The significance of repetitive hair-pulling behaviors in eating disorders

Nancy Zucker, Ann Von Holle, Laura M. Thornton, Michael Strober, Kathy Plotnicov, Kelly L. Klump, Harry Brandt, Steve Crawford, Scott Crow, Manfred M. Fichter, Katherine A. Halmi, Craig Johnson, Allan S. Kaplan, Pamela Keel, Maria LaVia, James E. Mitchell, Alessandro Rotondo, D. Blake Woodside, Wade H. Berrettini, Walter H. KayeCynthia M. Bulik

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


We studied the relation between intrusive and repetitive hair pulling, the defining feature of trichotillomania, and compulsive and impulsive features in 1,453 individuals with anorexia nervosa and bulimia nervosa. We conducted a series of regression models examining the relative influence of compulsive features associated with obsessive-compulsive disorder, compulsive features associated with eating disorders, trait features related to harm avoidance, perfectionism, and novelty seeking, and self harm. A final model with a reduced sample (n = 928) examined the additional contribution of impulsive attributes. One of 20 individuals endorsed hair pulling. Evidence of a positive association with endorsement of compulsive behavior of the obsessive-compulsive spectrum emerged. Hair pulling may be more consonant with ritualistic compulsions than impulsive urges in those with eating disorders.

Original languageEnglish (US)
Pages (from-to)391-403
Number of pages13
JournalJournal of clinical psychology
Issue number4
StatePublished - Apr 2011


  • Addiction
  • Anorexia nervosa
  • Bulimia nervosa
  • Compulsivity
  • Eating disorders
  • Hair pulling
  • Impulsivity
  • Trichotillomania

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