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      Body esteem in adolescent hair pullers

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          Abstract

          Background and aims

          Trichotillomania (TTM) often first presents in adolescence, a developmental period marked by vulnerability in body image. To date, no one has studied the relationship between this disorder and body esteem.

          Methods

          49 adolescents with DSM-IV TTM or chronic hair pulling (HP) and 23 control adolescents were administered diagnostic assessments and self-report measures of hair pulling and body esteem.

          Results

          HP youth vs. controls reported lower levels of body esteem on all Body-Esteem Scale for Adolescents and Adults (BESAA) subscales (appearance, attribution and weight satisfaction). HP contributed to lowered body esteem, independent of comorbid anxiety or depression. As expected, HP youth with vs. without comorbid anxiety or depression reported lowered levels of body esteem. Further, greater HP severity and distress were significantly associated with lower levels of body esteem. HP severity alone but not distress/impairment predicted lower levels of body esteem, independent of comorbid anxiety and depression.

          Conclusions

          Both hair pulling and comorbid anxiety and depression can independently impact body esteem in adolescent hair pullers.

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          Most cited references19

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          Body-image and eating disturbances predict onset of depression among female adolescents: a longitudinal study.

          This study examined data from a 4-year school-based longitudinal study (n = 1,124), to test whether the increase in major depression that occurs among girls during adolescence may be partially explained by the body-image and eating disturbances that emerge after puberty. Elevated body dissatisfaction, dietary restraint, and bulimic symptoms at study entry predicted onset of subsequent depression among initially nondepressed youth in bivariate analyses controlling for initial depressive symptoms. Although the unique effect for body dissatisfaction was not significant in the multivariate model, this set of risk factors was able to fairly accurately foretell which girls would go on to develop major depression. Results were consistent with the assertion that the body-image- and eating-related risk factors that emerge after puberty might contribute to the elevated rates of depression for adolescent girls.
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            Weight concerns, body image, depression and anxiety in Swedish adolescents.

            To assess weight problems and correlates in respect of body image, depression, anxiety and demographic background factors. 405 Swedish adolescents were assessed in respect of Body Mass Index (BMI), biographical data, the Body Esteem Scale for Adolescents and Adults (BESAA), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI). Boys were in the positive and girls in the negative direction from ideal BMI for age and gender. Girls and boys differed in respect of CDI, MASC and of BESAA where girls generally were shifted in the "pathological" direction. The adolescents' own positive attitude to slimness, negative mood (girls), and anxiety symptoms that reflect social fears (boys) and physical aspects of anxiety (girls and boys) were important correlates of lower BMI than ideal. Adolescent cultural norms need to be addressed in preventive work. However, in girls' separation anxiety might be a protective factor against underweight. In girls, overweight seems to be associated with negative self-esteem.
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              Pathologic hairpulling, skin picking, and nail biting.

              Pathologic hairpulling (HP), skin picking (SP), and nail biting (NB) are repetitive, intentionally performed behaviors that cause noticeable hair loss or substantial physical damage, and result in clinically significant distress or functional impairment. To date, HP, SP, and NB have received little attention in the psychiatric literature despite being widespread behaviors. The present article reviews the up-to-date research findings on these three forms of pathologic behavior, highlighting their similarities and differences. Despite HP, pathologic grooming behaviors have not yet been explicitly included in the diagnostic nomenclature. Phenomenology, triggers, consequences and functionality of HP, SP, and NB are similar, which suggest their joint diagnostic categorization. Sufferers often fail to admit the self-inflicted nature of their physical damage out of shame and embarrassment, which complicates the recognition and differential diagnosis of sufferers. Thus, practitioners need to be particularly attentive to physical signs possibly related to these behavior disorders. Research suggests that HP, SP, and NB are underrecognized problems that occur on a continuum ranging from mild to severe. Further research is needed, especially regarding the etiology of pathologic HP, SP, and NB, to foster the development of both effective and long-lasting treatments and prevention strategies.
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                Author and article information

                Journal
                2006
                122266
                Journal of Behavioral Addictions
                JBA
                Akadémiai Kiadó, co-published with Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V.
                2062-5871
                2063-5303
                1 June 2014
                5 April 2014
                : 3
                : 2
                : 124-127
                Affiliations
                [ 1 ] Psychology Department, The Ohio State University, 181 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
                [ 2 ] Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
                Author notes
                [* ] +1-614-292-9775, +1-614-688-8261, altenburger.20@ 123456buckeyemail.osu.edu
                Article
                6
                10.1556/jba.3.2014.010
                7becedf5-888c-46ae-a0d9-3bf508e5eb48
                © 2014 The Author(s)

                Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 11 October 2013
                : 18 January 2014
                : 19 January 2014
                Categories
                Brief Report

                Medicine,Psychology,Social & Behavioral Sciences,Clinical Psychology & Psychiatry
                trichotillomania,hair pulling,body esteem

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