Dissociation May Worsen the Impact of Hair-Pulling, Study Finds
Action without Awareness?
A recent study from the University of Chicago, published in April 2025 in the Journal of Psychological Research, offers new insight into one of the most misunderstood aspects of trichotillomania.
Researchers examined the role of dissociation—a psychological state where a person feels disconnected from themselves or their environment—and how it relates to body-focused repetitive behaviors (BFRBs) such as trichotillomania and skin picking disorder.
But before we dive into the findings, there’s something important to acknowledge:
The data doesn’t account for the fact that there is often shame associated with admitting awareness during pulling.
Sometimes people describe the behavior as “unconscious” not because they aren’t aware—but because it feels safer than facing the judgmental question.
“If you know you’re doing it, why can’t you just stop?”
This study helps move the conversation toward a more compassionate, evidence-based understanding of dissociation.
What the Study Looked At
The research team surveyed 370 adults living with trichotillomania or skin picking disorder. They asked about symptom severity and whether participants experienced dissociative states—things like zoning out, losing track of time, emotional numbness, or feeling disconnected from one’s body or surroundings.
Key Findings
Nearly 50% of participants reported high levels of dissociation.
Those with higher dissociation were significantly more likely to report emotional distress
Surprisingly, dissociation wasn’t linked to how often someone pulled or picked—but to how distressed they felt about it.
This suggests that dissociation may not cause more hair pulling—but could intensify the emotional suffering around it.
Not Everyone Pulls Without Realizing It
The study does not suggest that all people with trichotillomania dissociate during pulling.
Many do it consciously- in the same way they might scroll through social media, without purpose but with awareness.
Others experience it as automatic or trance-like. Both experiences are valid and reflect different emotional and neurological pathways.
This diversity further points to what Strands has long been calling for- the need for more individualized treatment approaches—and less one-size-fits-all thinking.
Why This Matters
For many people, treatment has focused primarily on stopping the behavior eg substituting habits. But if someone is pulling while dissociated, these techniques may not be enough.
This research encourages clinicians to consider therapies that support mindfulness, emotional regulation, and grounding techniques—helping individuals feel more connected to themselves in moments where they feel the impulse to pull their hair.
Not the Full Picture- but Worth Paying Attention
As with all research, context matters. The study was based on self-reported surveys and didn’t measure other important factors like anxiety. It doesn’t prove cause and effect—but it does point to a real pattern that deserves more attention.
