... These findings generally resemble those reported in previous literature on clinical samples, and are consistent with clinical evidence showing that TTM is often associated with negative emotional states including sadness, irritability, shame, frustration, embarrassment, and low self-esteem (Casati, 2000;SHORT TITLE: AFFECTIVE CORRELATES IN ITALIAN HAIR PULLERS 2005a; 2005b; Roberts et al., 2015; Stemberger et al., 2000; du Toit et al., 2001). Such emotional states – likely the direct result of finishing a hair pulling episode – often act as further triggers of the behavior, thus perpetuating the behavior as a means of regulating emotion (Mansueto et al., 1997; Roberts et al., 2015 ). For example, both symptom-based shame (related to pulling) and body shame (related to the consequences on physical appearance due to hair pulling) might drive further hair pulling behaviors, thus fostering the dysfunctional emotion regulation cycle (Weingarden and Renshaw, 2015). ...