Trichotillomania and skin-picking disorder: associations with childhood maltreatment and the mediating role of depressive symptoms.

BACKGROUND

Childhood maltreatment (CM) is a well-known risk factor for a wide range of adult mental disorders. However, little is known about the role of CM in trichotillomania (TTM) and skin-picking disorder (SPD). The current study therefore aimed to explore the relationship between CM and symptom severity in patients with TTM and SPD, as well as to compare their baseline CM levels with those of patients with borderline personality disorder (BPD) and a healthy control group.

METHODS

The Childhood Trauma Questionnaire-Short Form (CTQ-SF), along with validated measures of disorder-specific severity and depressive symptoms (e.g., MGH-HPS, SPRS, and PHQ-9), was administered to patients with TTM (n = 82), SPD (n = 75), BPD and subthreshold BPD (n = 123), and a healthy control group (n = 157) prior to treatment. Between-group differences in CM were explored with Kruskal Wallis tests, while disorder-specific associations in the TTM and SPD groups were examined through correlational and mediational analyses.

RESULTS

The TTM and SPD group reported higher levels of CM than the healthy control group, especially emotional abuse and emotional neglect. However, these levels were lower than in the BPD group. Several EMs were significantly positively associated with TTM and SPD severity, although the associations were more numerous and stronger in TTM than in SPD. Depressive symptoms fully mediated the relationship between emotional neglect and self-reported TTM severity and partially mediated the relationship between emotional abuse and self-reported TTM severity.

CONCLUSION

These findings suggest that several forms of CM are prevalent in individuals with TTM and SPD. The results are also consistent with, though do not prove, an emotion-regulation model in which hair-pulling serves as a maladaptive coping strategy for depressive symptoms.