Background and aims: Limited treatment options are available for trichotillomania (TTM) and most have modest outcomes. Suboptimal treatment results may be due to the failure of existing approaches to address all TTM styles. Methods: Thirty-eight DSM-IV TTM participants were randomly assigned across two study sites to Dialectical Behavior Therapy (DBT) -enhanced cognitive-behavioral treatment (consisting of an 11-week acute treatment and 3-month maintenance treatment) or a minimal attention control (MAC) condition. MAC participants had active treatment after the 11-week control condition. Follow-up study assessments were conducted three and six months after the maintenance period. Results: Open trial treatment resulted in significant improvement in TTM severity, emotion regulation (ER) capacity, experiential avoidance, anxiety and depression with changes generally maintained over time. In the randomized controlled trial, those with active treatment had greater improvement than those in the MAC condition for both TTM severity and ER capacity. Correlations between changes in TTM severity and ER capacity were not reported at post-treatment but did occur in maintenance and follow-up indicating reduced TTM severity with improved ER capacity. Conclusions: DBT-enhanced cognitive-behavioral treatment is a promising treatment for TTM. Future studies should compare this approach to other credible treatment interventions and investigate the efficacy of this approach in more naturalistic samples with greater comorbidity.

We propose a model of healthy intentional emotion regulation that includes (1) a large repertoire of (2) adaptive strategies that (3) one persists with despite initial negative feedback. One hundred forty-four undergraduates (average age = 19.20 years; 68% female, 79% Caucasian) completed a novel performance task indicating what they would think or do to feel better in response to eleven stressful vignettes. After their initial response, participants indicated four more times how they would respond if their previous strategy was not working. Raters categorized each response as an emotion regulation strategy and coded the adaptiveness of each strategy. Participants self-reported Neuroticism, Extraversion, Conscientiousness, Borderline Personality Disorder (BPD) symptoms, and depressive symptoms. We regressed each personality dimension and psychopathology symptom on our model of healthy emotion regulation. Neuroticism was negatively associated with adaptiveness and persistence. Extraversion was positively associated with adaptiveness. Conscientiousness was positively associated with repertoire, adaptiveness, and persistence, while BPD symptoms were negatively associated with all three variables. Depressive symptoms were negatively associated with persistence. These preliminary findings suggest that people with larger repertoires of more adaptive emotion regulation strategies who persist with these strategies despite initial negative feedback report less personality pathology and psychological distress.

Little is known about the etiology of hair pulling (HP) and its relationship to other obsessive compulsive (OC) spectrum disorders. In a large-sample family study, we examined the familial aggregation of HP and co-transmission of obsessive compulsive disorder (OCD) and skin picking (SP). Our sample consisted of 110 proband cases with HP and 48 controls without HP, plus 128 first-degree case relatives and 50 first-degree control relatives. Case versus control relatives had higher recurrence risk estimates for both HP and OCD but not SP. The finding that HP is familial is consistent with the only existing twin study. Additional analyses suggest that there may be a familial subtype of HP with comorbid OCD. Those adult proband cases with HP + OCD had more anxiety and depression than cases without OCD. Probands with HP + OCD also had earlier onset of OCD. Identification of an HP subtype with comorbid OCD may have significant theoretical and treatment implications. The data did not provide evidence for an etiologic relationship between HP and SP. Replication of these findings in future studies with larger cohorts of case and control relatives is warranted.

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