Academic journal article Journal of Mental Health Counseling

Perfectionism, Shame, and Trichotillomania Symptoms in Clinical and Nonclinical Samples

Academic journal article Journal of Mental Health Counseling

Perfectionism, Shame, and Trichotillomania Symptoms in Clinical and Nonclinical Samples

Article excerpt

This study explored the relationships between multidimensional perfectionism (adaptive and maladaptive), shame (characterological, behavioral, and bodily), and trichotillomania (TTM) symptom severity in a nonclinical sample of 284 college students and a clinical sample of 125 individuals with TTM. Results suggested that the clinical sample reported significantly higher levels of maladaptive perfectionism, all three subtypes of shame, and TTM compared to the nonclinical sample. While none of the three subtypes of shame mediated the relationship between either form of perfectionism and TTM for the nonclinical sample, behavioral shame was a significant mediator between maladaptive perfectionism and TTM for the clinical sample. Implications for mental health counselors are discussed.

The treatment of compulsive hairpulling is a significant issue for mental health counselors. Some research indicates that current treatments have resulted in limited success and fail to address symptom presentation in different types of hair pullers (Keuthen, Tung, Tung, Curley, & Flessner, 2016; Woods, Wetterneck, & Flessner, 2006). Despite the limited treatments, Woods (2011) suggested that trichotillomania (TTM) rates "are approaching, matching, or even exceeding those of more commonly researched disorders" (p. 747). Estimates of TTM prevalence range from 0.6% to 3.4% of the population (e.g., Duke, Keeley, Geffken, & Storch, 2010). In addition, several researchers (Duke, Keeley, Ricketts, Geffken, & Storch, 2009; Woods & Miltenberger, 1996) have found behavioral patterns (e.g., problematic hairpulling) consistent with some aspects of TTM occurring at rates up to 13.3% in college students. TTM is often comorbid with other mental health issues. Frequently cooccurring disorders include anxiety and depression (Duke et al., 2009), personality disorders (Christenson, Chernoff-Clementz, & Clementz, 1992; Keuthen et al., 2015), and TTM-related social avoidance (Mansueto, 1990). Despite the increase in diagnoses of TTM, very limited research exists in the literature, particularly within the last decade.

A growing body of research suggests a significant relationship between obsessive-compulsive disorder (OCD) and TTM (Christenson & Mackenzie, 1995; Duke et al., 2010). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) developed an independent chapter for OCD and related disorders, including TTM. This change has been attributed to recent research that identified commonalities with obsessive thoughts and repetitive behaviors (American Psychiatric Association [APA], 2013). The high comorbidity and strength of the connection between TTM and OCD symptomatology have led TTM to be conceptualized as an obsessive-compulsive (OC) spectrum disorder. For example, Stewart, Jenike, and Keuthen (2005) found that 18.8% of individuals in an inpatient sample treated for OCD reported low rates of hairpulling, 15.6% reported moderate to severe hairpulling, and 7.8% reported severe hairpulling. Similarly, Hajcak, Franklin, Simons, and Keuthen (2006) found positive relationships between hairpulling, anxiety, stress reactivity, skin picking, and OC symptoms in a nonclinical sample. Wetterneck, Lee, Flessner, Leonard, and Woods (2016) found that individuals with TTM displayed significantly higher impulsivity levels, as well as anxiety, anxiety-related, and borderline features, when compared to a control group of individuals without TTM.

Although TTM poses a significant issue for many clients seeking counseling, few studies have investigated how individual characteristics, such as personality, may be related to TTM (e.g., Chamberlain & Odlaug, 2014; Keuthen, Altenburger, & Pauls, 2014; Keuthen et al., 2015; Keuthen et al., 2016; Wetterneck et al., 2016). An increasing amount of research in the counseling field is being focused on how personality traits and individual characteristics may be connected to emotions and behaviors (Ghorpade, Lackritz, & Singh, 2007; Moate, Gnilka, West, & Bruns, 2016; O'Connor & Paunonen, 2007). …

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