Personality traits in trichotillomania and skin picking disorder
Trichotillomania (hair picking) and skin picking (BFRB: body-focused repetitive behavior disorders) is a disorder which causes functional deterioration and anxiety and which is characterized by repetitive pulling and picking behavior that could lead to hair loss, beard loss, eyebrow loss, etc. or that can cause skin peeling.
In the psychiatric literature, very little is known about the personality traits in trichotillomania (hair picking) and skin picking disorder, and about the contributions of the personality traits in clinical presentations. In this study, personality traits were evaluated in a large and well-characterized sample, which consists of adults with trichotillomania or skin picking disorder or both.
Personality traits were analyzed in the participants with trichotillomania, skin picking disorder or both trichotillomania and skin picking disorder, as well as in the healthy control group. The participants were given the NEO-FFI self-report scales; the NEO Five-Factor Inventory is a reliable and valid 60-item self-report scale that assesses the personality traits below: Neuroticism, Extraversion, Openness, Adaptability, and Sense of Responsibility. Moreover, demographic data were obtained; neurocognitive tests were run, and the clinical traits of the BFRB patients were determined through scales.
The analyses show that the increasing neuroticism is statistically and significantly correlated with the severity of both hair picking and skin picking, as well as with anxiety, depression, and perceived stress. Introversion (which is the relative lack of extraversion) is another significant personality variable in people with BFRB. Introversion measures the reduction in social participation and the individual’s tendency to focus on his own thoughts or feelings. Surprisingly, the data show that introversion is significantly correlated with a higher severity of skin picking, and a worse state of mind, and higher levels of perceived stress. One interpretation of these data states that extraversion may have a healing or “protective” effect on the severity of the disorder, and that it may be associated with a better state of mind and less stress in both disorders. A recent study on generalized anxiety disorder showed that both cognitive-behavioral therapy and metacognitive therapy are effective in increasing extraversion. Therefore, it may be beneficial to analyze whether a similar therapy could increase extraversion in individuals with BFRB and possibly heal the symptoms simultaneously.
The lack of the sense of responsibility was correlated with more depressive symptoms, more impulsiveness, and higher levels of perceived stress both in trichotillomania and skin picking. The sense of responsibility measures the tendency to be target-oriented. The correlation between the lack of the sense of responsibility and the increasing impulsiveness are in coherence with the previous conceptualization that connects both concepts to one another. The most recent data show that there is a subtype, which is characterized by an apparent impulsiveness, for both trichotillomania and skin picking disorder. This was also confirmed by a couple of studies that found deficiencies in the objective cognitive measurements on the response inhibition. Increasing the sense of responsibility could probably be a way to improve the impulsive reaction and to improve the symptoms of BFRB as a result. A recent study conducted on adults with depression found out that an attentiveness-based cognitive therapy successfully improved the sense of responsibility, though having a small impact.
REFERENCES:
– Grant, J. E., & Chamberlain, S. R. (2021). Personality traits and their clinical associations in trichotillomania and skin picking disorder. BMC psychiatry, 21(1), 1-7.
