The full study was published in the Journal of Clinical Psychiatry 1996
Summary by Jennifer L.Soriano, AB & Richard L. O'Sullivan, MD
Copyright © 1996 In Touch Newsletter #13 - a TLC publication

Despite the fact that hair pulling may cause feelings of guilt and shame, there has been little research on the effects of trichotillomania on self-esteem. We conducted the study to identify factors predictive of self-esteem in individuals with trichotillomania. Sixty-two women (over one-quarter of whom responded to an advertisement for the study in "In Touch") completed a survey including questions about their hair pulling and their feelings about themselves. As predicted, frequency of hair pulling was related to self-esteem. The more time subjects spent pulling, the lower their self-esteem. Severity of hair loss from pulling, however, was not related to subjects' level o self-esteem; hair pulling may have an impact on self-image regardless of the actual amount of hair loss incurred. High levels of anxiety and depression in subjects were also associated with low self-esteem, an important finding given that many individuals with trichotillomania report feelings of depression and anxiety as a result of chronic hair pulling. Subjects also reported a high rate of dissatisfaction with aspects of their appearance unrelated to hair pulling. The greater such dissatisfaction with appearance, the lower the self-esteem. The results of this study suggest that treatment for trichotillomania should not focus solely on the hair pulling behavior itself. Issues of self-esteem, depression, anxiety and dissatisfaction with appearance or body image can be significant for individuals with trichotillomania and should be acknowledged and addressed in treatment as well.


A study conducted through the Massachusetts General Hospital Obsessive-Compulsive Disorder and Trichotillomania Clinics. Authors: Jennifer L. Soriano, AB; Richard L. O'Sullivan, MD; Lee Baer, PhD; Katharine A. Phillips, MD; Richard J. McNally, MD; Michael A. Jenike, MD