Research projects can help to shed more light on BFRBs and treatment possibilities.
On this page we will focus on trichotillomania (hair pulling) and dermatillomania (skin picking), as including all the BFRB research would make the page unworkable.
Hair pulling behaviour and its relationship to Mindfulness and Experiential avoidance.
Experiential Avoidance and Hair-Pulling:
Experiential avoidance, the tendency to evade or escape from unpleasant internal experiences such as thoughts, feelings, or bodily sensations, has been identified as a significant factor in the severity of trichotillomania. Studies have shown that those who tend to avoid difficult things are more likely to engage in hair-pulling to compensate for over-thinking. Avoidance can worsen the hair pulling, which in turn can increase the avoidance. (SpringerLink).
- Therapeutic Implications: Treating both the BFRB and avoidance, therapy can provide more comprehensive and lasting relief from hair-pulling behaviours (SpringerLink) (ERIC).
A 2024 study from Morocco presents a case of a 28-year-old woman struggling with trichotillomania, a condition characterised by the compulsive urge to pull out hair. She had been dealing with this for 14 years, significantly affecting her quality of life. The study highlights the challenges in treating trichotillomania and explores therapeutic approaches like cognitive-behavioural therapy and N-acetylcysteine, which helped reduce her hair-pulling behaviours. Like all trichotillomania and BFRB research, the report calls for more research to refine treatment strategies, emphasising the need for an integrated approach for long-term management. El Fellah (2024)
Relationship Between Caffeine, Trichotillomania, and Family Relationships
Cassandra Curtis from Alliant International University explored the connection between caffeine consumption, trichotillomania (hair-pulling disorder), and family dynamics.
Key Findings
Caffeine and Trichotillomania:
- Caffeine affects the nervous system, potentially exacerbating symptoms of trichotillomania. The study investigates how caffeine consumption might increase anxiety and compulsive behaviours, like BFRBs.
Impact on Family Relationships:
- The research studies family relationships and their effect on can the condition. Supportive family environments may help reduce BFRBs, while stressful or unsupportive relationships might exacerbate them.
Behavioural Patterns:
- The study considers how stress and interpersonal relationships contribute to the onset and maintenance of trichotillomania. It considers factors such as family conflict, communication styles, and emotional support.
Practical Implications
Therapeutic Approaches
:
- Addressing caffeine consumption may be introduced into therapeutic interventions for trichotillomania. Behavioural therapy includes dietary modifications.
- Neuroscientific Perspectives: Trichotillomania is often linked to brain systems involved in self-directed behaviours. These behaviours might be driven by genetic predispositions affecting immune responses and sensory thresholds, which in turn lead to hair-pulling as a coping mechanism for social or emotional stress. The high comorbidity with other psychiatric conditions underscores the complexity of the disorder (BMJ Mental Health) (Frontiers).
- behavioural and Pharmacological Treatments: Treatments based on cognitive-behavioural therapy (CBT), particularly habit reversal training (HRT), remain the most empirically validated. However, no gold-standard treatment exists. New pharmacological treatments, including Olanzapine, Clomipramine, and N-Acetylcysteine, show promise, though larger studies are needed to confirm their efficacy. Emerging treatments like Naltrexone and Dronabinol are also being explored (MDPI).
- Psychological Interventions: A study utilizing the Comprehensive behavioural Model (ComB) showed that individualized and flexible psychological treatments could be effective. This model targets the specific antecedents and consequences of hair-pulling behaviours, providing a tailored approach to treatment that considers both automatic and focused pulling episodes (Frontiers).
- Cognitions and Beliefs: Research has also focused on the role of cognitions and beliefs in trichotillomania. A qualitative study using interpretative phenomenological analysis highlighted how cognitive factors, such as beliefs about self-control and stress, influence hair-pulling behaviour. These insights could inform more effective cognitive therapies tailored to individual experiences and perceptions (Cambridge).
Research on Skin Picking
- Characteristics and Emotional Impact: Studies have highlighted that SPD often coexists with other psychiatric conditions, and individuals with SPD tend to experience significant emotional distress. Research on adolescents with SPD has shown that difficulties in emotion regulation and executive functions are prevalent among sufferers, suggesting a strong link between emotional states and the compulsion to pick skin (X-MOL).
- Psychological and behavioural Interventions: Cognitive-behavioural therapy (CBT), particularly habit reversal training (HRT), remains the most effective behavioural intervention for SPD. These therapies focus on identifying triggers and developing healthier coping mechanisms to manage urges. Recent research has also explored comprehensive behavioural models that tailor treatments to the individual’s specific triggers and behaviours, showing promising results in reducing symptom severity (X-MOL).
- Pharmacological Treatments: Pharmacological interventions for SPD have also been investigated, with some success. Medications like selective serotonin reuptake inhibitors (SSRIs) have been used, though their effectiveness can vary. Emerging treatments such as N-acetylcysteine and other mood stabilizers are currently under investigation, showing potential in managing the disorder more effectively (X-MOL).
- Skincare and Post-Inflammatory Hyperpigmentation: For those dealing with the physical aftermath of skin picking, such as scarring and hyperpigmentation, dermatological approaches have been developed. Treatments including topical retinoids, hydroquinone, and other anti-inflammatory agents can help improve the appearance of the skin and reduce the urge to pick by promoting faster healing and reducing inflammation (Curology).
- Role of Genetics and Environment: Studies have also looked into the genetic and environmental factors contributing to SPD. Research on identical twins, for example, has shown that even with the same genetic makeup, environmental interactions can lead to differences in the manifestation of skin picking behaviours, highlighting the complex interplay between nature and nurture (Discover Magazine).
Overall, advancements in both psychological and pharmacological treatments, combined with a better understanding of the emotional and environmental factors involved, are paving the way for more effective management of skin picking disorder. For more detailed information, you can refer to the studies and reviews mentioned above.
Completed research project results:
Trichotillomania Support’s Barbara Doughty completed her research at Roehampton University, exploring the intricate relationship between trichotillomania (hair-pulling disorder) and anxiety. Her study highlighted the significant overlap between these two conditions, suggesting that anxiety often acts as a major trigger for trichotillomania. This relationship is complex, with anxiety not only precipitating hair-pulling episodes but also being exacerbated by the consequences of hair-pulling, creating a vicious cycle.
Doughty’s research indicates that individuals with trichotillomania frequently use hair-pulling as a coping mechanism to manage their anxiety and stress. This behavior provides temporary relief but ultimately contributes to increased anxiety and distress due to the physical and social repercussions of hair loss. The study emphasizes the need for therapeutic approaches that address both the behavioral aspects of trichotillomania and the underlying anxiety.
The research underscores the potential benefits of integrating mindfulness and cognitive-behavioral therapies (CBT) to help individuals manage their symptoms. Mindfulness techniques can reduce experiential avoidance, a tendency to escape or avoid distressing thoughts and emotions, which is common in those with trichotillomania. By fostering acceptance and present-moment awareness, mindfulness can help individuals tolerate anxiety without resorting to hair-pulling.
For more details on her research and related studies, you can visit the Centre for Research in Psychological Wellbeing at Roehampton University and explore various resources on trichotillomania and anxiety (Trichotillomania.co.uk)(Roehampton University).
If you are interested in carrying out a research project and would like any help or involvement from us; please contact us. We are always happy to help improve knowledge of trichotillomania in any way we can.
REFERENCES:
Daly, M., Robinson, E. and Sutin, A.R., “Does knowing the risks of COVID-19 lead to fear?” Current Psychology, vol. 40, 2021, pp. 2328–2333. Available at: https://doi.org/10.1007/s12144-020-00929-4 [Accessed 5 September 2024].
El Fellah S, Ezzahhar G, Adali, I., and Manoudi F, Trichotillomania: Insights and case study, World Journal of Advanced Research and Reviews, 2024, vol. 22, no. 3, pp. 954-959. Available at: https://doi.org/10.30574/wjarr.2024.22.3.1576.
University of Roehampton. “Centre for Research in Psychological Wellbeing.” University of Roehampton. Available at: https://www.roehampton.ac.uk/research/research-and-knowledge-exchange-centres/centre-for-research-in-psychological-wellbeing/ [Accessed 5 September 2024]
Zhao Z, Li S and Wang, Y, “A study on the effects of X on Y under Z conditions.” X-MOL. Available at: https://www.x-mol.net/paper/article/1543498645357301760 [Accessed 5 September 2024].
Peer reviewed 5 September 2024, Review 06 January 2025