کشیدن مو و ارتباط عاطفی آن در یک نمونه از دانشگاه آفریقایی آمریکایی

Like other clinical phenomena, repetitive hair pulling in African-Americans has attracted little systematic investigation. Slightly over 200 participants were recruited from a historically black university. Participants completed the Hair Pulling Scale [Stanley, M. A., Borden, J. W., Bell, G. E., & Wagner, A. L. (1994). Nonclinical hair pulling: phenomenology and related psychopathology. Journal of Anxiety Disorders, 8, 119–130], the Beck Depression Inventory, and the Beck Anxiety Inventory (BAI). Ten percent of the African-American sample thought about pulling out hair and 6.3% actually pulled out hair. A variety of types of affect was reported before, during, and after pulling or picking. Several statistically significant relationships were found: status as a person who thinks about pulling out hair is significantly correlated with anxiety as measured by the BAI (r = .265, p = .000), status as a person who pulls hair is significantly correlated with anxiety as measured by the BAI (p = .192, r = .007). Implications are discussed.

Trichotillomania (TTM) is a disorder that is characterized by the repetitive pulling out of one's own hair from the scalp, eyelashes, eyebrows, pubic area, or other body sites. Often a chronic condition, TTM is typically associated with significant emotional distress, diminished self-esteem, and interpersonal problems (Stemberger, Thomas, Mansueto, & Carter, 2000). TTM is included in the latest edition of the Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association, 2000) within the category of “Impulse Control Disorders Not Otherwise Specified.” Diagnostic criteria include recurrent hair pulling resulting in noticeable hair loss, tension either before pulling or when resisting pulling, pleasure, gratification, or relief when pulling, and clinically significant distress or impairment. Utility of diagnostic criteria for TTM has been criticized on a number of grounds, an important one being that large numbers of hair pulling patients do not manifest full diagnostic criteria (O'Sullivan, Mansueto, Lerner, & Miguel, 2000). Focusing on the diagnostic requirements of tension prior to pulling and pleasure, gratification, or relief during pulling, Christenson and Mansueto (1999) noted that while 17–23% of hair pullers in clinical populations failed to meet one or both criteria, many investigators of TTM routinely chose to include those individuals as research participants. The authors preferred a “broader definition of trichotillomania to include any clinically significant hair pulling not occurring in the context of psychosis.” (p. 4) Once viewed as a rare disorder, preliminary epidemiological studies conducted with university student populations suggest that hair pulling is more common than previously thought in the general population. Reported rates vary according to the rigidity with which diagnostic criteria were applied. As might be expected, estimates of prevalence of TTM in the general population are substantially higher when less restrictive criteria are utilized. Christenson, Pyle, and Mitchell (1991) reported that 0.6% of 2579 college freshmen who were surveyed met existing diagnostic criteria (DSM-III-R) for TTM during their lifetimes, but when the tension reduction criterion was dropped, 2.5% of subjects (1.5% of males and 3.4% of females) had at least at some point engaged in clinical levels of hair pulling. Rothbaum, Shaw, Morris, and Ninan (1993) surveyed 490 freshmen psychology students at one university and later, 221 freshmen psychology students at another university. In the first sample, 10% of students acknowledged engaging in noncosmetic hair pulling with 2% reporting both visible hair loss and distress as a result of pulling. In the second sample, 13% reported hair pulling, 1% reported visible hair loss, and 1% reported distress. Graber and Arndt (1993) surveyed 98 undergraduate students utilizing an 11-item questionnaire. In this sample, 11% of the students acknowledged engaging in noncosmetic hair pulling, however, resultant distress and visibility of hair loss were not assessed. Stanley, Borden, Belt, and Wagner (1994) surveyed 288 college undergraduates and found that 15% of the subjects reported having engaged in noncosmetic hair pulling during the prior year. None of the subjects, however, reported visible hair loss as a result of pulling. In a later study (Stanley, Borden, Mouton, & Beckenridge, 1995), a similar questionnaire was administered to 165 undergraduate university students. In this sample, 13% of the students acknowledged noncosmetic hair pulling during the previous year. Many of the studies focused on prevalence rates of hair pulling also report descriptive data on pulling, such as situations where participants are more likely to pull, frequency of pulling, and body sites where pulling occurs. While these data may simply help describe the problem, we have argued in other venues (Mansueto, Golomb, Thomas, & Stemberger, 1999; Mansueto, Stemberger, Thomas, & Golomb, 1997) that many of these variables represent critical information for integration into behavioral treatment plans for reducing hair pulling. Stanley et al. (1994) reported that a little over 20% of participants pulled once a month, 20% pulled once a week, and a little under 20% pulled several times a week, with just over 13% pulling several times a day. Just over three-quarters of the sample pulled from the scalp, over 30% pull eyebrows, one-quarter pull eyelashes, with less than 10% pulling from other sites. Pullers engaged in the behavior in various situations, including while studying (just over 50%), working or watching television (just under 30% for each), and lying in bed (30%). Several points are worth making with regard to the aforementioned studies. First, it appears that in university samples, approximately 10–15% of participants will admit to problematic hair pulling, though far less report noticeable hair loss, and data regarding emotional correlates of pulling are not always available. Second, solid epidemiological data are sparse for TTM and also for hair pulling that does not fully meet current diagnostic criteria. Third, of the 3781 participants in these studies, only 18 were identified as African-American (or “black”). Questions about the incidence of TTM among African-Americans have particular importance because of the relative absence of such individuals presenting for treatment (e.g., Neal-Barnett & Crowther, 2000). The continuing underrepresentation of ethnic minority groups in the clinical psychology literature was decried recently by Iwamasa, Sorocco, and Koonce (2002). With regard to TTM, McCarley, Spirrison, and Ceminski (2002) took a significant step toward addressing the problem in a recent study of hair pulling prevalence in a subset of 176 African-American college students contained within a sample of 635 undergraduate psychology students. Overall, the authors reported a surprisingly high percentage (10.2%) of students reporting hair pulling that resulted in noticeable hair loss, with 2% of the sample endorsing items consistent with most DSM-IV criteria. There was no significant difference in reported rates of hair pulling in African-American versus non-African-American participants. Thus, it would appear that any scarcity of African-American individuals in the clinical population is not due to absence of hair pulling among the group. One possibility is that hair pulling African-Americans do not experience the degrees of distress resulting from hair pulling that is characteristic of the larger non-African-American populations. Because information as to whether hair pulling caused significant distress or impairment in functioning was not gathered in the McCarley study (McCarley et al., 2002), questions remain about possible roles played by emotional variables associated with hair pulling in African-American individuals. The relationship between emotion and hair pulling has been considered by a number of writers in the field, who have relied on data from predominantly Caucasian samples. Christenson and Mansueto (1999) as well have noted the frequent comorbidity of TTM with depression and a variety of anxiety disorders. Mansueto et al. (1997) argued that anxiety, depression, and other emotions can function both as triggers for individual episode of hair pulling as well as emotional consequences of pulling. Stemberger et al. (2000) reported that anxiety and depression are among a range of emotional features highly common to individuals with TTM. Stanley et al. (1995) examined various types of emotion experienced before, during, and after hair pulling and found that emotional distress was experienced at all stages of the pulling process. Stanley et al. (1994) also found that 15% of their college sample pulled hair and that hair pulling was related to higher levels of interpersonal sensitivity, anxiety, and neuroticism. Finally, studies assessing emotions have generally used clinical samples but have not always employed assessment devices that could be described in any way as standardized. A notable exception is the work of Stanley et al. (1995) comparing college and clinical samples with instruments such as the SCL-90. The present study attempts to answer the following questions regarding hair pulling: What is the prevalence in an African-American university sample, and how does it compare to estimates from primarily Caucasian samples and the one other study of African-American students? What percentage of those who pull hair in the sample meet full DSM criteria for trichotillomania? Under what situations does pulling occur? What is the severity of pulling in this sample? What affective experiences are associated with pulling? Finally, what is the impact of affect associated with hair pulling on the broader functioning of these participants?