established unsituated measure of trichotillomania, the MGH-HPS, indicating that situated and unsituated measures capture different information.
... Previous research in TTM and SPD has not objectively examined parental bonding but has hinted indirectly at possible problems in the childparent relationship. Some researchers have looked at personality correlates of TTM and have found high levels of neuroticism among individuals with TTM (including significantly higher scores on all neuroticism subscales) [8][9][10]. This may be of potential importance to parenting as some research has suggested a connection between neuroticism levels and one's perceived relationships with their parents (perceived parental affectionless control was associated with high neuroticism) [11]. ...
Background
One means of understanding the effect of environmental factors on psychiatric disorders is by examining perceived parenting behavior in the childhood of individuals with trichotillomania and skin picking disorder (i.e. body focused repetitive behaviors (BFRBs)). We hypothesized that adults with BFRBs would show higher scores on dimensions of “care” and “overprotection”. Specifically, we predicted that adults with BFRBs would have parents in the “affectionate constraint” quadrant, based on a combination of high care and high protection scores.Methods
We assessed demographic and clinical differences in 184 adults between the ages of 18 and 65 with Trichotillomania (TTM) (n = 43) and Skin Picking Disorder (SPD) (n = 75), and both (n = 66). The Parental Bonding Instrument (PBI) measured “care” and “overprotection” items. Results from the PBI were compared across groups and with normal control data using independent sample t-tests.ResultsIndividuals in the BFRB group had significantly lower maternal and paternal care scores compared to controls. The TTM, SPD, and TTM + SPD (combined) groups all had lower maternal care scores than controls. The TTM + SPD (combined) group had significantly lower paternal care scores and higher maternal protection scores than the normative averages. The most common parenting patterns in subjects with BFRBs were maternal and paternal affectionless control (low care/high protection). From our sample, only 27 % reported optimal maternal parenting and 28 % reported optimal paternal parenting.DiscussionThese preliminary data suggest that low maternal and paternal care may be associated with BFRBs. However, the nature of this relationship should be further explored, as these results do not necessarily mean that affectionless control parenting leads to a predisposition to BFRBs, and there may in fact be other environmental factors at play. Identifying how individuals perceive familial relationships may provide direction for clinicians in developing tools to address the burden caused by BFRBs.
... The RST, developed to explain personality, does provide a testable theory of motivation. The five factor model of personality in which those with TTM were high in Neuroticism (Hagh-Shenas, Moradi, Dehbozorgi, Farashbaindi, & Alishahian, 2004;Keuthen et al., 2015;McCrae & Costa, 1987) points to high sensitivity to punishment in those with TTM. As does other research (Odlaug, Chamberlain, Schreiber, & Grant, 2013) which points to a sensitivity to punishment in those with TTM by arguing that motivation to pull hair is principally to avoid punishment. ...
Trichotillomania (TTM) is postulated to be a disorder in which both impulsivity, motivated by reward, and compulsivity, motivated by punishment, contribute equally. Three separate studies were conducted to measure response to reward and punishment within the context of the reinforcement sensitivity theory of personality to examine whether hair-pulling behaviours could be predicted by sensitivity to reward and/or punishment. For study 1, a MANOVA was conducted to identify differences in sensitivity to reward and punishment in a cohort recruited via the internet, with hair-pulling symptoms (n = 89) and without symptoms (n = 206). For study 2, a stepwise discriminate function analysis was conducted to assess whether sensitivity to reward and punishment, along with anxiety and depression could predict group membership (in n = 25 individuals with hair-pulling symptoms and n = 25 without symptoms). Study 3 attempted to replicate the results of study 2 in a cohort of individuals who met clinical diagnostic criteria for trichotillomania (n = 22) and healthy controls (n = 22). It was concluded that both sensitivity to reward and sensitivity to punishment drive the motivation for hair-pulling in non-clinical samples. When participants met diagnostic criteria for TTM, depression and sensitivity to punishment became more important.
... Regarding psychological factors, personality structure has also been consistently shown to be an important predictor of stress reactivity, resilience and well-being (Amstadter et al., 2016;Hengartner, 2015;Roberts et al., 2007). Moreover, dysfunctional personality patterns have consistently been confirmed to constitute an early risk factor of various psychiatric conditions including obsessive-compulsive disorder (Rector et al., 2002;Rees et al., 2006Rees et al., , 2014Samuels et al., 2000;Wu et al., 2006) and trichotillomania (Chamberlain and Odlaug, 2014;Hagh-Shenas et al., 2015;Keuthen et al., 2015Keuthen et al., , 2016 which share notable similarities to SPD. Nevertheless, the link between personality traits and SPD is still understudied. ...
Although skin-picking is a relatively common behaviour, data concerning factors which underlie skin-picking severity and functional impairment caused by picking are still limited. In the present study we examined whether some emotion regulation strategies (cognitive reappraisal and expressive suppression) and personality features
influence skin-picking in a university sample; the moderating role of personality traits in the relationship between emotion regulation strategies and skin-picking was also considered. A total sample of 252 adults (mean age 24.03; SD=5.66) completed the Skin-Picking Scale-Revised, Temperament and Character Inventory and Emotion Regulation Questionnaire. The linear regression analyses indicated that the use of cognitive reappraisal as emotion regulation strategy decrease skin-picking severity. Reduced novelty seeking and reduced self-directedness were identified as significant predictors of skin-picking severity, whereas decreased self-directedness and elevated cooperativeness predicted functional impairment caused by skin-picking. Further moderation analysis revealed that cognitive reappraisal decreases skin-picking severity only among individuals with low and moderate novelty seeking, however, not among those with high novelty seeking. These results indicate that emotion regulation strategies and specific personality traits are important factors associated with skin-picking behaviours in a university sample. Further research is needed to establish the link between emotion regulation
strategies and personality traits in clinical sample.
... A possible explanation may be offered by the very nature of the measure itself. When looking into what constitutes Agreeableness, we find that it includes characteristics such as trust, straightforwardness, altruism, compliance and conflict avoidance (Hagh-Shenas et al., 2004). Individuals who are low in agreeableness have a tendency to express hostility inwards (Dewe et al., 1993). ...
The study examined the relationships between the two types of Work-Family Conflict (WFC): Work Interfering with Family (WIF) and Family Interfering with Work (FIW) and perceived stress as well as the role of the big five personality factors as possible moderators in the WFC-Stress relationship. Data was collected from 188 working parents in Malaysia. Hierarchical moderated regression analyses revealed that both WIF and FIW were significant predictors of stress. Among the big five personality factors, agreeableness and emotional stability moderated the WFC-stress relationships but in different ways. Agreeableness exacerbates stress as WIF increases but alleviates stress when FIW increases. Emotional stability on the other hand heightened stress when work interfered with the family. Practical implications and suggestions for reducing stress among working parents are discussed in accordance to the findings.
Reviews studies concerning pharmacologic and behavioral treatment of trichotillomania (compulsive hair pulling), based on epidemiological data suggesting that the disorder is more common than was once thought. Although some drug therapy has proven effective for some patients, more work is needed to find treatment regimens that provide long-term suppression of symptoms. Comorbidity, drug response data, familiarity, and phenomenology of trichotillomania may extend the concept of obsessive-compulsive disorder (OCD) to a spectrum of inappropriately released, excessive grooming behaviors. Studies that examine the similarities and differences between trichotillomania and OCD may help define the neurobiology of OCD, and possibly of other impulse control disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study investigated the comprehensiveness of the Five-Factor Model for description of personality. The issue addressed was, specifically, whether a sixth psychopathology factor is needed to account for personality variation in nonclinical populations. Three samples provided questionnaire data for the present analyses, in employment selection settings: two female samples of 527 and 583 subjects, and one male sample of 266 subjects. The Revised NEO-Personality Inventory was administered to all the subjects. In addition, one female sample completed the Basic Personality Inventory, and the other two samples completed the Personality Assessment Inventory. Factor analyses of the data showed that a sixth factor, consisting primarily of psychopathological variables was needed to account for the variance.
Hair pulling is an uncommon behavior for which a standard treatment modality has not yet been established; additionally its prognosis is generally guarded. This article reviews the literature and comments upon the demographic, dermatologic, clinical and psychodynamic features of trichotillomania. The various diagnostic association and the treatment approaches are discussed. A case of trichotillomania is presented and the possible relationship between trichotillomania and anxiety is explored.