Racial identity may affect impact of trichotillomania on black women: pulling hair from scalp, pubic region

OB/GYN News, Dec 1, 2003 by Betsy Bates

CHICAGO -- Trichotillomania among African American women often involves pulling of the pubic hair as well as pulling of hair from the scalp, eyelashes, or eyebrows, which may add to the profound sense of shame patients feel, Angela Neal-Barnett, Ph.D., reported.

The compulsive pulling out of hair is a poorly understood phenomenon, with debate still raging over whether it is an anxiety disorder or a habit disorder. A review of the literature shows a dearth of good epidemiologic studies describing the disorder in any population, she said at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

Dr. Neal-Barnett does not know whether trichotillomania is more common in African Americans than in other ethnic groups, she said in an interview, "but I do believe it is more hidden."

The pulling of pubic hair had been noted in previous studies, but in Dr. Neal-Barnett's extensive interviews and psychological testing of 41 African American women from the United States, France, the Netherlands, and South Africa, it became clear that the pulling of hair from more than one body site is a common experience among this group.

The third most frequent body site for pulling hair was the pubic region, behind the scalp and eyelashes, said Dr. Neal-Barnett, a psychologist from Kent (Ohio) State University.

Fourteen subjects pulled hair from the eyelashes and pubic area, 11 from the scalp and pubic area, and 5 from the eyebrows and pubic area. Several women pulled hair from their underarms, arms, and/or legs.

Women who acknowledged trichotillomania were significantly more likely to have negative emotions, to have first-degree relatives who were cosmetologists, to have a history of abuse, and to have received negative messages about hair as children.

Importantly, a strongly significant negative correlation was round between the subjects' ratings of how much hair-pulling interfered with their lives and the racial identity dimension of private regard.

Robert Sellers, Ph.D., described four dimensions of racial identity, including private regard, described as "the extent to which individuals feel positively or negatively toward African Americans as well as how positively or negatively they feel about being African American," she said.

In Dr. Neal-Barnett's study, women who had high private regard described the impact of trichotillomania on their lives as minimal, and vice versa. "I really, really want to stress that this does not mean a woman hates being black so she pulls out her hair," Dr. Neal-Barnett said at the meeting, also sponsored by Howard University.

Anxiety disorders may lead to cognitive distortion, offering a potential insight into the findings, she noted.

The profound level of embarrassment expressed by women in the study suggests that patients suffering from the disorder may hide the problem from physicians, psychologists, and cosmetologists.