Article

Affective states and racial identity among African-American women with trichotillomania

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Abstract

Affective correlates of hair pulling were investigated in a sample of 43 African-American women with trichotillomania. The relationship among affective correlates and dimensions of racial identity was also examined. Via phone interview, participants completed the hair-pulling survey on which they rated the intensity of 10 different affective states across three different points in the hair-pulling episode (before, during and after). Participants also completed the Multidimensional Inventory of Racial Identity, which assesses racial identity across the dimensions of centrality, regard and ideology. Univariate analyses identified the feelings of being bored, happy, anxious, guilty and relieved as reflecting a time difference. Negative correlations were found among the racial identity dimension of private regard and the affective correlates of happy and relief that were experienced during and after pulling. Negative correlations were found between the racial identity dimension of humanist ideology and relieved affect as well as humanist ideology and relieved affect during a pulling episode. In light of the results, the importance of understanding and assessing cultural factors in the affective experience of African-American women with trichotillomania is discussed.

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... Scant published research is available concerning TTM among African American females [13]. This is puzzling given that for many Black women, hair is an emotional issue [14][15][16][17]. ...
... As part of Black hair alteration, rituals or habits related to hair have become routine in many Black communities. These include but are not limited to weekly visits to the hairdresser, weekend hair washing, and heat alteration, family braiding parties, and use of certain hair products (i.e., Dixie Peach, Royal Crown [13][14][15][16][17]). ...
... Similar to their White counterparts, African American women are most likely to pull hair from the scalp region [13,[22][23][24]. Research with African American college students suggests that some of the hair pulling may be in response to skin irritation [23], although a subsequent replication study found that African American college students were no more likely than Whites or other ethnic groups to pull for this reason [22]. ...
Article
Trichotillomania (TTM) is a little understood disorder that has been underresearched in the African American community. Furthermore, the incorporation of cultural factors into TTM research has virtually been ignored. Existing data from an African American college student population suggest TTM is associated with high levels of anxiety. In this study, we explored anxiety symptoms and cultural hair messages in an African American female community sample with TTM symptoms. We predicted high levels of TTM severity and impairment would be associated with high level of anxiety symptoms. We also predicted that cultural messages about hair will influence both TTM and anxiety symptoms. In this telephone study, 41 African American females participated in interviews about their TTM. TTM impairment and severity was positively correlated with general anxiety symptoms as measured on the Symptom Checklist 90-Revised (SCL 90-R(®) ). Severity was also positively correlated with obsessive-compulsive symptoms. Given the significance of hair for African American women, we also explored the childhood cultural messages receive about hair. Over half the sample received at least one cultural message about hair. Although many women received the same message, the value they placed on the message differed. Messages received about hair were not associated with TTM severity or impairment. The association among obsessive-compulsive symptoms and hair messages approached significance. Results highlight the importance of assessing anxiety comorbidity and culture with African American TTM samples. Little is known about TTM in African American samples. Existing research indicates this population seeks TTM help from their hairdressers. Among college students, a significant correlation has been found for anxiety as measured on the Beck Anxiety Inventory and TTM. To the best of our knowledge, this is the first paper to examine cultural messages about hair in an African American sample. In addition, rather than looking at college students, this research is conducted with a community sample of mostly professional African American women. The use of the SCL-90-R(®) specific anxiety dimensions demonstrates the relationship with TTM severity and impairment.
... Scant published research is available concerning chronic hair pulling among American minorities (Neal-Barnett & Stadulis, 2006), and the majority of existing literature focuses on African Americans. Similar to their White counterparts, African American women are most likely to pull hair from the scalp (Dubose & Spirrson, 2006;McCarley, Spirrison, & Ceminsky, 2002;Neal-Barnett & Stadulis, 2006;Neal-Barnett et al., 2000). ...
... Scant published research is available concerning chronic hair pulling among American minorities (Neal-Barnett & Stadulis, 2006), and the majority of existing literature focuses on African Americans. Similar to their White counterparts, African American women are most likely to pull hair from the scalp (Dubose & Spirrson, 2006;McCarley, Spirrison, & Ceminsky, 2002;Neal-Barnett & Stadulis, 2006;Neal-Barnett et al., 2000). Research with African American college students suggests that some pulling may be in response to skin irritation (McCarley et al., 2002), although a subsequent replication study found that African American college students were no more likely than Whites or other ethnic groups to pull for this reason (Dubose & Spirrson, 2006). ...
... All rights reserved. doi:10.1016/j.janxdis.2010.03.014 episode (Mansueto, Thomas, & Brice, 2007;Neal-Barnett & Stadulis, 2006). ...
Article
In this Internet study, we explore differences among minority and Caucasian participants in the phenomenology of, interference and impairment related to, and perceived efficacy of treatments for trichotillomania (TTM) symptoms. A demographic difference was found for number of children only. Results indicate that the minority sample was less likely to report pulling from their eyebrows and eyelashes than the Caucasian sample. Minorities were less likely to report increased tension before a pulling episode. Minorities reported high levels of TTM interference with home management but Caucasians reported higher TTM interference with their academic life. Caucasians with TTM reported higher daily stress than their minority counterparts. Although minorities were less likely to utilize treatment, no significant differences were found for treatment improvement. This Internet study sheds important light on differences in TTM symptoms among minorities and Caucasians. The lack of economic and education differences between groups is a strength of this research.
... Findings from a few studies have demonstrated that affective states change over the course of hair pulling episodes both in clinical (Diefenbach et al., 2002(Diefenbach et al., , 2008Neal-Barnett and Stadulis, 2006) and non-clinical samples (Duke et al., 2009;Ghisi et al., 2013;Mansueto et al., 2007;Stanley et al., 1995). Overall, anxiety, boredom, tension, and frustration have been observed to decrease across the pulling cycle, whereas shame, sadness, guilt, indifference, relief, calm, feelings of satisfaction, and anger emerged to increase during the pulling cycle. ...
... Past research findings on affective correlates of hair pulling highlighted that several emotional states may be involved in the hair pulling cycle both in clinical (Diefenbach et al., 2002(Diefenbach et al., , 2008Neal-Barnett and Stadulis, 2006) and non-clinical hair pullers (Duke et al., 2009;Ghisi et al., 2013;Mansueto et al., 2007;Stanley et al., 1995). We conducted the current study to explore variations across time in affective correlates during hair pulling episodes in a sample of Italian individuals reporting TTM; to date, researchers have only investigated this question in an Italian context in one study (Ghisi et al., 2013) using non-clinical hair pullers. ...
... We should mention that observed mean scores showed an increasing trendalthough not significant -from the pre-pulling to the post-pulling phase. The absence of significant variations in guilt is consistent with findings from a community sample of Italian individuals who had reported having pulled hair at least once a week (Ghisi et al., 2013), but inconsistent with findings from clinical samples of American individuals (Diefenbach et al., 2002(Diefenbach et al., , 2008Neal-Barnett and Stadulis, 2006). Therefore, cross-cultural differences may account for discrepancies between our findings and those of other non-Italian studies. ...
Article
Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers.
... Similarly, Penzel (2003) states in the Stimulus Regulation Model that people may use hair pulling as a homeostatic regulating method capable of modulating aversive affective statesincreasing arousal when individuals are bored or tired, and reducing arousal when tension and other negative emotions occur (Begotka et al., 2004). (Diefenbach et al., 2002;Neal-Barnett and Stadulis, 2006) and non-clinical samples (Duke et al., 2009;Ghisi et al., 2013;Mansueto et al., 2007;Stanley et al., 1995). Overall, anxiety, boredom, tension, and frustration have been observed to decrease across the pulling cycle, whereas shame, sadness, guilt, indifference, relief, calm, feelings of satisfaction, and anger emerged to increase during the pulling cycle. ...
... Past research findings on affective correlates of hair pulling highlighted that several emotional states may be involved in the hair pulling cycle both in clinical (Diefenbach et al., 2002;Neal-Barnett and Stadulis, 2006) and non-clinical hair pullers (Duke et al., 2009;Ghisi et al., 2013;Mansueto et al., 2007;Stanley et al., 1995). We conducted the current study to explore variations across time in affective correlates during hair pulling episodes in a sample of Italian individuals reporting TTM; to date, researchers have only investigated this question in an Italian context in one study (Ghisi et al., 2013) using non-clinical hair pullers . ...
... Overall, our findings are consistent with previous literature (Diefenbach et al., 2002;Duke et al., 2009;Ghisi et al., 2013;Mansueto et al., 2007;Neal-Barnett and Stadulis, 2006); we found differential patterns of change in distinct affective states. These findings further support the importance of considering emotional changes following hair pulling behaviors, rather than focusing only on those experienced during hair pulling as required by the DSM-IV-TR criteria for TTM (Stanley et al., 1995). ...
Article
Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers.
... In a telephone study, black females reported that trichotillomania impairment and severity were positively correlated with symptoms of anxiety [9]. A study of 43 black women found significant correlations between aspects of a participant's racial identity and their affect before, during and after a hair pulling episode [10]. Another study of black students (n=176) compared to non-black students (n=422; which included ethnic minorities and white Caucasians) found that black individuals were more likely to pull hair in response to skin irritation and had higher rates of noticeable hair loss due to pulling [11] (other research failed to find similar results however; see [12]). ...
Article
Full-text available
Background: Body-focused repetitive behaviors (BFRBs), such as trichotillomania and skin picking disorder, are psychiatric disorders characterized by repetitive grooming that result in hair loss or excoriations. Questions remain as to whether there are racial/ethnic differences in the clinical presentation of BFRBs. Methods: We recruited 539 adults with DSM-5 trichotillomania or skin picking disorder. Of these, 76 (14.1%) self-identified as Black, Asian, or Minority Ethnic (BAME), while 463 (85.9%) self-identified as white Caucasian (hereafter referred to as non-BAME). BAME and non-BAME participants were compared on demographics, symptom severity, comorbid conditions and psychosocial impairment. Results: Groups did not differ in terms of age, sex, or education levels. BAME individuals reported significantly more time spent picking or hair pulling per day compared to non-BAME individuals, and were less likely to have received treatment for their BFRB symptoms. Some differences were also found with respect to where on the body people pull and pick from. Discussion: In general, the clinical profiles of BFRBs appeared similar between those from BAME versus non-BAME backgrounds. However, differences were found in terms of treatments received and an aspect of symptom severity. The findings highlight the need to better understand the heterogeneity of BFRBs including potential health inequalities.
... For some, this included a near-total absence of awareness of such experiences, while for others this involved facilitating positive emotions and cognitions in place of the negative ones (Rehm et al., 2013). Similarly, among African-American women with TTM, participants with negative perceptions of their racial identity were more likely to experience happiness, calmness or relief during and after hairpulling episodes compared to those with positive perceptions of their racial identity (Neal-Barnett & Stadulis, 2006). This suggests that self-construals may influence the type of emotion-regulation function that hairpulling serves. ...
... We conclude with an appeal for more research on the sister circles intervention. This paper extends our work on anxiety and anxiety-related disorders among African American women (Meinert, Blehar, Peindl, Neal-Barnett, & Wisner, 2003;Neal-Barnett, 2003;Neal-Barnett & Crowther, 2000;Neal-Barnett & Stadulis, 2006;Neal-Barnett, Statom, & Stadulis, 2010). It builds on an earlier focus group paper concerning whether and how sister circles could be used in the treatment of anxiety (Neal-Barnett et al., 2011), and it lays the groundwork for an empirical investigation of the effectiveness of sister circles, to be reported in the future. ...
Article
[Clin Psychol Sci Prac 18: 266–273, 2011] Research on anxiety treatment with Black women reveals a need to develop interventions that address factors relevant to their lives. Such factors include feelings of isolation, multiple roles undertaken by Black women, and faith. A recurrent theme across treatment studies is the importance of having support from other Black women. Sister circles are support groups that build upon existing friendships, fictive kin networks, and the sense of community found among Black women. Sister circles appear to offer many of the components Black women desire in an anxiety intervention. In this article, we explore sister circles as an intervention for anxious Black women. Culturally infused aspects from our sister circle work with middle-class Black women are presented. Further research is needed.
... There is a paucity of research on the cross-cultural impact of TTM; however findings from two studies of African American women with TTM show that the individuals experienced feelings of guilt following a pulling episode, embarrassment due to the effects of pulling, and social avoidance (Neal-Barnett & Stadulis, 2006;Neal-Barnett, Ward-Brown, Mitchell, & Krownapple, 2000). ...
Article
Full-text available
Trichotillomania (TTM), or chronic hair pulling, is associated with significant levels of distress and impairment. While research is in its infancy, more data are accumulating regarding the impact, phenomenology, maintaining variables, etiology, and treatment of TTM. Behavior therapy and clomipramine have been moderately effective in reducing TTM symptoms in clinical trials. Enhancing behavior therapy with techniques designed to address TTM patients' emotional control tendencies (e.g., acceptance-based procedures) represents a promising direction in treating TTM.
... Several studies in clinical samples, as well as large Internet surveys, indicate that a similar proportion of adults in both diagnostic groups (around 80%) report increased tension before picking/pulling and relief or gratification during the act (Arnold et al., 1998; Cohen et al., 1995; Odlaug & Grant, 2008a; Tucker et al., 2011; Wilhelm et al., 1999;). Also, a series of studies have asked people with HPD and SPD to retrospectively rate the intensity of various affective states before, during and after skin picking or hair pulling episodes (Diefenbach, Mouton-Odum, & Stanley, 2002; Diefenbach, Tolin, Meunier, & Worhunsky, 2008; Duke, Bodzin, Tavares, Geffken, & Storch, 2009; Duke, Kelley, Ricketts, Geffken, & Storch, 2010; Meunier, Tolin, & Franklin, 2009; Neal-Barnett & Stadulis, 2006; Neziroglu, Rabinowitz, Breytman, & Jacofsky, 2008; Shusterman, Feld, Baer, & Keuthen, 2009; Snorrason, Smari, & Olafsson, 2010; Wilhelm et al., 1999 ). Results show that the majority of patients in both groups report a rise in gratification or relief during pulling/picking. ...
... In clinical and non-clinical samples, individuals with HP and SP consistently report that emotions such as boredom, anxiety, tension, and frustration are present prior to BFRBs and decrease during or after pulling or picking episodes (Roberts et al., 2013). Guilt, shame, sadness, and anger may develop during or after BFRB episodes, as do feelings of satisfaction, indifference, and relief (Bohne, Wilhelm, Keuthen, Baer, & Jenike, 2002;Diefenbach, Mouton-Odum, & Stanley, 2002;Duke et al., 2009;Mansueto, Thomas, & Brice, 2007;Neal-Barnett & Stadulis, 2006;Wilhelm et al., 1999). Furthermore, two studies that measured ER in individuals with and without BFRBs found that individuals with HP and SP reported greater difficulty regulating negative affective states than did controls (Shusterman et al., 2009;Snorrason et al., 2010), and that difficulty regulating particular emotions predicted the degree to which those emotions triggered HP (Snorrason et al., 2010). ...
... Previous studies exploring the role of affective regulation in TTM have been limited by small sample sizes and have focused on the arc of emotions before, during, and after hair-pulling episodes (Mansueto, Thomas, & Brice, 2007;Neal-Barnett & Stadulis, 2006;Stanley et al., 1994Stanley et al., , 1995. These studies have looked at affect with respect to hair-pulling. ...
Article
Full-text available
Trichotillomania (TTM), a repetitive hair-pulling disorder, is underrepresented in the clinical literature. The current project explores the relationship between affective regulation and disordered hair-pulling. Previous research suggests that cycles of emotional states are correlated with the disorder and may induce, reinforce, or otherwise contribute to hair-pulling behavior. We use anonymous internet survey responses from 1162 self-identified hair-pullers to address four questions about affective regulation in people with TTM: (1) Do hair-pullers experience greater difficulty "snapping out" of affective states than non-pullers? (2) Does difficulty with emotional control correlate with TTM severity? (3) Are subtypes identifiable based on the emotions that trigger hair-pulling behavior? (4) Does difficulty "snapping out" of an emotion predict whether that emotion triggers pulling behavior? The results showed a small-to-moderate relationship between affective regulation and problematic hair-pulling. In addition, individual patterns of emotion regulation were systematically related to emotional cues for hair-pulling as well as overall hair-pulling severity. These findings contribute to an understanding of the phenomenology of TTM and provide empirical support for treatments focused on affect regulation.
... As in Caucasian samples, African Americans have reported several emotional states (boredom, happi- ness, anxiety, guilt, etc.) before, during, and after pulling behavior. The main difference observed was the greater frequency of pleasant states during and after pulling in African American woman (McCarley et al., 2002;Neal-Barnett & Stadulis, 2006). These authors pointed out that the uniqueness of the physical properties of hair in African people makes hair a symbol of racial identity. ...
Chapter
Cultural competence and evidence-based practices (EBPs) should be proposed as key and interdependent approaches in quality of mental health, given that cross-cultural research is the way to provide knowledge about diverse populations and to validate EBPs for them. Recent modifications referring to obsessive-compulsive and related disorders (OCRDs) within the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) have encouraged an evolving interest in the investigation and development of new strategies and assessment tools for these disorders. In differential diagnosis of OCRDs, it is recommended that when working with people from specific sociocultural contexts the existence of cultural syndromes related to OCRDs is explored. Empirically validated measures have the main role in assessing symptom severity. Most assessment measures are translated or adapted for different cultures. Cultural adaptations are available for some measures assessing the severity of hoarding, tics, body dysmorphic disorder (BDD), hair pulling, and skin picking.
... This finding should be considered with care, as little is currently understood about cultural factors that could potentially be important in the treatment of trichotillomania. Some work has been performed examining racial identity and culture and potential correlates with trichotillomania and related symptoms (Neal-Barnett et al., 2010;Neal-Barnett & Stadulis, 2006), but much work is needed to fully understand the role of these factors with regard to trichotillomania. ...
... Although research is extremely limited, Neal-Barnett et al. (2010) assessed small sample of Latinos and African Americans with TTM and found that they experience less tension before hair pulling in comparison with their non-Hispanic White counterparts. Given that African Americans have been shown to experience anxiety prior to hair pulling (Mansueto, Thomas, & Brice, 2007;Neal-Barnett & Stadulis, 2006), the authors suggest that in future studies the word "tension" may need to be replaced with another affective descriptor, such as "uptight," to better capture feelings of anxiety prior to hair pulling in ethnoracial minorities with TTM. Clinicians should also be sure to use more broad descriptors, as well as be cognizant of any language barriers that may influence reporting style and the assessment process. ...
Chapter
Full-text available
Obsessive-Compulsive and Related Disorders (OCRDs) can cause considerable distress, disability, and impairment in social, occupational, and general daily functioning. Although there has been much research on OCRDs development, maintenance, and treatment there is sparse scholarship focused on OCRDs in ethnoracial minority groups. This may be due to low census of ethnoracial minorities in OCRD treatment centers, where much OCRDs literature is produced, leading to an absence of ethnoracial minorities in research studies. This chapter will review attitudes towards mental health, shame and stigma, and barriers to treatment of OCRDs in five ethnoracial minority groups, including African Americans, Hispanic/Latino Americans, Asian Americans/Indian Americans, Native Americans/Alaskan Natives, and Arab Americans. Additionally, the current chapter will suggest implications for treatment of OCRDs within each ethnoracial minority groups based upon beliefs and attitudes towards mental health.
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Trichotillomania is a psychiatric syndrome characterized by inability to control repetitive hair pulling. Based on psychiatric sources, trichotillomania is not usually observed among the family members of patients, and in investigation of previous studies, only one familial trichotillomania was reported. In this study, we report a familial trichotillomania which afflicted four sisters, and discuss the importance of genetic factors in this disorder. This report suggests that the same as many other psychiatric disorders trichotillomania could be detected in other family members and genetic factors not only have a significant role in forming such disorders, but also in determination of disorder subtype. Also, this report shows that the comorbidities in one of the member of family might predict the existence of comorbidities in other patients in the family. Base on response to medication authors suggest a genetic disorder like Polymorphism in Serotonin receptors or dopamine can cause such disorder.
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The term body-focused repetitive behaviors (BFRBs) refers to a group of recurrent, problematic, destructive behaviors directed toward the body, including hair-pulling, skin-picking, and nail-biting. Individuals with BFRBs report diminished control over the behavior and a range of physical and psychological sequelae. Recent research on psychological models for BRFBs has investigated the role of emotion regulation (ER), and many authors in this area have conceptualized problematic body-focused behavior as a maladaptive ER mechanism. This article organizes and reviews the empirical research on the ER model for BRFBs. First, the three most common BFRBs are described, as are the conceptualization, phenomenological similarities and covariation, and psychological and physical impact of BFRBs. Next, psychodynamic models and several cognitive-behavioral (CB) models are described. The article focuses on the ER model, including a review of studies of comorbidity in BFRBs, naturalistic and experimental studies, studies of subtypes of BFRBs, and treatment trials. The implications of the findings are discussed and the authors make recommendations for future research. The article concludes with a discussion of the limitations of psychological models for BFRBs and the limitations of the review.
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Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders.
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This chapter discusses scientific advances in the phenomenology of trichotillomania (TTM). Evidence is reviewed on TTM definition and conceptualization, epidemiology, gender-related issues, age of onset and course, phenomenological characteristics, impairment, comorbidity, and cultural considerations. TTM is located in the Obsessive-Compulsive and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Diagnostic criteria include chronic hair pulling causing hair loss, multiple attempts to quit or reduce hair pulling, and clinically significant distress or impairment. TTM is associated with significant psychosocial impairment. Research has examined impairment within specific functional contexts, including social, occupational/academic, and psychological domains. The chapter reviews the negative psychosocial effects associated with TTM. Dissemination of scientific knowledge regarding TTM might help educate clinicians and other medical providers to identify and properly address hair pulling in clinical environments, possibly paving the way for reducing stigma and encouraging more open dialogue between patients and professionals.
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Of the few attempts to determine the prevalence rate of trichotillomania, virtually none have investigated potential ethnic differences. The present study provides data on the prevalence of hair twirling and hair pulling behavior among 176 African American and 422 non-African American students and systematically explores differences between these 2 groups. Fully 10.2% of the sample reported hair pulling that resulted in noticeable hair loss, with African American women reporting the highest rate (15.7%). Overall, 2% of participants responded consistently with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) criteria for trichotillomania; rates did not differ significantly among genders or ethnic backgrounds. African Americans, and especially African American women, were more likely than other participants to report hair pulling in response to skin irritation. Results are discussed in the context of previous research, the importance of hair care in the African American community, and directions for future research.
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Research on African American racial identity has utilized 2 distinct approaches. The mainstream approach has focused on universal properties associated with ethnic and racial identities. In contrast, the underground approach has focused on documenting the qualitative meaning of being African American, with an emphasis on the unique cultural and historical experiences of African Americans. The Multidimensional Model of Racial Identity (MMRI) represents a synthesis of the strengths of these two approaches. The underlying assumptions associated with the model are explored. The model proposes 4 dimensions of African American racial identity: salience, centrality, regard, and ideology. A description of these dimensions is provided along with a discussion of how they interact to influence behavior at the level of the event. We argue that the MMRI has the potential to make contributions to traditional research objectives of both approaches, as well as to provide the impetus to explore new questions.
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Trichotillomania is a psychiatric condition characterised by chronic hair pulling, which is often associated with considerable comorbidity. Typically striking during critical developmental periods in childhood or early adolescence. the disorder tends to follow a chronic course. Trichotillomania is currently classified in DSM-IV as an impulse control disorder. However, phenomenological observations, neurobiological investigations and pharmacological responsivity have suggested similarities between hair pulling and affective states, compulsions, tics, and displacement activities involving excessive grooming. These findings indicate that the classification and theories of the aetiology of trichotillomania may need to be reconsidered. Few pharmacological treatment studies have been conducted for trichoti 110- mania. and among those that have been published several discrepant results have been noted. Nonetheless, certain clinical guidelines can be offered. The usual recommended pharmacological approach is to initiate treatment with an antidepressant that has serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibiting properties. This should be administered for 8 to 12 weeks. Depending on the clinical context. augmentation with anxiolytics. thymoleptics. antipsychotics.topical corticosteroids and other agents may be useful. Behavioural treatment is also an important treatment approach and should be considered either as the initial intervention or in concert with medication. Although rational options for the treatment of trichotillomania can be recommended based on the currently available literature. further controlled studies of pharmacological and nonpharmacological interventions are clearly needed.
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Presents a historical account of the role skin color, facial features, and hair have played in the lives of US Blacks. Special attention is given to the effect these issues have had on Black females, as they strive for feelings of attractiveness, positive self-esteem, and identity in a dominant White society. A list of reading materials is included for clinicians to recommend to clients who are experiencing difficulties related to skin color and features. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study was constructed to detail the demographic and phenomenological features of chronic hair pullers as well as to assess psychiatric comorbidity in a sizable study group. Subjects were drawn from an outpatient population of chronic hair pullers who had been referred to a trichotillomania clinic or had responded to a newspaper advertisement announcing a treatment study of adults who pull out their hair. Sixty adult chronic hair pullers completed a semistructured interview that focused on their hair-pulling behavior and demographic characteristics and that incorporated screening questions for DSM-III-R axis I disorders. The data were tabulated to derive a comprehensive picture of this group. The typical subject was a 34-year-old woman who had pulled hair from two or more sites for 21 years. All subjects described either tension before or relief/gratification after pulling hair from the primary site, but 17% (N = 10) failed to describe both of these characteristics and thus failed to fulfill the DMS-III-R criteria for trichotillomania. Forty-nine subjects (82%) qualified for past or current axis I diagnoses other than trichotillomania. Several characteristics of the study group suggested phenomenological differences between obsessive-compulsive disorder and trichotillomania. Adult trichotillomania is a chronic disorder, frequently involving multiple hair sites, and is associated with high rates of psychiatric comorbidity. Its relation to obsessive-compulsive disorder requires further clarification. The tension-reduction requirement in DSM-III-R for the diagnosis of trichotillomania may be overly restrictive.
Article
Trichotillomania, an irresistible impulse to pull out one's own hair, is a chronic psychiatric illness that causes severe discomfort, interferes with daily activities, and leads to social isolation. Treatment is usually unsatisfactory. Thirteen women with severe trichotillomania completed a 10-week double-blind, crossover trial of clomipramine, a new tricyclic antidepressant agent with selective antiobsessional effects, and desipramine, a standard tricyclic antidepressant. Treatment with clomipramine resulted in significantly greater improvement in symptoms than desipramine, as indicated by physicians' ratings of the women's clinical progress on a scale in which lower scores indicate improvement (mean [+/- SD] scores: at base line, 10.0; after desipramine treatment, 8.7 +/- 2.4; after clomipramine treatment, 4.7 +/- 3.1; P = 0.006) and by scores on a trichotillomania-impairment scale, in which higher scores indicate greater impairment (at base line, 6.8 +/- 1.7; after desipramine treatment, 6.2 +/- 1.7; after clomipramine treatment, 4.2 +/- 2.7; P = 0.03). The severity of symptoms (mean base-line score, 15.9 +/- 3.8) was reduced more by clomipramine (10.6 +/- 6.4) than by desipramine (14.4 +/- 3.9). The patients reported that the compulsion decreased in intensity and that they were more able to resist the urge to pull out their hair during treatment with clomipramine. We conclude that clomipramine appears to be effective in the short-term treatment of trichotillomania.
Article
The purposes of the current study were to examine the affective states associated with hair-pulling in a nonclinical sample and to compare levels of general psychopathology in nonclinical hair-pullers and clinic patients with trichotillomania (TM) or obsessive-compulsive disorder (OCD). Subjects included 66 college undergraduates who engaged in hair-pulling unrelated to grooming, 18 patients with TM and 29 patients with OCD. Dimensional (but not categorical) ratings of affective experiences in the nonclinical sample indicated that hair-pulling was associated with decreases in tension, boredom, anger and sadness. Further, the relationship between emotional experiences before and after hair-pulling was more salient than the pre-during relationship conceptualized as central in current diagnostic criteria for TM. Comparisons of psychopathology in nonclinical and clinical samples failed to support a continuum notion of increasing symptomatology in nonclinical pullers, TM patients and individuals with OCD. Some evidence of increased pathology in nonclinical pullers relative to TM patients was obtained, as was further support for a distinction between TM and OCD. Implications of this investigation for conceptualization of TM are discussed.
Article
The experience of racism is a complex, multidimensional phenomenon. At present, there are few instruments that attempt to capture the experience of racism in all of its complexity. For this study, a new instrument, the Perceived Racism Scale, has been constructed to assess the experience of racism in African Americans in a multidimensional manner. The scale not only provides a measure of the frequency of exposure to many manifestations of racism (including individual and institutional, overt and covert, attitudinal, behavioral, and cultural), but takes a step forward in more comprehensively measuring the experience of racism by assessing emotional and behavioral coping responses to racism. These responses are measured with respect to exposure to racism in three situational domains: on the job, in academic settings, and in the public realm. Measurement of responses to a fourth domain, that of exposure to racist statements, is also included. It is hoped that the Perceived Racism Scale will facilitate a more comprehensive understanding of the experience of racism among African Americans and, through its use in research and clinical settings, will ultimately move us closer to reducing the prevalence and potentially untoward effects of racism.
Article
The authors examined whether African American hair care professionals saw individuals who met general criteria for trichotillomania, chronic hair pulling that results in significant hair loss. Thirty-eight African American hair care professionals and 1 Caucasian hair care professional were interviewed about their customers' hair-pulling behavior and condition of their hair. Sixteen African American hair care professionals saw 21 individuals who met general criteria for trichotillomania and reportedly perceived the behavior to be problematic. Four African American hair care professionals saw 6 individuals who met general criteria for trichotillomania but did not reportedly perceive the behavior to be problematic. Hair care professionals attributed most customers' hair-pulling behavior to bad nerves, stress, habit, and worry. Hair care professionals appeared adept at treating the consequences of chronic hair pulling but offered little assistance for the actual pulling behavior. Hair care professionals' contact with individuals who engage in chronic hair pulling raises interesting implications for prevention.
Article
Affective correlates of hair pulling were investigated in a sample of 44 participants diagnosed with trichotillomania (TM). Participants completed the Hair Pulling Survey on which they rated the intensity of ten different affective states across three different phases of hair pulling (before, during and after). Repeated measures analysis of variance was used to examine the change of emotional experience across the hair pulling cycle. Results indicated significant decreases in boredom, anxiety and tension, and significant increases in guilt relief, sadness and anger across time (p<0.005). The role of co-existent anxiety and mood disorders also was examined using repeated measures analysis of variance. Results of these analyses indicated that patients with and without co-existent disorders differed only on patterns of anger across time, and therefore do not support affective subtypes of TM patients based on co-existent diagnosis. Implications of these findings for conceptualization and treatment of TM are discussed.
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