A Qualitative Study Exploring the Role of Perfectionism in Trichotillomania

Objective: Trichotillomania (TTM) is a condition in which individuals repeatedly pull out their hair despite adverse consequences. Several models have suggested underlying processes, with a central feature of hairpulling being an external means to regulate internal states. The frustrated action model suggests that certain affective states arise from perfectionistic beliefs and an overactive, overprepared style of planning, triggering episodes of hairpulling. To date, there is limited research investigating perfectionism in people with TTM. The current study investigated the experiences of hairpulling behaviour in people with TTM, with specific attention given to perfectionism.

Design: A qualitative methodology was employed.

Method: Twenty participants completed online screening questionnaires and were interviewed via an online communication platform. Data were analysed using reflexive thematic analysis.

Results: The findings identified the role and development of maladaptive perfectionism in hairpulling. Furthermore, a maintenance cycle is proposed, in which hairpulling is maintained via the positive function it plays in preventing confirmation of self-critical cognitions.

Conclusions: The results indicate that interventions targeting perfectionism specifically in individuals with TTM could be beneficial. Furthermore, clinicians should be sensitive to the positive functions that hairpulling can serve for people with TTM.