(PS7-1) A Contextual Analysis of Hair-pulling in Trichotillomania Using Descriptive Ecological Momentary Assessment Data

Abstract Text:

Introduction: Trichotillomania (TTM) is characterized by recurrent hair-pulling, often influenced by emotional and environmental factors (Grant and Chamberlain, 2016). Individuals with TTM may engage in pulling automatically (i.e., with little awareness), or in a more focused manner to regulate emotions such as stress, boredom, or anxiety (Flessner et al, 2008). Research on TTM is critical due to its chronic nature, high rates of comorbidity with anxiety and depressive disorders, and significant impact on daily functioning and quality of life (Grant et al., 2016). Prevalence rates of TTM hover around 1-3% (Thomson et al., 2022), which makes data collection with large samples difficult. As such, real-world data on the contextual triggers of hair-pulling episodes remains limited. Ecological momentary assessment (EMA) allows for real-time data collection, providing a more precise understanding of behavioral patterns. The present study provides an in-depth descriptive look at self-reported hair-pulling severity, emotional state, and environmental context using EMA in individuals with TTM.

Methods: Data were obtained from a six-week EMA study focused on real-time hair-pulling in 40 adults with TTM. For the present analyses, participants were excluded if they withdrew from the study early or had a survey compliance rate < 33% (final N=27). Participants were prompted to report on hair-pulling episodes four times daily during a pre-determined window (i.e., random notifications 8a-noon, 12-4p, 4-8p, and 8-midnight). Each survey captured self-reported hair-pulling episode severity, concurrent activities, emotional states, and hair-pulling method (e.g., fingers, tweezers). Measures of TTM severity administered at baseline and after six weeks included the self-report Massachusetts General Hospital Hairpulling Scale (MGH-HS).

Results: Participants’ ages ranged from 19 to 71 (Mage = 37; primarily female and White, Non-Hispanic/Latino). On average across the six-week period, 30% of participants reported more than one pulling episode per day (MMGH at baseline = 17.1), 48% reported one episode per day (M MGH = 16.8), and 22% reported less than one episode per day (MMGH = 14.5). Most (89%) participants reported at least one pulling episode while getting ready, relaxing, and working. Relaxing was reported as the most frequent activity while pulling for 30% of participants. Most (93%) participants reported feeling anxious and tired at least once while pulling. Tiredness was reported as the most frequent mood while pulling for 33% of participants.

Discussion: These findings highlight the importance of emotional and environmental contexts in hair-pulling, suggesting that both internal and external triggers can influence TTM symptoms. EMA provides a nuanced understanding of TTM beyond traditional self-report measures. Future research should explore individualized patterns of TTM symptoms and examine how these contextual influences interact with other neurocognitive and behavioral factors.