8/3/2019 29_3_02-Haghshenas

1/4

IJMSVol 29, No 3, September 2004

105

Trichotillomania-Associated PersonalityCharacteristics

AbstractBackground: Patients with Trichotillomania (TC) have anirreversible urge to pull their hair. This self-mutilation behav-

ior is associated with high level of tension before and a sense

of gratification and relief after TC.

Objective: To investigate the personality characteristics of

patients suffering from TC.

Method: The study was performed on 43 TC patients and 43gender and age-matched non-psychiatric control individuals

who were asked to complete a Persian version of the NEOPersonality Inventory-Revised (NEO PI-R).

Results: The TC patients had significantly higher scores on

Neuroticism (p

8/3/2019 29_3_02-Haghshenas

2/4

H. Hagh-Shenas, A. Moradi, G. Dehbozorgi, et al

106

a systematic study on personality characteris-tics utilizing structured interview, includingDSM-third edition-Revised (DSM-III-R) criteriaas well as the revised version of the MinnesotaMultiphasic Personality Inventory-2

ndedition

(MMPI-2).10

Their findings on 42 patients withdiagnosis of TC were in contrast with 48

matched females who showed that the TCgroup had lower incidence of cluster A person-ality symptoms or schizoid, Schizotypal, andparanoid. They concluded that no particularpersonality disorder could differentiate be-tween TC patients and control individuals.

10

Although the foregoing report did not showany particular relationship between hair pullingand personality characteristics, such self-mutilating behavior may not develop withoutany underlying psychological background. TheMMPI-2 seems to be less sensitive to normalaspect of personality and is more concernedwith pathological aspects.

The present study, therefore, was designedto investigate personality characteristics of pa-tients suffering from TC in contrast to non-psychiatric female individuals. NEO Personal-ity Inventory-Revised (NEO PI-R) was utilized.This inventory was originally designed forevaluating normal aspects of personality andcommonly used in counseling and psychother-apy settings.

11

Patients and Methods

The present study was carried out from Octo-ber 1996 to March 2003 and comprised 43

patients with TC referred by dermatologists topsychotherapy clinics of Hafez Hospital in Shi-raz for psychotherapy. Inclusion criteria for thepatients consisted of TC diagnosis by interviewand clinical judgment, age from 19 to 39 yrsand minimum formal education of 9 yrs. Con-trol individuals were selected from a pool ofindividuals who participated for standardizationof the Iranian version of the NEO PI-R.

12The

groups were matched for age, gender and yrsof formal education. The domestic version ofthe NEO PI-R was utilized for personality as-sessment. This is a questionnaire composed of240 statements measuring 5 major domains of

personality.

13

These include Neuroticism, Ex-traversion, Openness, Agreeableness, andConscientiousness. The score for each domainwas the summation of six lower order facets.For example, the score of Neuroticism was thesum of scores of lower order facets of: anxiety,angry-hostility, depression, self-conscious-ness,impulsivity and vulnerability to stress. The in-ventory had been standardized for 502 Iranianindividuals and were acceptable, reliable andvalid as consistent and internal.

12

Statistical analysisData are presented as MeanSD. A multivari-ate analysis of variance (MANOVA) test wasutilized for analysis of the data. In this modelgender and groups under study were selectedas independent and the scores for NEO PI-Rdomains as dependent variables. Student t testwas also used to compare the group scores offacets.

Results

The present study was performed on 43 Pa-tients with TC, including 34 females (79.1%)and 9 males (20.9%) as well as 43 non-psychiatric individuals comprising 34 femalesand 9 males. The mean age of the TC patientswas 21.95.35 and that of the control groupwas 20.96.3. The mean yrs of formal educa-tion for patient and control groups were 12.62.1 and 12.92.9 respectively. The resultsshowed no gender effect, whereas significantdifference was found between groups with re-spect to the scores of domains (p

8/3/2019 29_3_02-Haghshenas

3/4

Trichotillomania-associated personality characteristics

107

der,5, 6

mental retardation,7

and schizophrenia.8

The clinical picture of the TC also resembles aself-mutilation behavior.

9Regardless of the

wide range of disorders co-morbid with TC, no

remarkable personality disorder has yet beenreported to differentiate between TC patientsand control individuals.

10

The results of the present study suggested thatpatients with TC had remarkably negativeemotions. According to Costa and McCrae, theinitiators of NEO Personality Inventory, peoplehaving elevated scores on the neuroticismdomain are emotionally unstable with over-whelmingly negative emotions.

14More details

about individuals with high scores on neuroti-cism domain may be found by searchingthrough the scores of their domain subscales.According to professional manual of the NEO

PI-R, people with high anxiety scores are sug-gested to be apprehensive, fearful, prone toworry, nervous, tense, and jittery.

14Individuals

with high angry-hostility scores are expected tohave a tendency to experience anger and re-lated status such as frustration and bitterness.High depression scores are associated withfeeling of guilt, sadness, hopelessness, andloneliness. Individuals with high self-consciousness are not at ease with others,sensitive to ridicule, and prone to feelings ofinferiority. High impulsiveness is usually asso-ciated with inability to control craving andurges. Elevated scores on vulnerability to

stress subscale shows inability to cope withstress, becoming dependent, hopeless, or pan-icky when facing emergency situations. In ad-dition to these characteristics, the TC patientsparticipated in the present study showed sig-nificantly lower scores on agreeableness do-main in contrast to the control individuals. Thelower scorers in this domain were likely to bedisagreeable, antagonist or egocentric.

14They

seemed to be skeptical of others intentionsand competitive rather than cooperative. The

patients in the present study had also lowerscorers on the compliance subscale with inter-personal conflicts, aggressiveness and wereprone to express anger whenever necessary

and had marginally lower scorers on the trustsubscale that is cynically skeptical of othersassuming that they may be dishonest. As de-scribed elsewhere,

14the picture of the person-

ality trait or characteristics displayed by thedata presented in our study is more likely toresemble borderline personality traits or evendisorder. Self-mutilation, among various per-sonality characteristics of individuals with bor-derline personality disorders, is performed toelicit help from others, to express anger ornumbness against overwhelming stimuli whichis best described for the TC patients.

2

All TC patients participating in the present

study showed satisfactory cooperation withtheir psychotherapists. They were highly hon-est in reaction to the personality test because,as they were told, it was to be used for plan-ning their psychotherapy. The results obtainedare utilized for the patients' cognitive-behavioral psychotherapy. The data for non-psychiatric individuals drawn from a pool pre-pared for standardization of the Iranian versionof NEO PI-R are among limitations imposed onpresent investigations. The control individualsfor future studies maybe selected from themember of patients' family or relevant socio-economic group for a more appropriate com-

parison.

Acknowledgement

This research was supported by ResearchCommittee and Psychiatry Research Center ofShiraz University of Medical Sciences, Shiraz,Iran.

Table 2: The mean scores for Neuroticism and Agreeableness facets

DomainsSubscales

TC Patients Non- psychiatric controls p-value

NeuroticismAnxiety 19.8 6.4 16.1 5.70 0.006Angry-Hostility 21.0 6.18 15.2 6.00 0.0001

Depression 22.6

6.05 17.0

6.15 0.0001Self-consciousness 19.3 4.82 17.3 3.68 0.033Impulsivity 18.2 4.52 14.3 4.08 0.0001Vulnerability to Stress 18.5 5.70 14.0 5.42 0.0001

AgreeablenessTrust 17.2 5.83 19.3 4.47 0.06 NSStraightforwardness 18.0 4.96 19.2 4.98 0.27 NSAltruism 20.5 4.26 21.3 3.80 0.42 NSCompliance 14.7 4.75 17.0 3.95 0.015Modesty 17.0 5.30 17.8 4.43 050 NSTender-Mindedness 19.7 3.51 19.5 2.75 0.81 NS

8/3/2019 29_3_02-Haghshenas

4/4

H. Hagh-Shenas, A. Moradi, G. Dehbozorgi, et al

108

References

1 Bennett JC, Plum F: Cecil Textbook ofMedicine 21

stEdition. Philadelphia: Saun-

ders Company, 2000: 2293.2 Sadock BJ, Sadock VA: Synopsis of Psy-

chiatry; Behavioral Sciences/Clinical Psy-

chiatry, Lippincott Williams and Wilkins,PA, 2003: 809.

3 Adam BS, Kashani JH. Trichotillomania inchildren and adolescents: Review of the lit-erature and case report. Child PsychiatryHum Dev1980; 20: 159-68.

4 Swedo SE: Trichotillomania. In: HollanderE (Ed). Obsessive-Compulsive RelatedDisorders. Washington DC: American Psy-chiatric, 1993: 93-111.

5 Christensen GA, Mackenzie TB, MitchellJE. Characteristics of 60 adult chronic hairpullers. Am J Psychiatry 1991; 148: 365-70.

6 Stein DJ, Simeon D, Cohen LJ, HollanderE. Trichotillomania and obsessive-compulsive disorder. J Clin Psychiatry1995; 65: 28-35.

7 Kanner L: Child Psychiatry 2nd

Edition. Illi-nois: Springfield, 1948: 540.

8 Chauhan S, Jain R, Dhir G. Trichotilloma-nia: A phenomenological study. Indian JClin Psychology1985; 2: 47-50.

9 Favazza AR. The coming of age of self-mutilation. J Nerv Ment Dis 1998; 186:

259-68.10 Christenson GA, Chernoff-Clementz E,

Clementz BA. Personality and clinicalcharacteristics in patients with Trichotillo-mania. J Clin Psychiatry1992; 53: 407-13.

11 McCrae RC. The Five-Factor Model and itsassessment in clinical setting. J Pers Ass1991; 57: 399-414.

12 Hagh-Shenas H. Persian Standardizationand norms for NEO Personality Inventory-Revised (NEO PI-R). Andisheh va RaftarQuartery1999; 16: 38-47.

13 Montag I, Levin J: The Five Factor Modeland psychopathology in no clinical sam-

ples. Pers Indiv Diff; 17: 1-7.14 Costa PT, McRae RR. NEO PI-R:Profes-

sional Manual. FL: PAR Inc, 1992.