What Beliefs Are Associated With Hair Pulling in Trichotillomania?

What you need to know

• A new scale called the Beliefs in Trichotillomania Scale (BiTS) was developed to measure beliefs and thought patterns associated with hair pulling.
• The BiTS identified three main types of beliefs related to trichotillomania: negative self-beliefs, perfectionism, and low coping efficacy.
• Negative self-beliefs were most strongly linked to hair pulling severity, even after accounting for depression and anxiety symptoms.
• Understanding these belief patterns may help improve cognitive-behavioral treatments for trichotillomania.

Understanding trichotillomania and associated beliefs

Trichotillomania, also known as hair pulling disorder, is a condition where a person feels strong urges to pull out their own hair, often resulting in noticeable hair loss. This can affect various body areas like the scalp, eyebrows, and eyelashes. While we know that behavior therapy can help reduce hair pulling, less is understood about how a person’s thoughts and beliefs may contribute to the disorder.

To explore this, researchers developed a new questionnaire called the Beliefs in Trichotillomania Scale (BiTS). They surveyed over 800 adults, some who reported problematic hair pulling and others who did not. By analyzing their responses, the researchers identified three main types of beliefs associated with trichotillomania:

1. Negative self-beliefs

This refers to having very critical or shame-based views about oneself. Examples include:

• Feeling uncomfortable with who you are
• Believing you are abnormal or defective compared to others
• Feeling embarrassed or ashamed about yourself

2. Perfectionism

This involves having very rigid standards and a strong need for things to be “just right.” Examples include:

• Never being satisfied with “good enough”
• Striving for perfection in everything you do
• Feeling a strong urge to fix anything perceived as imperfect

3. Low coping efficacy

This reflects a lack of confidence in one’s ability to handle stress and emotions effectively. Examples include:

• Believing you can’t cope with stress
• Feeling that you have no choice but to act on urges or impulses
• Wanting to avoid dealing with problems

How these beliefs relate to hair pulling severity

The researchers found that all three types of beliefs were associated with more severe hair pulling symptoms. However, negative self-beliefs showed the strongest connection to hair pulling, even after accounting for symptoms of depression and anxiety. This suggests that how a person views themselves may play an important role in trichotillomania, beyond just general emotional distress.

Interestingly, these belief patterns were linked more strongly to “focused” hair pulling - pulling done with awareness to regulate emotions - rather than “automatic” pulling done without much conscious awareness. This fits with the idea that certain thoughts or beliefs may trigger intentional hair pulling as a way to cope with distressing feelings.

Implications for treatment

Current behavioral treatments for trichotillomania often focus on increasing awareness of hair pulling urges and learning alternative behaviors. While effective for many, some people continue to struggle even after such treatments. The findings from this study suggest that addressing underlying belief patterns, especially negative views of oneself, could potentially enhance treatment outcomes.

Cognitive-behavioral therapy (CBT) approaches that specifically target shame, perfectionism, and building coping skills may be beneficial additions to trichotillomania treatment. For example, techniques that help challenge overly harsh self-judgments or unrealistic standards could complement behavioral strategies for reducing hair pulling.

It’s important to note that this study cannot tell us whether these belief patterns cause hair pulling or develop as a result of living with trichotillomania. It’s likely a complex relationship that goes both ways. However, recognizing and working on these thought patterns may still be a helpful part of managing the disorder.

Conclusions

• People with trichotillomania often experience negative beliefs about themselves, perfectionistic thinking, and doubts about their ability to cope.
• Negative self-beliefs appear to be especially relevant to hair pulling severity.
• Addressing these underlying thought patterns, in addition to behaviors, may improve treatment outcomes for trichotillomania.
• More research is needed to understand how these beliefs develop and interact with hair pulling symptoms over time.

If you or a loved one is struggling with trichotillomania, discussing these types of thoughts and beliefs with a mental health professional could be an important part of developing a comprehensive treatment plan. Remember that hair pulling is a complex disorder, and a combination of behavioral techniques and cognitive strategies is often most effective for managing symptoms.