Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting

PLoS One. 2017 Sep 13;12(9):e0183806. doi: 10.1371/journal.pone.0183806. eCollection 2017.

Abstract

Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8.6). Hierarchical factor analysis was used to identify a common latent factor and the multiple indicators and multiple causes (MIMIC) modelling was applied to test the predictive effect of borderline personality disorder symptoms, impulsivity, distress and self-esteem on pathological grooming. Pearson correlation coefficients between TTM, SP and NB were between 0.13 and 0.29 (p < 0.01). The model yielded an excellent fit to the data (CFI = 0.992, TLI = 0.991, χ2 = 696.65, p < 0.001, df = 222, RMSEA = 0.030, Cfit of RMSEA = 1.000), supporting the existence of a latent factor. The MIMIC model indicated an adequate fit (CFI = 0.993, TLI = 0.992, χ2 = 655.8, p < 0.001, df = 307, RMSEA = 0.25, CI: 0.022-0.028, pclose = 1.000). TTM, SP and NB each were loaded significantly on the latent factor, indicating the presence of a general grooming factor. Impulsivity, psychiatric distress and contingent self-esteem had significant predictive effects, whereas borderline personality disorder had a nonsignificant predictive effect on the latent factor. We found evidence that the category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting. This latent underlying factor is not better explained by indicators of psychopathology, which supports the notion that the urge to self-groom, rather than general psychiatric distress, impulsivity, self-esteem or borderline symptomatology, is what drives individual grooming behaviours.

MeSH terms

  • Adult
  • Animals
  • Disruptive, Impulse Control, and Conduct Disorders / classification
  • Disruptive, Impulse Control, and Conduct Disorders / diagnosis
  • Disruptive, Impulse Control, and Conduct Disorders / epidemiology
  • Disruptive, Impulse Control, and Conduct Disorders / etiology
  • Female
  • Grooming*
  • Humans
  • Male
  • Nail Biting / psychology*
  • Obsessive-Compulsive Disorder / classification
  • Obsessive-Compulsive Disorder / diagnosis
  • Obsessive-Compulsive Disorder / epidemiology
  • Obsessive-Compulsive Disorder / etiology*
  • Self-Injurious Behavior / epidemiology
  • Self-Injurious Behavior / etiology*
  • Skin / injuries*
  • Skin / pathology
  • Stress, Psychological / complications*
  • Stress, Psychological / epidemiology
  • Trichotillomania / epidemiology
  • Trichotillomania / etiology*
  • Young Adult

Grants and funding

This work was supported by Hungarian National Research, Development and Innovation Office (Grant number: K111938). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.