The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.
Affective regulation in trichotillomania: Evidence from a large-scale internet survey
Abstract
Trichotillomania (TTM), a repetitive hair-pulling disorder, is underrepresented in the clinical literature. The current project explores the relationship between affective regulation and disordered hair-pulling. Previous research suggests that cycles of emotional states are correlated with the disorder and may induce, reinforce, or otherwise contribute to hair-pulling behavior. We use anonymous internet survey responses from 1162 self-identified hair-pullers to address four questions about affective regulation in people with TTM: (1) Do hair-pullers experience greater difficulty "snapping out" of affective states than non-pullers? (2) Does difficulty with emotional control correlate with TTM severity? (3) Are subtypes identifiable based on the emotions that trigger hair-pulling behavior? (4) Does difficulty "snapping out" of an emotion predict whether that emotion triggers pulling behavior? The results showed a small-to-moderate relationship between affective regulation and problematic hair-pulling. In addition, individual patterns of emotion regulation were systematically related to emotional cues for hair-pulling as well as overall hair-pulling severity. These findings contribute to an understanding of the phenomenology of TTM and provide empirical support for treatments focused on affect regulation.
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“Additionally, using latent class analysis, we identified four subtypes consisting of unique emotional profiles and demonstrated that cluster membership predicted hair pulling severity.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Shusterman et al., 2009
In the citing paper
“Our findings from a large Internet survey of TTM demonstrated that hair pullers had more difficulty than normal controls in managing their emotions, with a small to moderate relationship between affective regulation and hair pulling severity (Shusterman et al., 2009).”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Shusterman et al., 2009
In the citing paper
“This finding is consistent with Shusterman et al.'s (2009) argument that more idiographic assessment of ER difficulties is warranted for hair pullers.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Shusterman et al.'s (2009)
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
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Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,766
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099
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Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990) · Cognitive Therapy and Research · doi:10.1007/bf01172967 · Cited by 4,279
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Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.08.008 · Cited by 919
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Barlow, D. H. (2001) · Cited by 782
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Psychodermatologic Disorders with Primary Psychopathology
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O’Connor, K. P., Lavoie, M. E., & Schoendorff, B. (2017) · Wiley eBooks · doi:10.1002/9781119167303.refs
Tic disorders and trichotillomania
Miltenberger, R. G., Stiede, J. T., Woods, D. W., & Himle, M. B. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-805469-7.00008-5
THE RELATIONSHIP BETWEEN BOREDOM AND BODY FOCUSED REPETITIVE BEHAVIOR DISORDERS AMONG ADOLESCENTS
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Session 8: Practicing Acceptance and Commitment Therapy (ACT)
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0008
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Modifications for Working with Adolescents
Petersen, J. M. (2023) · doi:10.1093/med-psych/9780197670309.003.0011
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0005
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0002
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0004
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0003
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0001
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Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0006
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Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0009
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0003
Session 10: Review and Relapse Prevention
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Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0004
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Obsessive‐Compulsive and Related Disorders
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Trichotillomania: The interplay between emotional states, urges and hair pulling episodes
Gallinat, C., Wilhelm, M., Moessner, M., & Bauer, S. (2026) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2026.152727
Rizk, A., Ibrahim, A., Malaeb, D. N., Ali, A. M., Fawaz, M. A., Said, N. O. E., Merdad, N., Amin, R., Saeed, W., Barakat, M. M., et al. (2026) · Health Science Reports · doi:10.1002/hsr2.73112
Metadata
- Authors
- Shusterman, A., Feld, L., Baer, L., & Keuthen, N.
- Affiliations
- Wesleyan University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Shusterman, Anna
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 47
- Issue
- 8
- Pages
- 637-644
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2053285253
- Cited by
- 127
- References
- 34
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 27 · 2022: 3 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 5 · 2017: 14 · 2016: 13 · 2015: 13 · 2014: 4 · 2013: 3 · 2012: 6
- FWCI
- 5.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- trichotillomania, emotion regulation, emotional triggers, symptom severity
- MeSH terms
- Adolescent, Adult, Affect, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Male, Middle Aged, Surveys and Questionnaires, Trichotillomania, Internet
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