Emotion regulation in individuals with and without trichotillomania

https://doi.org/10.1016/j.jocrd.2017.01.003Get rights and content

Highlights

  • 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.

Abstract

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.

Section snippets

Participants

Participants were eligible if they were aged 18 years or older, proficient in the English language, and willing and able to participate in a clinical interview either in-person or via teleconferencing software (Skype). Participants were ineligible if they experienced current high suicide risk, past or current psychotic illness or current substance and/or alcohol dependence. Of the 74 participants who consented to take part in the study, five participants were excluded due to current cannabis or

Measures

The clinical interview was comprised of the MINI (Sheehan et al., 1997, Sheehan et al., 1998), which is a brief, structured interview designed to screen participants for common psychological disorders according to DSM-IV criteria. Sheehan et al. (1997) reported that specificity values were at least .85 for all diagnoses, and sensitivity values were above .70 for most diagnoses, excluding dysthymia, OCD, and current substance dependence. The MINI has demonstrated excellent inter-rater

Procedure

All participants completed diagnostic interviews, the duration of which ranged from 30 to 90 min. A provisional psychologist (IR) completed diagnostic interviews using the DIT and MINI with all participants who self-identified as having TTM. NS participants completed their MINI diagnostic interview with the same provisional psychologist (IR) and/or a suitably trained research assistant (TA). Both interviewers received training and supervision in using the MINI and DIT from a qualified clinical

Statistical Analyses

Data were analyzed using the Statistical Package for Social Sciences (SPSS 20). To investigate the relationship between TTM, depressive symptoms, and emotion regulation constructs (DERS, DTS, AAQ-II), zero-order correlations and partial correlations controlling for DASS-21-D scores were calculated for TTM participants. A multivariate analysis of covariance (MANCOVA) was conducted to test the hypothesis that emotion regulation skills would be significantly poorer among TTM participants than NS

Discussion

This study examined the relationships between TTM symptoms and emotion regulation constructs after controlling for the influence of depressive symptoms, and additionally explored the relationships between emotion regulation constructs and specific hair-pulling styles (automatic and focused). As hypothesized, individuals with TTM symptoms reported significantly higher levels of emotion regulation difficulties, distress intolerance, and experiential avoidance relative to control participants.

Role of funding sources

No funding for this study was provided.

Contributors

Authors 2 and 3 designed the study and wrote the protocol. Author 1 conducted a literature analysis and provided summaries of previous research studies. Author 1, with the guidance of authors 2 and 4, conducted statistical analyses. Authors 1 and 2 recruited participants and collected relevant data. Author 1 wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

Conflict of Interest

All authors declare that they have no conflict of interest.

Acknowledgments

The authors wish to thank the Anxiety Recovery Centre of Victoria for their support with participant recruitment.

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