Trichotillomania: Internal and External Cues in the Investigation of Hair Pulling Modalities

Objective: The current study was exploratory and utilized a large, diverse Internet sample to evaluate the affective, cognitive, and environmental hair pulling cue modalities of the Comprehensive Behavioral Model (ComB model) of trichotillomania (TTM). The study aims were to (1) examine hair-pulling cues in the context of the demographic variables of the study sample and hair pulling episodes, and (2) explore the co-occurrence of internal and external hair pulling cues within individual hair pulling episodes.
Participants and Methods: Participants were 1,934 users of StopPulling.com, a self-help website for decreasing hair-pulling behavior. Information about thoughts, emotions, and activities individuals experienced in 16,594 hair-pulling episodes was analyzed. Results and Conclusions: Frequencies and descriptive analyses revealed that thoughts justifying hair-pulling behavior, anxiety, and intellectual activities are the most commonly experienced hair-pulling cues. Chi-square analyses revealed an overall significant association between internal and external hair-pulling cues and an overall significant effect of age of onset, gender, and ethnicity on hair pulling cues. Regression results revealed a high impact of types of cognitions experienced and activities and behaviors related to focused hair pulling behavior (e.g., grooming). Neutral affect was sometimes more important for hair pulling behavior than positive or negative affect, indicating that affect regulation may not be pertinent in all hair pulling scenarios.