Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample

Abstract

Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders.

Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling

“…Hair pulling often involves one or more body areas and may take place for consecutive hours or shorter intervals that appear throughout the day. Pulling generally occurs when alone as opposed to social environments, and many studies have demonstrated that the vast majority of those suffering from trichotillomania report feelings of unattractiveness, humiliation, and low self-confidence (4).…”

The Beliefs in Trichotillomania Scale (BiTS): Factor analyses and preliminary validation

“…All participants were asked, ‘Over the past 12 months, have you experienced difficulties with pulling out your hair or urges to pull out your hair for non‐cosmetic purposes?’ Participants who responded affirmatively were classified as hair pulling participants, while those who responded negatively were classified as control participants. Similar procedures for sampling participants with and without non‐cosmetic hair pulling behaviours in online, student, and community settings have been utilized elsewhere (Bottesi et al ., ; Duke, Bodzin, Tavares, Geffken, & Storch, ; Duke, Keeley, Ricketts, Geffken, & Storch, ; Shusterman et al ., ). Of the 841 participants, 527 participants (62.7%) were classified as hair pulling participants.…”

Pubic trichotillomania in a beauty pageant contestant

“…Trichotillomania is an obsessive–compulsive related disorder characterized by irresistible urges to pull out hair, resulting in secondary alopecia and functional impairment. [ 1 ] Trichotillomania can affect any body area, although exclusive involvement of the pubic area is very infrequent. Trichotillomania is a major psychiatric disorder,[ 1 ] even though many patients may consult a dermatologist rather than a psychiatrist.…”

“…[ 1 ] Trichotillomania can affect any body area, although exclusive involvement of the pubic area is very infrequent. Trichotillomania is a major psychiatric disorder,[ 1 ] even though many patients may consult a dermatologist rather than a psychiatrist. Here, we present the case of a young woman with trichotillomania affecting exclusively the pubic area and who showed a good response to N-acetylcysteine and behavioral therapy.…”

“…However, pubic trichotillomania may be underreported: a recent study described pubic hair pulling in more than 40% of patients with trichotillomania when a nonpresential interview was carried out, suggesting that feelings of shame may lead to underreporting in face-to-face interviews. [ 1 ] Trichotillomania symptoms typically initiate in early adolescence and can cause a severe impact on the patient's quality of life, interfering with sentimental relationships, studying/working, and social life. Patients may present with low self-esteem, high social anxiety, a history of substance abuse, and major depressive disorders.…”