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Disentangling Reward Processing in Trichotillomania: ‘Wanting’ and ‘Liking’ Hair Pulling Have Distinct Clinical Correlates

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Abstract

Trichotillomania (TTM; hair-pulling disorder) is characterized by an irresistible urge or desire to pull out one’s own hair, and a sense of pleasure when hair is pulled out. Evidence from translational neuroscience has shown that ‘wanting’ (motivation to seek a reward) and ‘liking’ (enjoyment when reward is received) are each mediated by overlapping but distinct neural circuitry, and that ‘wanting’ contributes to addictive/compulsive behaviors more so than ‘liking’. In the present study, we developed the Hair Pulling Reward Scale (HPRS), a self-report measure that consists of two subscales designed to assess (a) cue-triggered urges and appetitive motivation to pull hair (i.e., putative correlates of ‘wanting’), and (b) momentary pleasure and gratification during pulling episodes (i.e., putative correlates of ‘liking’). We administered the HPRS to 259 individuals with TTM and examined its psychometric properties. Confirmatory factor analysis supported a two-factor model reflecting correlated Wanting and Liking scales. Consistent with predictions, Wanting, much more than Liking, had robust correlations with TTM severity, impulsiveness, difficulties in emotion regulation, psychiatric symptoms, and sleep dysfunction. The results suggest that the HPRS is a psychometrically sound instrument that can be used as a symptom-level measure of reward processing in TTM.

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Funding

The research reported in this publication was supported by the National Institute of Mental Health T32MH073517 research support and K23MH113884 grant funding to Dr. Ricketts, and UL1TR000124 grant funding to Dr. Rozenman. The content is the responsibility of the authors and is not necessarily representative of the views of the National Institutes of Health.

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  1. Ivar Snorrason

    Present address: Behavioral Health Partial Program, McLean Hospital, Belmont, MA, USA

  2. Ivar Snorrason

    Present address: Department of Psychiatry, Harvard Medical School, Boston, MA, USA

Authors and Affiliations

  1. Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA

    Ivar Snorrason

  2. Department of Psychiatry, Columbia University Medical Center, New York, NY, USA

    Ivar Snorrason

  3. Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA

    Emily J. Ricketts, Michelle Rozenman, Christopher S. Colwell & John Piacentini

  4. Department of Psychology, University of Iceland, Reykjavik, Iceland

    Ragnar P. Olafsson

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  1. Ivar Snorrason
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Correspondence to Ivar Snorrason.

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Ivar Snorrason, Emily J. Ricketts, Ragnar P. Olafsson, Michelle Rozenman, Christopher S. Colwell, and John Piacentini declare no potential conflict of interest.

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Snorrason, I., Ricketts, E.J., Olafsson, R.P. et al. Disentangling Reward Processing in Trichotillomania: ‘Wanting’ and ‘Liking’ Hair Pulling Have Distinct Clinical Correlates. J Psychopathol Behav Assess 41, 271–279 (2019). https://doi.org/10.1007/s10862-018-9712-4

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