Dysfunctional beliefs associated with hair pulling disorder: an examination in clinical versus non-clinical groups

ObjectiveUntil recently, empirical studies had been limited with respect to investigating factors that influence the onset and maintenance of hair pulling disorder (HPD), particularly regarding the role of dysfunctional cognitions and beliefs. The primary aim of this study was to examine the relationships between symptom severity and belief domains in a sample with hair pulling disorder compared with non-clinical participants, using the Beliefs in Trichotillomania Scale (BiTS); a recently developed measure of relevant negative self-beliefs, coping efficacy beliefs, and perfectionist cognitions.MethodTwenty adults with HPD and 43 age- and gender-matched control participants completed the BiTS and several measures of related constructs.ResultsHPD severity was significantly and positively correlated with negative self-beliefs and low coping efficacy, but not perfectionism, even after controlling for anxiety and depressive symptoms. Focussed hair pulling, but not automatic hair pulling, was correlated with each BiTS domain; however, once anxiety and depressive symptoms were controlled for, the significant relationship between focussed hair pulling and perfectionism was no longer apparent. The BiTS psychometric properties demonstrated good internal consistency and differentiated clinical from non-clinical participants, with clinical participants endorsing greater negative self-beliefs, lower coping efficacy, and greater perfectionism compared with control participants.ConclusionsNegative self beliefs, low coping efficacy, and perfectionism have differential relationships with HPD severity and hair pulling styles, variable on the presence of co-occurring anxiety and depressive symptoms. While further support for the BiTS internal consistency was obtained, future examination of divergent validity with a more diverse range of constructs is required. What is already known about this topic: Current cognitive-behavioural interventions for hair pulling disorder are designed to facilitate behaviour change by targeting the habit-formation and emotion-regulation mechanisms that maintain hair pulling behaviours.The Beliefs in Trichotillomania Scale (BiTS) measures three belief domains found to be relevant to hair pulling disorder: negative self beliefs, low coping efficacy, and perfectionism.Some cognitive-behavioural interventions additionally target cognitions and beliefs, however, few studies have investigated the relationships between relevant belief domains and hair pulling disorder severity and styles.What this topic adds: Independent of co-occurring anxiety and depressive symptoms, negative self beliefs and low coping efficacy, but not perfectionism, were associated with hair pulling severity.Negative self beliefs, doubts about one's coping efficacy, and perfectionism were all associated with focussed hair pulling behaviours, but not automatic hair pulling behaviours. However, perfectionism was no longer correlated with focussed hair pulling upon controlling for anxiety and depressive symptoms.Assessment for these domains of dysfunctional beliefs, as part of formulation-driven cognitive-behavioural interventions for hair pulling disorder, is appropriate.