title: Affective regulation in trichotillomania before and after self-help interventions.
abstract: OBJECTIVE
  Trichotillomania (TTM) is characterized by recurrent hair-pulling behaviours that cause significant distress. Deficits in affective regulation have been reported in individuals with TTM. We aimed to investigate temporal stability of affective regulation in TTM individuals.
  
  
  METHODS
  Eighty-one TTM individuals underwent an online intervention. Affective Regulation Scale (ARS), Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS), and Beck Depression Inventory (BDI) scores were obtained at baseline, post-treatment (4 weeks), and follow-up (6 months). We examined the effect of phenotypes including hair-pulling severity and depressive symptoms on absolute and relative stability of affective regulation over time, using multiple linear and hierarchical regression analyses.
  
  
  RESULTS
  The ARS total-score from the present TTM sample was significantly lower than the score from non-hair pullers (p < 0.001). ARS total-scores inversely correlated with the MGH-HPS total-scores at baseline (p = 0.001) and post-treatment (p = 0.02), and with BDI total-scores at all time-points (p < 0.001). Although ARS total-scores significantly increased, all ARS sub-scores, except guilt sub-scores, did not change over time, indicating absolute stability. Baseline ARS total-, and sub-scores (except tension) were found to predict their ARS follow-up scores (all p < 0.01), confirming relative stability (i.e., the extent to which the inter-individual differences remained the same over time). The relative stability of ARS total-scores and all but two sub-scores (irritability and guilt) were independent from BDI baseline scores.
  
  
  CONCLUSIONS
  Individuals with TTM reported deficits in affective regulation that demonstrated mostly high relative stability and partly absolute stability. Therefore, targeting to improve affective regulation in individuals with TTM during therapy is warranted.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland. Electronic address: steffi.weidt@usz.ch.
authors.forename: Steffi
authors.initials: S
authors.lastname: Weidt
authors.affiliation: Department of Psychiatry and Institute of Medical Science, University of Toronto, Canada; Neurogenetics Section, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Downing Site, Cambridge, CB2 3EB, United Kingdom.
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Zai
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.
authors.forename: Natalie
authors.initials: N
authors.lastname: Drabe
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.
authors.forename: Aba
authors.initials: A
authors.lastname: Delsignore
authors.affiliation: Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Downing Site, Cambridge, CB2 3EB, United Kingdom; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zürich, Switzerland.
authors.forename: Annette Beatrix
authors.initials: AB
authors.lastname: Bruehl
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Klaghofer
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Rufer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology* / Q000534:rehabilitation*; D009862:Online Systems; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014256:Trichotillomania / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D055815:Young Adult
keywords: Absolute stability; Affective regulation; Emotional dysregulation; Hair-pulling; Relative stability; Trichotillomania