Tangled in shame: A qualitative exploration of shame in adolescent hairpulling

OBJECTIVE: Trichotillomania (hairpulling disorder) is a body-focused repetitive behaviour characterised by the recurrent and compulsive pulling of one's own hair, where both the act of pulling and the visible consequences of hair loss cause distress and impairment. Shame has been identified as central to adult hairpulling, increasing the urge to pull and reinforcing the cycle of behaviour. Yet little is known about how adolescents experience this emotion, despite adolescence being the typical point of onset of trichotillomania and a developmental period marked by heightened sensitivity to shame. Hence, the present study explored how adolescents with problematic hairpulling experience, navigate and make sense of shame. DESIGN: A qualitative methodology was employed. METHOD: Twelve adolescents aged 16-19 with problematic hair-pulling participated in online semi-structured interviews. Data were analysed using reflexive thematic analysis. RESULTS: An overarching theme of 'There's something wrong with me'-The Stigmatised Self captured how experiences of pervasive stigma were internalised as shame, permeating participants' inner lives and social worlds. Under this, five themes were generated: The Flawed Self; The Scrutinised Self; The Misunderstood Self; The Isolated Self; and The Disempowered Self. Shame was experienced as an enduring, identity-shaping emotion that triggered, maintained and exacerbated hairpulling. CONCLUSIONS: These findings extend our understanding by positioning shame as a central process in adolescent hairpulling and highlight the developmental vulnerability of this age group. Clinically, the results underscore the need for interventions that target shame, and for family and social contexts to be addressed alongside behavioural symptoms.