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The role of emotion regulation in body-focused repetitive behaviours

Published online by Cambridge University Press:  30 March 2016

Sarah Roberts ,
Kieron O'Connor ,
Frederick Aardema ,
Claude Bélanger  and
Catherine Courchesne
Sarah Roberts
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada
Kieron O'Connor*
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada
Frederick Aardema
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada
Claude Bélanger
Affiliation:
University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada
Catherine Courchesne
Affiliation:
University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada
*
*Author for correspondence: K. O'Connor, PhD, Research Center, University Institute of Mental Health at Montreal, 7331 Hochelaga, Montreal, Quebec, Canada, H1N 3V2 (email: oconnor.kieron@umontreal.ca).
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Abstract

Body-focused repetitive behaviours (BFRBs) including trichotillomania, skin picking, and nail biting, are non-functional self-destructive habits, which have a severe negative impact on everyday functioning. Although BFRBs cause distress, they are maintained by both negative (relief) and positive (stimulation) reinforcement. The emotional regulation (ER) model proposes that people with BFRBs have a general deficit in ER and, as a consequence, engage in BFRBs to alleviate affect and reinforce the behaviour. The current study was designed to explore differences in ER between people with BFRBs and controls to identify specific emotions triggering BFRBs. Forty-eight participants (24 BFRB, 24 controls) completed questionnaires measuring Difficulties in Emotional Regulation (DERS), a Triggers Scale and an Affective Regulation Scale (ARS). Significant differences in people with BFRBs and controls were reported principally on the DERS subscales of lack of emotional clarity, difficulties in impulse control, and access to ER strategies. On the ARS, the BFRB group reported overall difficulty ‘snapping out’ of emotions. The majority of BFRBs were reported to be triggered by anxiety (78%), tension (70%), or boredom (52%). The clinical implication is that ER could be beneficially targeted in therapy for BFRBs.

Keywords

Anxietybodily sensationsCBTemotionperfectionismtics

Information

Type
Original Report
Information
the Cognitive Behaviour Therapist , Volume 9 , 2016 , e7
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

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References

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Keuthen, NJ, Rothbaum, BO, Fama, J, Altenburger, E, Falkenstein, MJ, Sprich, SE, Kearns, M, Meunier, S, Jenike, MA, Welch, SS (2012). DBT-enhanced cognitive-behavioral treatment for trichotillomania: a randomized controlled trial. Journal of Behavioral Additions 1, 106–114.CrossRefGoogle ScholarPubMed
Roberts, S, O'Connor, K, Bélanger, C (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review 33, 745–762.CrossRefGoogle ScholarPubMed
Rufer, M, Bamert, T, Klaghofer, R, Moritz, S, Schilling, L, Weidt, S (2014). Trichotillomania and emotion regulation: is symptom severity related to alexithymia? Psychiatric Research 218, 161–165.CrossRefGoogle ScholarPubMed

References

APA (2000). Diagnostic and Statistical Manual for Mental Disorders, 4th edn, text revision. Washington DC: American Psychiatric Association.Google Scholar
APA (2013). Diagnostic and Statistical Manual for Mental Disorders, 5th edn. Washington DC: American Psychiatric Association.Google Scholar
Arnold, LM, Auchenbach, MB, McElroy, SL (2001). Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 15, 351–359.Google Scholar
Azrin, NH, Nunn, RG (1973). Habit-reversal: a method of eliminating nervous habits and tics. Behavior Research and Therapy, 11, 619–628.Google Scholar
Bate, KS, Malouff, JM, Thorsteinsson, ET, Bhullar, N (2011). The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review. Clinical Psychology Review, 31, 865–871.CrossRefGoogle ScholarPubMed
Bohne, A, Wilhelm, S, Keuthen, NJ, Baer, L, Jenike, MA (2002). Skin picking in German students: prevalence, phenomenology, and associated characteristics. Behavior Modification, 26, 320–339.Google Scholar
Christenson, GA, Mackenzie, TB, Mitchell, JE (1991). Characteristics of 60 adult chronic hair pullers. American Journal of Psychiatry, 148, 365–370.Google ScholarPubMed
Derogatis, LR (2000). Symptom Checklist-90 – Revised. In: Handbook of Psychiatric Measures, pp. 81–84. Arlington, VA: American Psychiatric Association.Google Scholar
Derogatis, LR, Savitz, KL (2000). The SCL-90-R and Brief Symptom Inventory (BSI) in primary care. In: Handbook of Psychological Assessment in Primary Care Settings (ed. Maruish, M. E.), pp. 297–333. New Jersey: Lawrence Erlbaum Associations Inc.Google Scholar
Diefenbach, GJ, Mouton-Odum, S, Stanley, MA (2002). Affective correlates of trichotillomania. Behavior Research and Therapy 40, 1305–1315.Google Scholar
Diefenbach, GJ, Tolin, DF, Meunier, S, Worhunsky, P (2008). Emotion regulation and trichotillomania: a comparison of clinical and nonclinical hair pulling. Journal of Behavior Therapy and Experimental Psychiatry 39, 32–41.Google Scholar
du Toit, PL, van Kradenburg, J, Niehaus, DJH, Stein, DJ (2001). Characteristics and phenomenology or hair-pulling: an exploration of subtypes. Comprehensive Psychiatry 42, 247–256.CrossRefGoogle ScholarPubMed
Duke, DC, Bodzin, DK, Tavares, P, Geffken, GR, Storch, EA (2009). The phenomenology of hair-pulling in a community sample. Journal of Anxiety Disorders 23, 1118–1125.Google Scholar
Duke, DC, Keeley, ML, Ricketts, EJ, Geffken, GR, Storch, EA (2010). The phenomenology of hairpulling in college students. Journal of Psychopathology and Behavioral Assessment 32, 281–292.Google Scholar
First, B, Spitzer, L, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Fortin, MF, Coutu-Wakulczyk, G (1985). Validation and normalization of a mental health measure: SCL-90-R [in French]. Report presented to the Quebec Council for Social Research. Faculty of Nursing, University of Montreal.Google Scholar
Franklin, ME, Tolin, DF (2007). Treating Trichotillomania: Cognitive-behavioral Therapy for Hairpulling and Related Problems. Series in Anxiety and Related Disorders. New York, NY, US: Springer Science + Business Media Treating trichotillomania: cognitive-behavioral therapy for hairpulling and related problems.CrossRefGoogle Scholar
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment 26, 41–54.Google Scholar
Gross, JJ (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology 2, 271–299.Google Scholar
Hansen, DJ, Tishelman, AC, Hawkins, RP, Doepke, KJ (1990). Habits with potential as disorders: Prevalence, severity, and other characteristics among college students. Behavior Modification 14, 66–80.Google Scholar
Keuthen, NJ, Deckersbach, T, Wilhelm, S, Engelhard, I, Forker, A, O'Sullivan, RL, Jenike, MA, Baer, L (2001). The Skin Picking Impact Scale (SPIS): Scale development and psychometric analyses. Psychosomatics 42, 397–403.Google Scholar
Keuthen, NJ, Koran, LM, Aboujaoude, E, Large, MD, Serpe, RT (2010 a). The prevalence of pathologic skin picking in US adults. Comprehensive Psychiatry, 51, 183–186.Google Scholar
Keuthen, NJ, O'Sullivan, RL, Ricciardi, JN, Shera, D, Savage, CR, Borgmann, AS, Jenike, MA, Baer, L (1995). The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and factor analysis. Psychotherapy & Psychosomatics 64, 141–145.Google Scholar
Keuthen, NJ, Rothbaum, BO, Welch, SS, Taylor, C, Falkenstein, M, Heekin, M, Jordan, CA, Timpano, K, Meunier, S, Fama, J, Jenike, MA (2010 b). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety 27, 953–959.Google Scholar
Keuthen, NJ, Rothbaum, BO, Fama, J, Altenburger, E, Falkenstein, MJ, Sprich, SE, Kearns, M, Meunier, S, Jenike, MA, Welch, SS (2012). DBT-enhanced cognitive-behavioral treatment for trichotillomania: a randomized controlled trial. Journal of Behavioral Additions 1, 106–114.Google Scholar
Mansueto, CS, Thomas, AM, Brice, AL (2007). Hair pulling and its affective correlates in an African-American university sample. Journal of Anxiety Disorders 21, 590–599.CrossRefGoogle Scholar
Neal-Barnett, A, Stadulis, R (2006). Affective states and racial identity among African-American women with trichotillomania. Journal of the National Medical Association 98, 753–757.Google ScholarPubMed
O'Connor, K, Brisebois, H, Brault, M, Robillard, S, Loiselle, J (2003). Behavioral activity associated with onset in chronic tic and habit disorder. Behavior Research and Therapy, 41, 241–249.CrossRefGoogle ScholarPubMed
O'Connor, KP, Lavoie, ME, Robert, M, Stip, E, Borgeat, F (2005). Brain-behavior relations during motor processing in chronic tic and habit disorder. Cognitive Behavioral Neurology 18, 79–88.Google Scholar
Odlaug, BL, Grant, JE (2008). Trichotillomania and pathologic skin picking: clinical comparison with an examination of comorbidity. Annals of Clinical Psychiatry 20, 57–63.Google Scholar
Penzel, F (1995). Skin picking and nail biting: related habits. In Touch 2, 10–11.Google Scholar
Penzel, F (2002). A stimulus regulation model of trichotillomania. In Touch 3, 12–14.Google Scholar
Penzel, F (2003). The Hair-pulling Problem. Oxford: University Press.Google Scholar
Roberts, S, O'Connor, K, Aardema, F, Bélanger, C (2015). The impact of emotions on body-focused repetitive behaviors: evidence from a non-treatment-seeking sample. Journal of Behavior Therapy and Experimental Psychiatry 46, 189–197.Google Scholar
Roberts, S, O'Connor, K, Bélanger, C (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review 33, 745–762.CrossRefGoogle ScholarPubMed
Rufer, M, Bamert, T, Klaghofer, R, Moritz, S, Schilling, L, Weidt, S (2014). Trichotillomania and emotion regulation: Is symptom severity related to alexithymia? Psychiatric Research 218, 161–165.CrossRefGoogle ScholarPubMed
Schuck, K, Keijsers, GPJ, Rinck, M (2011). The effects of brief cognitive-behaviour therapy for pathological ski picking: a randomized comparison to wait-list control. Behaviour Research and Therapy 49, 11–17.CrossRefGoogle Scholar
Shusterman, A, Feld, L, Baer, L, Keuthen, N (2009). Affective regulation in trichotillomania: evidence from a large-scale internet survey. Behavior Research and Therapy, 47, 637–644.Google Scholar
Snorrasson, I, Ricketts, EJ, Flessner, CA, Franklin, ME, Stein, DJ, Woods, DW (2012). Skin picking disorder is associated with other body-focused repetitive behaviors: findings from an Internet study. Annals of Clinical Psychiatry 24, 292–299.Google Scholar
Snorrason, I, Smári, J, Ólafsson, RP (2010). Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. Journal of Behavior Therapy and Experimental Psychiatry 41, 238–245.CrossRefGoogle ScholarPubMed
Snorrason, I, Woods, DW (2014). Hair pulling, skin picking, and other body-focused repetitive behaviors. In: Obsessive-compulsive Disorder and its Spectrum: A Life-span Approach (ed. Storch, E. A. & McKay, D.), pp.163–184. Washington, DC, US: American Psychological Association.Google Scholar
Stein, DJ, Flessner, CA, Franklin, M, Keuthen, NJ, Lochner, C, Woods, DW (2008). Is trichotillomania a stereotypic movement disorder? An analysis of body-focused repetitive behaviors in people with hair-pulling. Annals of Clinical Psychiatry 20, 194–198.Google Scholar
Teng, EJ, Woods, DW, Marcks, BA, Twohig, MP (2004). Body-focused repetitive behaviors: the proximal and distal effects of affective variables on behavioral expression. Journal of Psychopathology and Behavioral Assessment, 26, 55–64.Google Scholar
Teng, EJ, Woods, DW, Twohig, MP, Marcks, BA (2002). Body-focused repetitive behavior problems: prevalence in a nonreferred population and differences in perceived somatic activity. Behavior Modification 26, 340–360.CrossRefGoogle Scholar
Tucker, BTP, Woods, DW, Flessner, CA, Franklin, SA, Franklin, ME (2011). The Skin Picking Impact Project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. Journal of Anxiety Disorders, 25, 88–95.Google Scholar
Twohig, MP, Woods, DW (2001). Habit reversal as a treatment for chronic skin picking in typically developing adult male siblings. Journal of Applied Behavior Analysis 34, 217–220.Google Scholar
Vallerand, RJ (1989). Towards a methodology for transcultural validation of psychological questionnaires: implications for research in the French language [in French]. Canadian Psychology 30, 662–680.Google Scholar
Wells, JH, Haines, J, Williams, CL (1998). Severe morbid onychophagia: the classification as self-mutilation and a proposed model of maintenance. Australia & New Zealand Journal of Psychiatry, 32, 534–545.Google Scholar
Wilhelm, S, Keuthen, NJ, Deckersbach, T, Engelhard, MS, Forker, AE, Baer, L, O’Sullivan, RL, Jenike, MA (1999). Self-injurious skin picking: clinical characteristics and comorbidity. Journal of Clinical Psychiatry 60, 454–459.CrossRefGoogle ScholarPubMed
Wilhelm, F, Margraf, J (1993). Nailbiting: description, etiological models and treatment. Verhaltenstherapie 3, 176–196.CrossRefGoogle Scholar
Williams, TI, Rose, R, Chisholm, S (2006). What is the function of nail biting: an analog assessment study. Behavior Research and Therapy 45, 989–995.CrossRefGoogle ScholarPubMed
Woods, DW, Wetterneck, CT, Flessner, CA (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44, 639–656.Google Scholar
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