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Hairpulling, also known as trichotillomania, is a body-focused repetitive behaviour (BFRB) that typically begins in early adolescence. Hairpulling can happen from anywhere on the body, including the scalp, eyelashes and eyebrows.
The new paper, published in JCPP Advances, looked at the severity of hairpulling, and the symptoms of depression and anxiety in 128 adolescents aged 13-18 years old who pull their hair. Study participants filled out an online survey. Despite adolescence being a critical age for the emergence of hairpulling, most research has focused on adults, leading to a gap in understanding.
Researchers, supported by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre and NIHR Applied Research Collaboration Oxford and Thames Valley, found that young people who self-identified with hair pulling disorder had high levels of shame, depression and anxiety. That shame significantly predicted anxiety and depression symptoms like low mood, loneliness, feeling nervous and on edge.
Study co-author Professor Clare Mackay shared her personal experience of BFRBs, and organised the first ever Oxford BFRB conference last year. She said:
Many of us with BFRBs know that shame plays a huge role, so it is no surprise that it shows up strongly in this group. What is important is that we have demonstrated that shame is already prevalent in young people aged 13-18, and that it strongly relates to depression and anxiety.”
The study also found being in a trance-like state during hair pulling was very common, with 88% of study participants reporting they were in a trance-like state when pulling their hair at least some of the time. 64% said they usually or always pull their hair without realising they are doing it.
Professor Mackay said: “We've also demonstrated that the trance-like state is experienced by nearly all of our young people. This is important because interventions need to consider how to help during times when there is little, or no, conscious control.”
Co-author of the paper, Associate Professor Polly Waite from the Department of Experimental Psychology, said:
Our research results suggests that negative self-evaluation plays a crucial role in maintaining hairpulling and co-occurring symptoms. Therapeutic interventions which reduce shame and enhance the ability to accept distressing internal experiences may be important in clinical approaches to adolescent hairpulling.”
One of the drivers of shame is stigma, which is why raising awareness of BFRBs is so important. Professor Mackay recently spoke about BFRBs to Oxford Sparks and the American Psychological Association’s ‘Psychology Speaks’ podcast.