Trichotillomania (TTM) often first presents in adolescence, a developmental period marked by vulnerability in body image. To date, no one has studied the relationship between this disorder and body esteem.
49 adolescents with DSM-IV TTM or chronic hair pulling (HP) and 23 control adolescents were administered diagnostic assessments and self-report measures of hair pulling and body esteem.
HP youth vs. controls reported lower levels of body esteem on all Body-Esteem Scale for Adolescents and Adults (BESAA) subscales (appearance, attribution and weight satisfaction). HP contributed to lowered body esteem, independent of comorbid anxiety or depression. As expected, HP youth with vs. without comorbid anxiety or depression reported lowered levels of body esteem. Further, greater HP severity and distress were significantly associated with lower levels of body esteem. HP severity alone but not distress/impairment predicted lower levels of body esteem, independent of comorbid anxiety and depression.
Both hair pulling and comorbid anxiety and depression can independently impact body esteem in adolescent hair pullers.
A Bohne N Keuthen S Wilhelm 2005 Pathologic hairpulling, skin picking, and nail biting Annals of Clinical Psychiatry 17 4 227 232.
G A Christenson C S Mansueto 1999 Trichotillomania: Descriptive characteristics and phenomenology D J Stein G Christenson E Hollander Trichotillomania American Psychiatric Publishing Washington, DC.
J F Harper E Marshall 1991 Adolescents’ problems and their relationship to self-esteem Adolescence 26 104 799 808.
S Helfert P Warschburger 2013 The face of appearance-related social pressure: Gender, age and body mass variations in peer and parental pressure during adolescence Child and Adolescent Psychiatry and Mental Health 7 16.
T Ivarsson P Svalander O Litlere L Nevonen 2006 Weight concerns, body image, depression and anxiety in Swedish adolescents Eating Behaviors 7 161 175.
S R Jónsdóttir E O Arnarson J Smári 2008 Body esteem, perceived competence and depression in Icelandic adolescents Nordic Psychology 60 1 58 71.
J Kaufman B Birmaher D Brent U Rao C Flynn P Moreci D Williamson N Ryan 1997 Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data Journal of the American Academy of Child & Adolescent Psychiatry 36 7 980 988.
N J Keuthen R L O'Sullivan P Goodchild D Rodriguez MA Jenike L Baer 1998 Retrospective review of treatment outcome for 63 patients with trichotillomania The American Journal of Psychiatry 155 4 560 561.
B K Mendelson D R White M J Mendelson 1997 Manual for the body-esteem scale for adolescents and adults Research Bulletin Concordia University Montreal.
B K Mendelson M J Mendelson D R White 2001 Body-esteem scale for adolescents and adults Journal of Personality Assessment 76 1 90 106.
B O Rothbaum P T Ninan 1994 The assessment of trichotillomania Behaviour Research & Therapy 32 6 651 662.
J L Soriano R L O'Sullivan L Baer K A Phillips R J McNally M A Jenike 1996 Trichotillomania and self-esteem: A survey of 62 female hair pullers Journal of Clinical Psychiatry 57 2 77 82.
R M Stemberger A M Thomas C S Mansueto J G Carter 2000 Personal toll of trichotillomania: Behavioral and interpersonal sequelae Journal of Anxiety Disorders 14 1 97 104.
E Stice C Hayward R P Cameron J D Killen C B Taylor 2000 Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study Journal of Abnormal Psychology 109 3 438 444.
D F Tolin G J Diefenbach C A Flessner M E Franklin N J Keuthen P Moore J Piacentini D J Stein D W Woods 2008 The trichotillomania scale for children: Development and validation Child Psychiatry and Human Development 39 3 331 349.