Mediating effect of loneliness between child maltreatment and skin picking/hairpulling: A multinational study from five Arab countries

Abstract

Childhood adversities, particularly maltreatment, may contribute to the occurrence and persistence of Body-Focused Repetitive Behaviors (BFRBs). Previous research has documented associations between child maltreatment and BFRBs, while loneliness has also been identified as a potential consequence of early maltreatment. However, the interplay between childhood maltreatment, loneliness and BFRBs remains insufficiently explored. The current study examines the mediating effect of loneliness on the relationship between child maltreatment and skin picking and hair-pulling behaviors among a sample of Arabic-speaking adults from Lebanon, Jordan, Palestine, Egypt and the Kingdom of Saudi Arabia. This is a cross-sectional study that was conducted between December 2024 and January 2025. The study included 1,494 Arabic-speaking participants from the 5 countries previously listed. Participants were recruited using the snowball sampling technique. Participants’ mean age was 24.97 ± 9.09 years, with 74.5% females. The results indicated that loneliness had a partial mediation role in the relationship linking child maltreatment and hairpulling, as well as skin-picking behaviors. Higher levels of child maltreatment were significantly correlated with greater levels of loneliness ( r  = 0.19, p  < 0.001), while greater loneliness was in turn associated with higher skin-picking and hair-pulling scores. Additionally, child maltreatment remained directly associated with both behaviors. According to the current mediation findings, loneliness may be a significant psychological target for preventive and therapeutic strategies, alongside trauma-focused approaches, intended to lessen the severity and persistence of body-focused repetitive behaviors.