Despite trichotillomania being a relatively common mental illness, many people are not aware that the condition exists. Trichotillomania is identified by repeated hair pulling and thus is, in some cases, accompanied by hair loss (Cavic et al., 2021). Skin picking disorder (sometimes referred to as dermatillomania) is also common, yet not many people are familiar with the disorder. It is characterized by recurrent skin picking and, in some cases, associated scarring or tissue damage.
Both trichotillomania and dermatillomania are generally accompanied by psychological distress and substandard sleep. They are grouped under a larger group of body-focused repetitive behaviour disorders (BFRBs). The conditions of these disorders can lead to significant distress and are often accompanied by increased anxiety and depression.
In a study conducted by UK and US researchers, Cavic et al. (2021) looked to investigate the idea that trichotillomania and skin picking disorder are associated with poor sleep quality compared to those without skin picking disorder or trichotillomania. Previous studies had suggested that poor sleep quality is associated with stress, leading to impulsivity, which is very relevant to today’s understanding of BFRBs. Indeed, in this study, the researchers found that those with a BFRB had significantly poorer sleep quality. Although more research is needed, it could be suggested that sleep disturbances could contribute to one’s experience of a BFRB. Worse sleep could impact the severity of symptoms that one reports. What these researchers contribute to our understanding of BFRBs is that impulsivity and stress contribute to impaired sleep, especially among those who experience trichotillomania or skin picking disorder. Interestingly, what Cavic et al. (2021) found in their research is that poor sleep quality is associated with worse hair pulling but not worse skin picking.
What is also important to note is that there is a possibility that those with BFRBs experience poor sleep quality due to spending less time sleeping due to hair pulling or skin-picking at nighttime. Then, this poor sleep can in turn worsen symptoms.
The factors that would explain the relationship between poor sleep and trichotillomania and skin picking are still uncertain. Some research suggests that poor sleep may result in an overactive emotional response to negative stimuli, which could possibly increase impulsivity and the severity of BFRB symptoms.
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Many people with trichotillomania report feeling shame and embarrassment relating to their condition. This makes it more difficult for them to access treatment due to the stigma that surrounds hair pulling (and skin picking). It is important for all of us to take action to raise awareness and talk about this disorder to help those who are struggling get the support that they need!
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