Think about your teenage self and every thing you needed to navigate: rising independence, altering physiology, and powerful 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 may really feel for 14-year-old you. Now, add to this the truth that you might have trichotillomania, often known as hairpulling dysfunction. Not solely are you navigating the everyday challenges of adolescence, however you might have 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 larger numbers estimated for hairpulling behaviours throughout the normal inhabitants (Grzesiak et al., 2017; Moreno-Amador et al., 2023). Despair 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 presently 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, damaging feelings and self-evaluation are key. Not solely are damaging self-evaluative feelings integral to the onset and upkeep of hairpulling, however they’ve additionally been linked to each melancholy and anxiousness. One such damaging emotion is disgrace.
Disgrace is characterised by the expertise of self-conscious and self-condemning feelings via 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 function of adolescence within the onset and upkeep of hairpulling, there was little to no analysis analyzing the function 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 larger for hairpulling behaviours usually.
Strategies
To study extra in regards to the phenomenology of hairpulling in adolescents and to discover the function 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 by way of social media, BFRB boards and charity web sites. Individuals accomplished 5 on-line questionnaires, the primary of which was created by the authors particularly for this examine. 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 ‘automated’ pulling, a generally researched however disputed subtype of trichotillomania. The remaining questionnaires had been established measures of hairpulling severity in youngsters, disgrace, melancholy and anxiousness.
Outcomes
One-hundred and twenty-eight members 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 members had been from the UK (43.8%), adopted by North America (33.6%).
The phenomenology of hairpulling in adolescents
Adolescents most regularly pulled from their scalp (75%), adopted by the pubic space (57%), with most members reporting pulling from a number of websites (80.5%). By way of pulling fashion, roughly half reported ‘normally’ or ‘all the time’ pulling with out realising and over three-quarters ‘normally’ or ‘all the time’ particularly searched out hairs with a selected feeling to drag. For post-pulling rituals, over three-quarters at the least ‘normally’ regarded on the hair or root afterwards and two-thirds both ‘normally’ or ‘usually’ rubbed the hair or root afterwards.
A singular side to this analysis was exploring the trance-like nature of hairpulling, which is a core function of trichotillomania. On this pattern, 88% reported pulling in a trance at the least ‘a few of the time’ and 61.8% reported that they skilled this ‘normally’ or ‘all the time’. 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 function 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 absolutely mediated the connection between hairpulling severity and anxiousness
These findings reveal that larger ranges of hairpulling severity are related to larger ranges of disgrace and melancholy, and that disgrace partially mediates the connection between melancholy and symptom severity. This means that disgrace explains a few 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 absolutely defined the connection between anxiousness and hairpulling severity.
88% of members reported hairpulling in a trance-like state, with 61.8% reporting that they normally or all the time hairpulled on this method.
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 necessary however different mechanisms are probably additionally concerned. Apparently, nevertheless, the complete mediation between anxiousness and hairpulling severity implies that this relationship might be defined by emotions of disgrace.
Moreover, findings from this examine recommend that the phenomenology of hairpulling in adolescents is very akin to that of grownup hairpulling. Importantly, the authors additionally discovered compelling proof for trance-pulling in adolescents, distinct from low consciousness or ‘automated’ pulling, suggesting the generally described ‘subtypes’ (‘automated’ vs ‘centered’ pulling) of trichotillomania might not be correct classifications of the situation.
On this examine, disgrace absolutely 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 examine, most notably that it offers novel analysis in a largely below researched space. By analyzing hairpulling phenomenology and the psychological function of disgrace in adolescents, a inhabitants notably absent from a lot of the prevailing BFRB literature, the examine makes a worthwhile contribution to analysis on trichotillomania. An additional energy is the use of lived expertise to information the analysis. Utilizing qualitative information and the lived expertise of the analysis workforce provides to the ecological validity of this examine, serving to to construct our understanding of hairpulling from the angle of those who really pull their hair, moderately than from scientists seeking to clarify behaviour they see however don’t really feel. In such an below researched space it’s vital to attract on the lived expertise of people with trichotillomania to deepen our understanding of the situation in a significant method.
Nonetheless, the energy of this analysis can be a possible limitation. The introduction of a novel hairpulling phenomenology questionnaire allowed the authors to entry experiences, equivalent to trance-pulling, that aren’t properly captured by current measures. Nonetheless, with out psychometric validation, these findings are greatest understood as descriptive moderately than definitive. The prominence of trance-pulling within the outcomes is theoretically intriguing, however its interpretation is essentially provisional. To handle this future analysis might purpose to check the assemble validity and inside reliability of the brand new scale.
One last level to contemplate is how the recruitment course of might have formed the pattern. The retained pattern was recruited predominantly by way of Reddit and Instagram, largely via BFRB‑particular on-line communities and influencer‑linked content material. This means that the findings might disproportionately mirror the experiences of adolescents already engaged with hairpulling‑associated on-line areas, who might have larger severity signs and/or have extra consciousness of their very own hairpulling. Future analysis might purpose to recruit a wider pattern from the final adolescent inhabitants. Prevalence of hairpulling behaviours is more likely to be larger there, and a broader pattern would additionally seize younger individuals with low-severity pulling who don’t but recognise it as a situation.
A energy 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 apply
Returning to that imagined 14‑12 months‑outdated model of your self, the findings of this examine really feel notably significant. This analysis means that for a lot of adolescents who hairpull, disgrace will not be merely an unlucky by‑product of the behaviour, however a psychologically energetic course of which will form emotional misery and co‑occurring anxiousness and melancholy. For that younger individual, this issues.
In apply, these findings invite a shift in emphasis for therapy of trichotillomania in adolescents. At the moment, interventions for adolescent hairpulling have usually prioritised behavioural management (e.g., behavior reversal coaching), turning 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 which will maintain misery. If disgrace performs a central function 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 increasingly embrace larger integration of compassion‑centered, 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 speak about hairpulling with younger individuals. Framing hairpulling purely as one thing to be “stopped” or “managed” might inadvertently reinforce disgrace, notably for adolescents who expertise pulling as trance‑like and troublesome to interrupt. Normalising the emotional context of hairpulling, acknowledging the lack of management many younger individuals report, and creating area to debate disgrace brazenly might already signify a significant shift in apply.
The examine additionally opens necessary 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 lowering disgrace via therapeutic intervention reduces hairpulling severity for adolescents. Additional growth and validation of measures capturing phenomenological experiences equivalent to trance-pulling would additionally enable these experiences to be built-in extra absolutely into principle and therapy.
For that youthful imagined self, this analysis provides one thing quietly highly effective: a reframing. Hairpulling will not be merely a foul behavior or a failure of management, however an expertise embedded in emotion, vulnerability, and self‑analysis. Recognising this doesn’t instantly remedy the issue, nevertheless it does provide a extra compassionate and probably simpler place to start.
Interventions for trichotillomania in adolescents might give attention to lowering disgrace moderately 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
Main paper
Talia Mayerson, Clare Mackay, & Polly Waite. (2025). The mediating function 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). Latest advances in trichotillomania: A story assessment. 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 Habits, 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. Scientific Psychology Assessment, 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 Scientific 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 function 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 Remedy of Hair Pulling in Youth. Journal of Youngster and Adolescent Psychopharmacology, 27(2), 132–139. https://doi.org/10.1089/cap.2016.0085
Roberts, S., O’Connor, Ok., & Bélanger, C. (2013). Emotion regulation and different psychological fashions for body-focused repetitive behaviors. Scientific Psychology Assessment, 33(6), 745–762. https://doi.org/10.1016/j.cpr.2013.05.004
