Pulling Styles and Impulse Control in Youth with Trichotillomania

Trichotillomania (TTM) is considered a heterogeneous disorder consisting of both automatic and focused styles of pulling. Automatic pulling (AP) occurs outside one’s awareness while engaging in other (mostly sedentary) activities (e.g. reading, watching TV) and realization occurs after the pulling session has ended. Focused pulling (FP) is conceptualized as intentional actionand may represent a behavioral attempt to down-regulate negative emotions. Response inhibition (RI) is a cognitive process that is required to cancel an intended movement or suppress previously learned stimulus-response associations. Individuals with TTM tend to display impaired inhibition of motor responses, and display increased perseveration on an object alternation task, which suggests difficulties with response flexibility. This suggests TTM may be maintained by individual’s lessened ability to inhibit undesirable but dominant behavior, and/or to shift their attention flexibly among different response sets. The current study aimed to examine these previous findings within each pulling type (AP vs FP) using an online Go/No-Go RI task among youth with a primary TTM diagnosis.Study participants were children (age 8 to 17) diagnosed with trichotillomania (N=28) based on the Trichotillomania Diagnostic Interview (TDI). Participants were administered the NIMH TTM interview, the Milwaukee Inventory for Styles of Trichotillomania-Children (MIST-C), and an online RI Go/No-Go task.Results indicate that in general higher pulling symptoms (NIMH total score) result in shorter reaction times on the Go/No-Go task (r = -.50, p = .021), greater omission errors (r = .53, p = .013), and fewer commission errors (r = -.32, p = .154). Specifically, FP is associated with greater overall accuracy (r = .46, p = .039), and fewer commission errors (r = -.39, p = .087), while AP is positively associated with increased commission errors (r = .37, p = .109) and slower reaction time (r = .332, p = .152).As TTM is an impulse control disorder it is not surprising that reaction times are shorter as symptoms become more severe, suggesting more trouble restraining urges and actions. In the contrast between FP and AP, findings indicate there may be a tendency for those with higher FP scores to focus on their immediate environment and self-regulation; while higher AP scores may indicate a tendency to lose focus, increasing reaction time and the number false positive identifications. Theoretical and clinical implications will be discussed