The significance of repetitive hair‐pulling behaviors in eating disorders

Abstract

We studied the relation between intrusive and repetitive hair-pulling, the defining feature of trichotillomania, and compulsive and impulsive features in 1453 individuals with anorexia nervosa and bulimia nervosa. We conducted a series of regression models examining the relative influence of compulsive features associated with obsessive compulsive disorder; compulsive features associated with eating disorders; trait features related to harm avoidance, perfectionism and novelty seeking; and self harm. A final model with a reduced sample (n=928) examined the additional contribution of impulsive attributes. One out of 20 individuals endorsed hair-pulling. Evidence of a positive association with endorsement of compulsive behavior of the obsessive compulsive spectrum emerged. Hair-pulling may be more consonant with ritualistic compulsions than impulsive urges in those with eating disorders.

Why are psychotic experiences associated with self-injurious thoughts and behaviours? A systematic review and critical appraisal of potential confounding and mediating factors

“…2 For example, have you thought about hurting yourself? 3 Skin picking (or dermatillomania/excoriation disorder) and hair pulling (or trichotillomania) have been established as separate disorders in the clinical literature (Zucker et al 2011;Grant & Chamberlain 2015). 4 Schizotypy is typically defined as traits stable over time with anomalies across multiple dimensions (perceptual, interpersonal), whereas PEs are more transitionary anomalies (Pedrero & Debbane 2017).…”

A case of hyperemesis in bulimia nervosa

“…Bezoar may be a cause of upper gastrointestinal obstruction but they are usually the consequence of the ingestion of hairs or vegetables in presence of predisposing conditions (e.g., postgastrectomy state). Trichophagia occurs in patients with psychiatric disorders but hair‐pulling behavior and eventual ingestion of hair is not likely a trait of impulsive urges of BN . Hair‐pulling behavior may be more consonant with ritualistic compulsions such as those characterizing AN, but trichophagia in AN has never been reported and previous bezoars found in such patients were made up of vegetable fibers .…”

“…Trichophagia occurs in patients with psychiatric disorders but hair‐pulling behavior and eventual ingestion of hair is not likely a trait of impulsive urges of BN . Hair‐pulling behavior may be more consonant with ritualistic compulsions such as those characterizing AN, but trichophagia in AN has never been reported and previous bezoars found in such patients were made up of vegetable fibers . Conversely, although binge eating episodes in BN appear to be characterized more by an abnormality in the amount of food consumed than by a craving for a specific nutrient, energy‐dense foods or foods having an hedonistic connotation are generally abused .…”

Predictors of comorbid eating disorders and association with other obsessive-compulsive spectrum disorders in trichotillomania

“…TTM and other OCSDs share phenomenology, neurobiology (i.e. fronto-cortico-striatal circuitry dysfunction), common comorbidities and familial/genetic features [5], [6], [7], [8], [9] . These disorders also share genetic vulnerability and occur in one another with increased prevalences [10] .…”

“…OCSDs and EDs are both characterized by difficulties inhibiting repetitive behaviors and a subjective sense of compulsion [6] . TTM and EDs are also part of a small group of disorders thought to have both compulsive and impulsive components [5] . In addition to sharing similar phenomenology and functionality [18] , they may also share pathophysiological mechanisms, including cortico-striatal dysfunction [15] .…”