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Cross-Sectional Study of Women with Trichotillomania: A Preliminary Examination of Pulling Styles, Severity, Phenomenology, and Functional Impact

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Abstract

The current study utilized a cross-sectional design to examine pulling severity, phenomenology, functional impact, and “focused” and “automatic” pulling styles in women with TTM across a wide age spectrum. “Automatic” pulling refers to pulling occurring primarily out of one’s awareness, while “focused” pulling refers to pulling with a compulsive quality that may include pulling in response to a negative emotional state (e.g., anxiety, stress, anger, etc.), an intense thought or urge, or in an attempt to establish symmetry. In the present study, data were collected from 1,471 female participants (age 10–69) meeting modified diagnostic criteria for TTM via two separate online surveys (one for children/adolescents, one for adults). Pulling severity remained stable across the different developmental cohorts. However, fluctuations in functional impact (e.g., social and interpersonal impairment) were noted. “Automatic” pulling showed relatively little fluctuation from adolescence to adulthood, while “focused” pulling demonstrated considerable fluctuation coinciding with psychological distress and typical ages of important biological changes (e.g., pubertal onset) in children/adolescents and adults (e.g., perimenopause). Conclusions, treatment implications, limitations, and future areas of research are discussed.

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Acknowledgments

This project was funded by the Trichotillomania Learning Center (TLC). We would like to thank the participants for their assistance on this project.

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Authors and Affiliations

  1. Department of Psychology, Bradley/Hasbro Research Clinic, University of Wisconsin-Milwaukee, Coro West Building, 2nd floor, 1 Hoppin St., Providence, RI, 02915, USA

    Christopher A. Flessner & Douglas W. Woods

  2. Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Martin E. Franklin

  3. Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Nancy J. Keuthen

  4. Semel Institute for Neuroscience and Human Behavior, University of California-Los Angeles, Los Angeles, CA, USA

    John Piacentini

Authors
  1. Christopher A. Flessner
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  2. Douglas W. Woods
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  3. Martin E. Franklin
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  4. Nancy J. Keuthen
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  5. John Piacentini
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Correspondence to Christopher A. Flessner.

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Flessner, C.A., Woods, D.W., Franklin, M.E. et al. Cross-Sectional Study of Women with Trichotillomania: A Preliminary Examination of Pulling Styles, Severity, Phenomenology, and Functional Impact. Child Psychiatry Hum Dev 40, 153–167 (2009). https://doi.org/10.1007/s10578-008-0118-5

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  • DOI: https://doi.org/10.1007/s10578-008-0118-5

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