The phenomenology of hairpulling in a community sample.

Assessment and treatment of trichotillomania (TTM) has evolved substantially over the past decade. However, standardized assessment and empirically supported treatment for TTM is still in early stages of development. We proposed that information important to the ongoing evolution of assessment and treatment could be obtained through the study of hairpulling across its range of severity. Hairpulling phenomenology was assessed in a large community sample across its range of presentation. Although the estimated prevalence rate of .6% for TTM is congruent with past studies, the 1.2% prevalence estimated for clinically significant hairpulling suggests that the current diagnostic criteria are overly restrictive. Overall, hairpulling occurred at a rate of 6.5%, while age of onset was 15.92 years. Symptoms of depression, anxiety, and history of teasing were positively associated with hairpulling, while self-esteem was negatively related to hairpulling. Cognitions most commonly associated with hairpulling were "feels coarse" (53.3%), "doesn't feel right" (30.0%), "is curly" (26.7%), and "doesn't look right" (23.3%). Environments most commonly associated with hairpulling included "while reading" (38.9%), "while watching television" (37.0%), and "in class" (35.25). Applications of findings to assessment and intervention formulation are suggested, and limitations and future directions are discussed.