Think about your teenage self and every part you needed to navigate: rising independence, altering physiology, and robust feelings, simply to call just a few. Consider the disgrace that may usually be felt as a part of this and the way intense this will really feel for 14-year-old you. Now, add to this the truth that you’ve gotten trichotillomania, also referred to as hairpulling dysfunction. Not solely are you navigating the everyday challenges of adolescence, however you’ve gotten additionally began to compulsively pull your hair.
Trichotillomania is a body-focused repetitive behaviour (BFRB) that includes the compulsive pulling of 1’s personal hair and sometimes emerges in early adolescence (Christensen et al., 2023). Roughly 1% of adolescents have clinically diagnosable trichotillomania, with a lot increased numbers estimated for hairpulling behaviours inside the common inhabitants (Grzesiak et al., 2017; Moreno-Amador et al., 2023). Melancholy and anxiousness generally co-occur with trichotillomania, with estimates of comorbidity starting from ~10-40% (Grant et al., 2020; Lochner et al., 2019). It’s at present unclear what psychological mechanisms underpin the connection between trichotillomania, melancholy, and anxiousness. The most typical explanations are emotion regulation (Roberts et al., 2013) and the excellent behavioural mannequin (ComB) of hairpulling (Mansueto et al., 1997). Inside each fashions, destructive feelings and self-evaluation are key. Not solely are destructive self-evaluative feelings integral to the onset and upkeep of hairpulling, however they’ve additionally been linked to each melancholy and anxiousness. One such destructive emotion is disgrace.
Disgrace is characterised by the expertise of self-conscious and self-condemning feelings by means of which a person scrutinises and negatively evaluates themselves, in addition to their behaviour (Noble et al., 2017). Disgrace is a generally reported feeling amongst hairpullers and has been linked to larger symptom severity, in addition to melancholy and anxiousness. But regardless of the hyperlink between disgrace and symptom severity, and the important thing position of adolescence within the onset and upkeep of hairpulling, there was little to no analysis inspecting the position of disgrace in adolescent hairpullers. That is the place Mayerson et al. (2025) are available.
Hairpulling usually begins in early adolescence, with estimates that 1% of adolescents have clinically diagnosable hairpulling dysfunction. This statistic is way increased for hairpulling behaviours typically.
Strategies
To be taught extra concerning the phenomenology of hairpulling in adolescents and to discover the position of disgrace in adolescent hairpulling and co-occurring melancholy and anxiousness, Mayerson and colleagues (2025) employed a cross-sectional survey design. They recruited a community-based pattern through social media, BFRB boards and charity web sites. Contributors accomplished 5 on-line questionnaires, the primary of which was created by the authors particularly for this research. The authors selected to create their very own measure of hairpulling phenomenology, drawing from their very own lived expertise and views from hairpullers mirrored in qualitative research. The actual focus of this was to ascertain the prevalence of ‘trance’ pulling, completely different from beforehand documented ‘computerized’ pulling, a generally researched however disputed subtype of trichotillomania. The remaining questionnaires had been established measures of hairpulling severity in kids, disgrace, melancholy and anxiousness.
Outcomes
One-hundred and twenty-eight individuals accomplished the survey, aged between 13-18 (M = 16.8, SD = 1.3), with 78.9% figuring out as feminine and 50% figuring out as white. Most individuals had been from the UK (43.8%), adopted by North America (33.6%).
The phenomenology of hairpulling in adolescents
Adolescents most often pulled from their scalp (75%), adopted by the pubic space (57%), with most individuals reporting pulling from a number of websites (80.5%). When it comes to pulling model, roughly half reported ‘often’ or ‘at all times’ pulling with out realising and over three-quarters ‘often’ or ‘at all times’ particularly searched out hairs with a selected feeling to tug. For post-pulling rituals, over three-quarters at the least ‘often’ appeared on the hair or root afterwards and two-thirds both ‘often’ or ‘usually’ rubbed the hair or root afterwards.
A novel side to this analysis was exploring the trance-like nature of hairpulling, which is a core characteristic of trichotillomania. On this pattern, 88% reported pulling in a trance at the least ‘a number of the time’ and 61.8% reported that they skilled this ‘often’ or ‘at all times’. This makes trance-pulling extra prevalent than a number of different generally mentioned hairpulling options and probably the most frequent phenomenological experiences reported.
The mediating position of disgrace
Regression and mediation analyses discovered that:
- Disgrace (r = 0.339), melancholy (r = 0.355), and anxiousness (r = 0.266) all considerably positively correlated with hairpulling symptom severity in adolescents
- Disgrace considerably positively correlated with anxiousness (r = 0.472) and melancholy (r = 0.620)
- Disgrace partially mediated the connection between hairpulling severity and melancholy
- Disgrace totally mediated the connection between hairpulling severity and anxiousness
These findings reveal that increased ranges of hairpulling severity are related to increased ranges of disgrace and melancholy, and that disgrace partially mediates the connection between melancholy and symptom severity. This implies that disgrace explains a number of the relationship between how extreme hairpulling is and the way extreme melancholy is in adolescents – however not all. That is in distinction to findings in relation to anxiousness, the place disgrace totally defined the connection between anxiousness and hairpulling severity.
88% of individuals reported hairpulling in a trance-like state, with 61.8% reporting that they often or at all times hairpulled on this means.
Conclusions
Mayerson et al. (2025) discovered that in adolescents, disgrace seems to play a job within the relationship between hairpulling and co-occurring anxiousness and melancholy. The partial mediation for melancholy signifies that disgrace is essential however different mechanisms are probably additionally concerned. Curiously, nevertheless, the complete mediation between anxiousness and hairpulling severity implies that this relationship might be defined by emotions of disgrace.
Moreover, findings from this research recommend that the phenomenology of hairpulling in adolescents is extremely akin to that of grownup hairpulling. Importantly, the authors additionally discovered compelling proof for trance-pulling in adolescents, distinct from low consciousness or ‘computerized’ pulling, suggesting the generally described ‘subtypes’ (‘computerized’ vs ‘targeted’ pulling) of trichotillomania might not be correct classifications of the situation.
On this research, disgrace totally mediated the connection between anxiousness and hairpulling severity in adolescents, however solely partially mediated the connection between melancholy and hairpulling severity.
Strengths and limitations
There are a number of strengths to this research, most notably that it offers novel analysis in a largely underneath researched space. By inspecting hairpulling phenomenology and the psychological position of disgrace in adolescents, a inhabitants notably absent from a lot of the prevailing BFRB literature, the research makes a invaluable contribution to analysis on trichotillomania. An extra power is the use of lived expertise to information the analysis. Utilizing qualitative information and the lived expertise of the analysis group provides to the ecological validity of this research, serving to to construct our understanding of hairpulling from the angle of those who truly pull their hair, fairly than from scientists seeking to clarify behaviour they see however don’t really feel. In such an underneath researched space it’s important to attract on the lived expertise of people with trichotillomania to deepen our understanding of the situation in a significant means.
Nevertheless, the power of this analysis can be a possible limitation. The introduction of a novel hairpulling phenomenology questionnaire allowed the authors to entry experiences, reminiscent of trance-pulling, that aren’t effectively captured by current measures. Nevertheless, with out psychometric validation, these findings are finest understood as descriptive fairly than definitive. The prominence of trance-pulling within the outcomes is theoretically intriguing, however its interpretation is essentially provisional. To deal with this future analysis might goal to check the assemble validity and inside reliability of the brand new scale.
One last level to think about is how the recruitment course of might have formed the pattern. The retained pattern was recruited predominantly through Reddit and Instagram, largely by means of BFRB‑particular on-line communities and influencer‑linked content material. This implies that the findings might disproportionately mirror the experiences of adolescents already engaged with hairpulling‑associated on-line areas, who might have increased severity signs and/or have extra consciousness of their very own hairpulling. Future analysis might goal to recruit a wider pattern from the overall adolescent inhabitants. Prevalence of hairpulling behaviours is more likely to be increased there, and a broader pattern would additionally seize younger folks with low-severity pulling who don’t but recognise it as a situation.
A power and a limitation of this analysis is the introduction of a novel hairpulling phenomenology measure. By designing it primarily based on lived expertise, it probably extra precisely represents the experiences of these with trichotillomania. Conversely, its novelty means it hasn’t been psychometrically examined.
Implications for observe
Returning to that imagined 14‑yr‑previous model of your self, the findings of this research really feel significantly significant. This analysis means that for a lot of adolescents who hairpull, disgrace isn’t merely an unlucky by‑product of the behaviour, however a psychologically energetic course of that will form emotional misery and co‑occurring anxiousness and melancholy. For that younger particular person, this issues.
In observe, these findings invite a shift in emphasis for therapy of trichotillomania in adolescents. Presently, interventions for adolescent hairpulling have usually prioritised behavioural management (e.g., behavior reversal coaching), changing into extra conscious of pulling, interrupting the behaviour, and studying competing responses (Rahman et al., 2017). Whereas these methods might be useful, this proof means that specializing in behaviour alone dangers overlooking the emotional processes that will maintain misery. If disgrace performs a central position in how hairpulling feels and the way it connects to broader psychological well being difficulties, then interventions that explicitly handle disgrace, self‑criticism, and self‑analysis could also be essential. This may occasionally embrace larger integration of compassion‑targeted, acceptance‑primarily based, or emotion‑regulation approaches alongside behavioural work. Certainly, there are some early indicators of analysis that exhibits some efficacy to taking such an strategy with grownup trichotillomania (Ong et al., 2023) and thus would warrant additional exploration.
The findings additionally spotlight the significance of how clinicians discuss hairpulling with younger folks. Framing hairpulling purely as one thing to be “stopped” or “managed” might inadvertently reinforce disgrace, significantly for adolescents who expertise pulling as trance‑like and tough to interrupt. Normalising the emotional context of hairpulling, acknowledging the lack of management many younger folks report, and creating house to debate disgrace overtly might already characterize a significant shift in observe.
The research additionally opens essential avenues for future analysis. Longitudinal work is required to know how disgrace, hairpulling, anxiousness, and melancholy affect each other over time, and whether or not decreasing disgrace by means of therapeutic intervention reduces hairpulling severity for adolescents. Additional improvement and validation of measures capturing phenomenological experiences reminiscent of trance-pulling would additionally permit these experiences to be built-in extra totally into concept and therapy.
For that youthful imagined self, this analysis presents one thing quietly highly effective: a reframing. Hairpulling isn’t merely a foul behavior or a failure of management, however an expertise embedded in emotion, vulnerability, and self‑analysis. Recognising this doesn’t instantly resolve the issue, but it surely does provide a extra compassionate and probably simpler place to start.
Interventions for trichotillomania in adolescents might give attention to decreasing disgrace fairly than focusing solely on the behaviour of hairpulling, which dangers overlooking the underlying emotional processes behind a drastically misunderstood situation.
Assertion of pursuits
Courtney Taylor Browne Luka has no conflicts of curiosity to declare.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major paper
Talia Mayerson, Clare Mackay, & Polly Waite. (2025). The mediating position of disgrace within the relationship between adolescent hairpulling and co‐occurring anxiousness and depressive symptomology. JCPP Advances, e70041. https://doi.org/10.1002/jcv2.70041
Different references
Christensen, R. E., Tan, I., & Jafferany, M. (2023). Current advances in trichotillomania: A story overview. Acta Dermatovenerologica Alpina, Pannonica, Et Adriatica, 32(4), 151–157.
Grant, J. E., Dougherty, D. D., & Chamberlain, S. R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Analysis, 288, 112948. https://doi.org/10.1016/j.psychres.2020.112948
Grzesiak, M., Reich, A., Szepietowski, J. C., Hadryś, T., & Pacan, P. (2017). Trichotillomania Amongst Younger Adults: Prevalence and Comorbidity. Acta Dermato-Venereologica, 97(4), Article 4. https://doi.org/10.2340/00015555-2565
Lochner, C., Keuthen, N. J., Curley, E. E., Tung, E. S., Redden, S. A., Ricketts, E. J., Bauer, C. C., Woods, D. W., Grant, J. E., & Stein, D. J. (2019). Comorbidity in trichotillomania (hair-pulling dysfunction): A cluster analytical strategy. Mind and Conduct, 9(12), e01456. https://doi.org/10.1002/brb3.1456
Mansueto, C. S., Townsley Stemberger, R. M., McCombs Thomas, A., & Goldfinger Golomb, R. (1997). Trichotillomania: A complete behavioral mannequin. Medical Psychology Evaluate, 17(5), 567–577. https://doi.org/10.1016/S0272-7358(97)00028-7
Moreno-Amador, B., Cervin, M., Falcó, R., Marzo, J. C., & Piqueras, J. A. (2023). Physique-dysmorphic, hoarding, hair-pulling, and skin-picking signs in a big pattern of adolescents. Present Psychology, 42(28), 24542–24553. https://doi.org/10.1007/s12144-022-03477-1
Noble, C. M., Gnilka, P. B., Ashby, J. S., & McLaulin, S. E. (2017). Perfectionism, Disgrace, and Trichotillomania Signs in Medical and Nonclinical Samples. Journal of Psychological Well being Counseling, 39(4), 335–350. https://doi.org/10.17744/mehc.39.4.05
Ong, C. W., Woods, D. W., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Twohig, M. P. (2023). The position of psychological flexibility in acceptance-enhanced conduct remedy for trichotillomania: Moderation and mediation findings. Behaviour Analysis and Remedy, 164, 104302. https://doi.org/10.1016/j.brat.2023.104302
Rahman, O., McGuire, J., Storch, E. A., & Lewin, A. B. (2017). Preliminary Randomized Managed Trial of Behavior Reversal Coaching for Therapy of Hair Pulling in Youth. Journal of Little one and Adolescent Psychopharmacology, 27(2), 132–139. https://doi.org/10.1089/cap.2016.0085
Roberts, S., O’Connor, Okay., & Bélanger, C. (2013). Emotion regulation and different psychological fashions for body-focused repetitive behaviors. Medical Psychology Evaluate, 33(6), 745–762. https://doi.org/10.1016/j.cpr.2013.05.004
Discussion about this post