How Common is Self-Injury in People with Hair Pulling and Skin Picking Disorders?

What you need to know

• About half of people with hair pulling or skin picking disorders report a history of non-suicidal self-injury
• Those with a history of self-injury tend to have more severe hair pulling/skin picking symptoms
• Self-injury in these disorders is associated with higher rates of other mental health and behavioral issues

Understanding hair pulling and skin picking disorders

Trichotillomania (hair pulling disorder) and skin picking disorder are conditions where people feel strong urges to pull out their hair or pick at their skin, often causing significant distress and problems in their lives. These behaviors are repetitive and can be difficult to control.

Historically, some researchers have viewed these disorders as forms of self-injury. However, the relationship between hair pulling/skin picking and more typical forms of self-harm, like cutting or burning oneself, hasn’t been well studied.

This research aimed to explore how common non-suicidal self-injury (NSSI) is among people with hair pulling and skin picking disorders, and how it might relate to other aspects of these conditions.

What is non-suicidal self-injury?

Non-suicidal self-injury refers to deliberately harming one’s body without intending to die. Common forms include cutting, burning, or hitting oneself. It’s important to note that in this study, hair pulling and skin picking were not considered forms of NSSI – the researchers were looking at other self-harming behaviors.

The study

The researchers surveyed 280 adults who had either trichotillomania, skin picking disorder, or both. Participants completed online questionnaires about their symptoms, mental health history, and whether they had ever engaged in NSSI.

Key findings

High rates of self-injury

The study found that about half (50.4%) of people with hair pulling or skin picking disorders reported a history of non-suicidal self-injury. This rate is much higher than what’s seen in the general population, where only about 5-6% of adults report a history of NSSI.

More severe symptoms

People who reported a history of self-injury tended to have more severe hair pulling or skin picking symptoms. This suggests that NSSI might be linked to more intense forms of these disorders.

Other mental health and behavioral issues

Those with a history of NSSI were more likely to have:

• Problems with alcohol use
• Symptoms of borderline personality disorder
• Compulsive buying behaviors
• Gambling problems
• Compulsive sexual behaviors
• Binge eating disorder

They also reported higher levels of dissociative symptoms, which involve feeling disconnected from one’s thoughts, feelings, or surroundings.

What might explain these findings?

The researchers propose several possible explanations for the high rates of self-injury and associated issues in people with hair pulling and skin picking disorders:

Impulse control difficulties

All of these behaviors – hair pulling, skin picking, and other forms of self-injury – might stem from a shared difficulty in controlling urges or impulses. This could point to underlying issues with the brain’s reward system or ability to regulate behavior.

Coping mechanisms

Some people might engage in self-injury as a way to cope with intense emotions or stress, similar to how hair pulling or skin picking can serve as maladaptive coping strategies.

Altered pain perception

People with trichotillomania and skin picking disorder often don’t report pain from their behaviors, even though they would likely be painful for others. This altered pain perception might extend to other forms of self-injury as well.

Personality factors

The link with borderline personality disorder symptoms suggests that for some people, hair pulling and skin picking might be related to broader issues with emotional regulation and identity.

Implications for treatment

These findings suggest that clinicians treating people for hair pulling or skin picking disorders should also screen for a history of self-injury and related mental health issues. Addressing these underlying factors might be crucial for effective treatment.

Some potential approaches that might be helpful include:

• Dialectical behavior therapy (DBT): Originally developed for borderline personality disorder, DBT focuses on improving emotional regulation and coping skills. Early studies have shown promise in using DBT techniques for trichotillomania.

• Targeting shared mechanisms: Treatments that focus on improving impulse control or addressing reward system dysfunction might be beneficial for people who struggle with both hair pulling/skin picking and other impulsive behaviors.

• Pain research: Further investigation into pain perception in this group could lead to new treatment approaches.

Limitations of the study

• The study relied on self-reported information, which can be less accurate than clinical evaluations.
• The survey only asked about lifetime history of self-injury, not current or recent behaviors.
• The sample was mostly female, so the findings might not apply equally to all genders.

Conclusions

• Non-suicidal self-injury is surprisingly common among people with hair pulling and skin picking disorders.
• This link to self-injury is associated with more severe symptoms and higher rates of other mental health and behavioral issues.
• These findings suggest that hair pulling and skin picking disorders might be more complex than previously thought, potentially involving broader issues with impulse control and emotion regulation.
• Clinicians should be aware of the potential for self-injury and related issues when treating people for hair pulling or skin picking disorders.
• Further research is needed to better understand the connections between these behaviors and develop more targeted treatments.