German study finds boredom, not stress, may trigger hair-pulling urges

ANBAR, Iraq — Researchers at Heidelberg University Hospital in Germany followed 61 patients with trichotillomania, a hair-pulling disorder, over 10 days using an ecological momentary assessment method. The team analyzed more than 2,500 momentary assessments and 702 instances of hair-pulling. They found that a strong urge appearing immediately before the act was the strongest predictor that the behavior would occur. The findings showed that boredom, fatigue and inattention triggered the urge to pull hair more than negative emotions such as anxiety or sadness. Researchers said trichotillomania may serve a function of regulating internal arousal levels in some patients, surfacing during periods of low energy or lack of external stimulation. The disorder, referenced in writings by Hippocrates and Aristotle, is estimated to affect 1 to 2 percent of the population. The study concluded that focusing solely on emotion regulation may be insufficient, and that understanding the brief window between the urge to pull hair and the behavior itself could support more effective control strategies.