{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:32:33Z","timestamp":1792099953283,"version":"4.4.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T00:00:00Z","timestamp":1625443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Trichotillomania (TTM) has been associated with childhood trauma and perceived stress. While it has been hypothesized that hair-pulling regulate negative emotions, the relationship between childhood trauma, perceived stress, emotion regulation, and hair-pulling has not been well-studied.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Fifty-six adults with TTM and 31 healthy controls completed the Childhood Trauma Questionnaire (CTQ), Perceived Stress Scale (PSS), and Difficulties in Emotion Regulation Scale (DERS). Hair-pulling severity was measured with the Massachusetts General Hospital-Hair Pulling Scale. CTQ, PSS, and DERS total scores were compared across groups using ANCOVA and the correlation between hair-pulling severity and emotion dysregulation was determined. Regression analyses were used to estimate the association of CTQ and PSS totals with DERS, and to determine whether associations between predictors and dependent variable (DERS) differed across groups.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> TTM patients reported higher rates of childhood trauma (<jats:italic>p<\/jats:italic> &amp;lt;= 0.01), perceived stress (<jats:italic>p<\/jats:italic> = 0.03), and emotion dysregulation (<jats:italic>p<\/jats:italic> &amp;lt;= 0.01). There was no association between emotion dysregulation and pulling severity (<jats:italic>r<\/jats:italic> = \u22120.02, <jats:italic>p<\/jats:italic> = 0.89). Perceived stress was associated with emotion dysregulation in both groups (<jats:italic>p<\/jats:italic> &amp;lt; 0.01), and no association between childhood trauma and emotion dysregulation in either group. Perceived stress was the only significant predictor of emotion dysregulation in both groups (<jats:italic>F<\/jats:italic> = 28.29, <jats:italic>p<\/jats:italic> &amp;lt; 0.01).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The association between perceived stress and emotion dysregulation is not specific to TTM, and there is no association between emotion dysregulation and hair-pulling severity, suggesting that key factors other than emotion dysregulation contribute to hair-pulling. Alternative explanatory models are needed.<\/jats:p>","DOI":"10.3389\/fpsyg.2021.675468","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T04:42:08Z","timestamp":1625460128000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Hair-Pulling Does Not Necessarily Serve an Emotion Regulation Function in Adults With Trichotillomania"],"prefix":"10.3389","volume":"12","author":[{"given":"Christine","family":"Lochner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salome","family":"Demetriou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kidd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronwyn\u00e8","family":"Coetzee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan J.","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.jad.2017.11.035","article-title":"Emotion regulation deficits in persons with body-focused repetitive behavior disorders","volume":"227","author":"Alexander","year":"2018","journal-title":"J. Affect. Disord."},{"key":"B2","year":"2013","journal-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jocrd.2017.01.003","article-title":"Emotion regulation in individuals with and without trichotillomania","volume":"12","author":"Arabatzoudis","year":"2017","journal-title":"J. Obsess. Compulsive Rel. Disord."},{"key":"B4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/s0145-2134(02)00541-0","article-title":"Development and validation of a brief screening version of the childhood trauma questionnaire","volume":"27","author":"Bernstein","year":"2003","journal-title":"Child Abuse Negl."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1176\/appi.ajp.163.7.1282","article-title":"Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania","volume":"163","author":"Chamberlain","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/j.jocrd.2016.04.005","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J. Health Soc. Behav."},{"key":"B7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jocrd.2016.04.005","article-title":"Trait anger, anger expression, and anger control in trichotillomania: Evidence for the emotion regulation model","volume":"9","author":"Curley","year":"2016","journal-title":"J. Obsess. Compulsive Rel. Disord."},{"key":"B8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jbtep.2006.09.002","article-title":"Emotion regulation and trichotillomania: a comparison of clinical and nonclinical hair pulling","volume":"39","author":"Diefenbach","year":"2008","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1053\/comp.2001.24586","article-title":"Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview","volume":"42","author":"Du Toit","year":"2001","journal-title":"Compr. Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.cpr.2009.10.008","article-title":"Trichotillomania: a current review","volume":"30","author":"Duke","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"B11","volume-title":"Structured Clinical Interview for DSM-IV Axis I Disorders - Patient Edition (SCID-I\/P).","author":"First","year":"1998"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1002\/jclp.20303","article-title":"Current posttraumatic stress disorder and history of trauma in trichotillomania","volume":"62","author":"Gershuny","year":"2006","journal-title":"J. Clin. Psychol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.euroneuro.2015.12.033","article-title":"The role of habit in compulsivity","volume":"26","author":"Gillan","year":"2016","journal-title":"Eur. Neuropsychopharmacol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/cdep.12307","article-title":"Trauma and long-term memory for childhood events: impact matters","volume":"13","author":"Goodman","year":"2019","journal-title":"Child Dev. Perspect."},{"key":"B15","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1176\/appi.ajp.2016.15111432","article-title":"Trichotillomania","volume":"173","author":"Grant","year":"2016","journal-title":"Am. J. Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.jocrd.2015.02.001","article-title":"Body focused repetitive behaviour disorders and perceived stress: Clinical and cognitive associations","volume":"5","author":"Grant","year":"2015","journal-title":"J. Obsess. Compuls. Rel. Disord."},{"key":"B17","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1023\/B:JOBA.0000007455.08539.94","article-title":"Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale","volume":"26","author":"Gratz","year":"2004","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"B18","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1037\/\/0022-3514.74.1.224","article-title":"Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology","volume":"74","author":"Gross","year":"1998","journal-title":"J. Pers. Soc. Psychol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.clindermatol.2011.11.015","article-title":"Emotional regulation, dissociation, and the self-induced dermatoses: clinical features and implications for treatment with mood stabilizers","volume":"31","author":"Gupta","year":"2013","journal-title":"Clin. Dermatol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"539","DOI":"10.3389\/fpsyg.2018.00539","article-title":"Psychometric properties of the difficulties in emotion regulation scale (DERS) and its short forms in adults with emotional disorders","volume":"9","author":"Hallion","year":"2018","journal-title":"Front. Psychol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/0006-8993(95)00788-r","article-title":"Social stress increases the acquisition of cocaine self-administration in male and female rats","volume":"698","author":"Haney","year":"1995","journal-title":"Brain Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jocrd.2016.09.003","article-title":"Trauma and trichotillomania: a tenuous relationship","volume":"11","author":"Houghton","year":"2016","journal-title":"J. Obsess. Compuls. Rel. Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.copsyc.2017.06.013","article-title":"Aging and emotions: experience, regulation, and perception","volume":"17","author":"Isaacowitz","year":"2017","journal-title":"Curr. Opin. Psychol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1159\/000289003","article-title":"The Massachusetts general hospital (MGH) hairpulling scale: 1. Development and factor analyses","volume":"64","author":"Keuthen","year":"1995","journal-title":"Psychother. Psychosomat."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1556\/JBA.1.2012.003","article-title":"DBT-enhanced cognitive-behavioral treatment for trichotillomania : A randomized controlled trial","volume":"1","author":"Keuthen","year":"2012","journal-title":"J. Behav. Addict."},{"key":"B26","doi-asserted-by":"publisher","first-page":"10028","DOI":"10.1002\/da.10028","article-title":"Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls","volume":"15","author":"Lochner","year":"2002","journal-title":"Depress. Anxiety"},{"key":"B27","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.comppsych.2004.03.010","article-title":"Dissociative experiences in obsessive-compulsive disorder and trichotillomania: clinical and genetic findings","volume":"45","author":"Lochner","year":"2004","journal-title":"Compr. Psychiatry"},{"key":"B28","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1177\/0145445508326260","article-title":"Affective and sensory correlates of hair pulling in pediatric trichotillomania","volume":"33","author":"Meunier","year":"2009","journal-title":"Behav. Modif."},{"key":"B29","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1093\/ageing\/afv078","article-title":"Do levels of perceived stress increase with increasing age after age 65? A population-based study","volume":"44","author":"Osmanovic-Thunstr\u00f6m","year":"2015","journal-title":"Age Ageing"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.2147\/NDT.S79554","article-title":"The relationship of psychological trauma with trichotillomania and skin picking","volume":"11","author":"\u00d6zten","year":"2015","journal-title":"Neuropsychiatr. Dis. Treatment"},{"key":"B31","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.jbtep.2014.10.007","article-title":"The impact of emotions on body-Focused repetitive behaviors: evidence from a non-treatment-seeking sample","volume":"46","author":"Roberts","year":"2015","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"B32","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/j.cpr.2013.05.004","article-title":"Emotion regulation and other psychological models for body-focused repetitive behaviors","volume":"33","author":"Roberts","year":"2013","journal-title":"Clin. Psychol. Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.psychres.2014.03.029","article-title":"Trichotillomania and emotion regulation: is symptom severity related to alexithymia?","volume":"218","author":"Rufer","year":"2014","journal-title":"Psychiatry Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/j.brat.2009.04.004","article-title":"Affective regulation in trichotillomania: Evidence from a large-scale internet survey","volume":"47","author":"Shusterman","year":"2009","journal-title":"Behav. Res. Ther."},{"key":"B35","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/09595230601036960","article-title":"Imaging stress- and cue-induced drug and alcohol craving: association with relapse and clinical implications","volume":"26","author":"Sinha","year":"2007","journal-title":"Drug Alcohol Rev."},{"key":"B36","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1017\/s1092852900014978","article-title":"An A-B-C model of habit disorders: hair-pulling, skin-picking, and other stereotypic conditions","volume":"11","author":"Stein","year":"2006","journal-title":"CNS Spectr."},{"key":"B37","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jpsychires.2015.12.020","article-title":"Affective regulation in trichotillomania before and after self-help interventions","volume":"75","author":"Weidt","year":"2016","journal-title":"J. Psychiatr. Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.4088\/jcp.v67n1207","article-title":"The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization","volume":"67","author":"Woods","year":"","journal-title":"J. Clin. Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1016\/j.brat.2005.05.006","article-title":"A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania","volume":"44","author":"Woods","year":"","journal-title":"Behav. Res. Ther."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.675468\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T04:42:11Z","timestamp":1625460131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.675468\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,5]]},"references-count":39,"alternative-id":["10.3389\/fpsyg.2021.675468"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2021.675468","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,5]]},"article-number":"675468"}}