How Does Impulsivity Affect Adolescent Girls with Hair-Pulling Disorder?

What you need to know

• Adolescent girls with trichotillomania (hair-pulling disorder) show higher levels of impulsivity and more difficulty with motor control compared to their peers without the disorder.
• Girls with trichotillomania tend to make riskier decisions and have more symptoms of anxiety and depression than girls without the disorder.
• Social anxiety symptoms were the strongest predictor of trichotillomania severity, suggesting that addressing social anxiety may be important in treatment.
• Impulsivity levels were not directly related to the severity of hair-pulling symptoms, indicating other factors may be more important in maintaining the disorder.

Understanding trichotillomania

Trichotillomania, also known as hair-pulling disorder, is a mental health condition where a person repeatedly pulls out their own hair. This can lead to noticeable hair loss and bald patches. People with trichotillomania often try to stop pulling their hair but find it very difficult to do so. The disorder can cause significant distress and interfere with daily life.

Trichotillomania typically starts in the teenage years. It appears to be more common in females than males. The exact causes aren’t fully understood, but researchers believe both genetic and environmental factors play a role.

How impulsivity relates to trichotillomania

One aspect of trichotillomania that researchers have been interested in is impulsivity. Impulsivity refers to acting quickly without thinking through the consequences. Some key features of impulsivity include:

• Difficulty controlling urges or impulses
• Acting without considering negative outcomes
• Making hasty decisions
• Seeking immediate rewards

Previous research has found that adults with trichotillomania tend to be more impulsive than those without the disorder. However, less was known about impulsivity in adolescents with trichotillomania. This study aimed to examine different aspects of impulsivity in teenage girls with the disorder.

What the researchers did

The researchers recruited 23 adolescent girls diagnosed with trichotillomania and 20 girls without the disorder to serve as a comparison group. All of the girls were between 12-18 years old.

The girls completed several questionnaires and computer tasks designed to measure different aspects of impulsivity and decision-making:

• Self-report questionnaires on impulsivity, anxiety, and depression symptoms
• A task measuring motor impulsivity (ability to stop an action that’s already started)
• A task assessing interference control (ability to ignore distracting information)
• A balloon pumping game measuring risky decision-making

The researchers then compared the scores between the trichotillomania group and the comparison group.

Key findings on impulsivity

The study found several important differences between girls with trichotillomania and the comparison group:

Higher self-reported impulsivity

Girls with trichotillomania rated themselves as significantly more impulsive on questionnaires compared to girls without the disorder. This included reporting more difficulties with self-control and more impulsive behaviors.

Poorer motor control

On a computer task measuring the ability to stop an action that’s already in progress, girls with trichotillomania performed worse than the comparison group. This suggests they have more difficulty controlling motor impulses.

More risky decision-making

In a game measuring risk-taking, girls with trichotillomania made riskier choices compared to girls without the disorder. This indicates a tendency toward more impulsive decision-making.

No difference in interference control

Interestingly, there was no significant difference between the groups on a task measuring the ability to ignore distracting information. This suggests that not all aspects of impulse control are equally affected in trichotillomania.

Other key findings

In addition to the impulsivity results, the researchers found some other important differences between the groups:

Higher anxiety and depression

Girls with trichotillomania reported significantly more symptoms of anxiety and depression compared to girls without the disorder. This aligns with previous research showing that mood and anxiety disorders often co-occur with trichotillomania.

Social anxiety linked to symptom severity

Among girls with trichotillomania, higher levels of social anxiety were the strongest predictor of more severe hair-pulling symptoms. This suggests that fear of social situations may play an important role in maintaining or worsening trichotillomania symptoms.

Impulsivity not linked to symptom severity

Interestingly, the researchers did not find a direct link between levels of impulsivity and the severity of hair-pulling symptoms. This indicates that while girls with trichotillomania tend to be more impulsive overall, being more impulsive doesn’t necessarily mean having more severe symptoms.

What this means for understanding and treating trichotillomania

These findings provide several important insights into trichotillomania in adolescent girls:

1. Impulsivity appears to be a key feature of the disorder, particularly difficulties with motor control and risky decision-making. This suggests that treatments targeting impulse control may be helpful.

2. The strong link between social anxiety and symptom severity highlights the importance of addressing anxiety, particularly in social situations, as part of trichotillomania treatment.

3. The lack of connection between impulsivity and symptom severity indicates that other factors beyond impulse control are likely important in maintaining the disorder. This could include emotional regulation difficulties or habitual behaviors.

4. The high rates of anxiety and depression symptoms underscore the need to assess for and potentially treat these co-occurring issues in girls with trichotillomania.

Limitations and future directions

It’s important to note some limitations of this study:

• The sample size was relatively small, so the findings may not apply to all adolescents with trichotillomania.
• Only girls were included, so we can’t be sure if the results would be the same for boys with the disorder.
• The study only looked at one point in time, so we can’t draw conclusions about how impulsivity might change over time or with treatment.

Future research could address these limitations by:

• Including larger, more diverse samples of adolescents with trichotillomania
• Following participants over time to see how impulsivity and symptoms change
• Testing whether treatments targeting impulse control or social anxiety lead to improvements in trichotillomania symptoms

Conclusions

• Adolescent girls with trichotillomania show higher levels of impulsivity, particularly in motor control and risky decision-making.
• Social anxiety appears to be an important factor in trichotillomania severity and may be a key target for treatment.
• While impulsivity is a feature of trichotillomania, other factors likely play important roles in maintaining the disorder.
• Comprehensive assessment and treatment of trichotillomania should consider impulse control, anxiety (especially social anxiety), and co-occurring mood symptoms.