The Effect of Impulsivity and Emotional Dysregulation on Trichotillomania in Bipolar Disorder: A Multidimensional Clinical Research

Objective: This study aimed to evaluate the effects of impulsivity and emotion dysregulation on trichotillomania (TTM) in adolescents with bipolar disorder (BD). We hypothesized that adolescents with comorbid BD and TTM would exhibit higher impulsivity, more severe emotion dysregulation, and a more complex clinical presentation compared to adolescents with BD alone and healthy controls. Method: In this cross-sectional study, 120 adolescents aged 12-18 were assessed, comprising three groups: BD with a history of TTM (n=40), BD without TTM (n=40), and healthy controls (n=40). Participants were evaluated using standardized measures including the Barratt Impulsivity Scale (BIS-11), the Difficulties in Emotion Regulation Scale (DERS), the Young Mania Rating Scale (YMRS), and the Trichotillomania Global Severity Scale (TGSS). Results: Both clinical groups (BD+TTM and BD-only) displayed significantly higher impulsivity than healthy controls, but there was no statistically significant difference between the two clinical groups in terms of impulsivity. However, a clear gradient was observed in emotion dysregulation; the BD+TTM group had the highest scores, followed by the BD-only group, with both being significantly higher than controls. Multiple regression analysis revealed that emotion dysregulation was the strongest predictor of TTM severity (β = 0.0598, p < 0.001). Furthermore, mania scores were significantly higher in the comorbid group and moderated the relationship between emotion dysregulation and impulsivity. Conclusion: A history of TTM in adolescents with BD is a clinical indicator of profound emotion dysregulation rather than merely elevated impulsivity. These findings suggest that hair-pulling may function as a maladaptive coping mechanism for overwhelming emotional states. Therapeutic interventions should therefore prioritize targeting emotion regulation skills in this high-risk comorbid population.