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The Role of Cognitions and Beliefs in Trichotillomania: A Qualitative Study Using Interpretative Phenomenological Analysis

Published online by Cambridge University Press:  12 August 2015

Imogen C. Rehm*
Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
Maja Nedeljkovic
Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia
Anna Thomas
Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia Australian Gambling Research Centre, Australian Institute of Family Studies, Melbourne, Victoria, Australia
Richard Moulding
Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Victoria, Australia
Address for correspondence: Imogen Rehm, Faculty of Health, Arts and Design, Swinburne University of Technology, PO.Box 218, Hawthorn, VIC 3122, Australia. Email:


Trichotillomania (TTM) is characterised by the removal of one's hair, causing hair loss. Phenomenological research on TTM has investigated its associated behavioural and affective factors. Few studies have investigated the possible role of cognitions and beliefs, despite emerging support for cognitive therapies in treating this disorder. This study aimed to explore and describe the cognitions and beliefs that contribute to the onset and maintenance of hairpulling in TTM. Eight women with TTM participated in semi-structured, in-depth interviews to explore their experience of cognitions and beliefs before, during and after typical hairpulling episodes. Interviews were analysed using the qualitative method of Interpretative Phenomenological Analysis. Six superordinate themes of beliefs were identified as important: negative self-beliefs, control beliefs, beliefs about coping, beliefs about negative emotions, permission-giving beliefs, and perfectionism. These preliminary findings suggest that cognitions may play an important role in TTM phenomenology. Future quantitative research on the role of cognitions and beliefs in TTM in larger samples has the potential to advance cognitive-behavioural models and treatments of this poorly understood disorder.

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