Boredom and Tiredness Outpace Negative Emotions as Predictors of Hair-Pulling

A recent investigation published in *Comprehensive Psychiatry* questions the long-standing view that hair-pulling disorder (trichotillomania) primarily serves to alleviate negative affect. The study, led by clinical psychologist Christina Gallinat of Heidelberg University Hospital, reports that boredom and tiredness are more reliable antecedents of pulling behavior than anxiety, sadness, or tension.

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The researchers employed ecological momentary assessment, prompting participants on their smartphones seven times per day over a ten-day interval. Sixty-one adults diagnosed with trichotillomania rated their current urge to pull (scale 1-5), recent pulling episodes, and a range of emotional states—including negative emotions, positive emotions, boredom, tiredness, and rumination. Data were analyzed for both prospective (state at one moment predicting behavior at the next check-in) and concurrent (state and behavior occurring simultaneously) associations.

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Prospective analysis showed that earlier urges strongly forecasted pulling at the subsequent assessment, and a prior pulling episode increased the likelihood of later episodes. Among emotional variables, boredom alone predicted a future pulling episode; negative emotions did not reach statistical significance. In concurrent analysis, higher urge intensity and boredom were linked to pulling at that moment, while negative emotions again showed no relationship. When examining what drives the urge itself, tiredness predicted an increase in future urge intensity, whereas negative emotions, boredom, and rumination did not. Across all time points, higher levels of negative emotions, boredom, and rumination were associated with a stronger current urge, while positive emotions correlated with a weaker urge.

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The authors suggest that trichotillomania may function to counteract under-arousal rather than merely to soothe distress, positioning repetitive pulling as a means of regulating stimulation levels. This perspective aligns with the removal of tension-relief criteria from recent diagnostic guidelines, which now recognize that many individuals pull automatically or out of boredom.

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The study acknowledges limitations: assessments were spaced up to four hours apart, potentially missing rapid emotional shifts, and no data were collected on participants’ physical surroundings or activities. The volunteer sample may underrepresent individuals with lower motivation or insight. Gallinat and colleagues recommend shorter assessment intervals and inclusion of environmental context in subsequent studies to better elucidate triggers and inform therapeutic approaches.

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