Comorbidity and quality of life in adults with hair pulling disorder
Open accessAbstract
Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and psychosocial functioning in a well-characterized sample of adults with HPD (N=85) who met DSM-IV criteria, had at least moderate hair pulling severity, and participated in a clinical trial. Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis. Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders. The relationships between certain comorbidity patterns, hair pulling severity, current mood and anxiety symptoms, and quality of life were also examined. Results showed that current depressive symptoms were the only predictor of quality of life deficits. Implications of these findings for the conceptualization and treatment of HPD are discussed. © 2016 Elsevier Ireland Ltd.
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- Findingown data
Among the variables examined, only BDI scores were significantly correlated with QOLI scores.
“Only BDI scores were significantly correlated with the QOLI.”
Quote in the paperSubstantial claim - Findingown data
The HPD sample showed substantial comorbidity with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders.
“Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders.”
Quote in the paperSubstantial claim - Findingown data
The average quality-of-life t-score was near the upper end of the low range (mean 41.2, SD 14.7).
“The average Quality of Life t-score was near the upper bound of the low range (M = 41.2, SD = 14.7).”
Quote in the paperNot a substantial claim - Findingown data
The current study's lifetime comorbidity rate for GAD was 14.1%, versus a previous-study average of 25.6%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claim - Findingown data
In the same sample, 78.8% had a lifetime (current or past) additional psychiatric diagnosis.
“Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis.”
- Also stated in: § 3.2. Comorbidity · plain
“According to the SCID-P (Table 4), the majority of patients (78.8%) met criteria for at least one lifetime comorbid psychiatric condition, and 38.8% were determined to be currently suffering from another Axis I disorder.”
Quote in the paperNot a substantial claim - Also stated in: § 3.2. Comorbidity · plain
- Findingown data
Among 85 adults diagnosed with HPD by DSM-IV criteria and with at least moderate pulling severity, 38.8% had a current additional psychiatric diagnosis.
“Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis.”
- Also stated in: § 3.2. Comorbidity · plain
“According to the SCID-P (Table 4), the majority of patients (78.8%) met criteria for at least one lifetime comorbid psychiatric condition, and 38.8% were determined to be currently suffering from another Axis I disorder.”
Quote in the paperSubstantial claim - Also stated in: § 3.2. Comorbidity · plain
- Findingown data
The current study's lifetime comorbidity rate for Substance Abuse Disorder was 4.7%, versus a previous-study average of 16.8%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claim - Findingown data
The current study's lifetime comorbidity rate for Specific Phobia was 2.4%, versus a previous-study average of 12.1%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claim - Findingown data
The most frequent lifetime comorbid conditions were Major Depression, Alcohol Abuse, PTSD, and GAD.
“The most common lifetime comorbid conditions were Major Depression, Alcohol Abuse, PTSD, and GAD.”
Quote in the paperNot a substantial claim - Findingown data
The baseline sample had moderately severe hair pulling on the MGH-HPS (mean 16.93, SD 4.53) and NIMH-TSS (mean 14.34, SD 3.64).
“The baseline sample reported moderately severe hair pulling according to both the MGH-HPS (M = 16.93, SD = 4.53) and NIMH-TSS (M = 14.34, SD = 3.64).”
Quote in the paperNot a substantial claim - Findingown data
The current study's lifetime comorbidity rate for Excoriation Disorder was 12.9%, versus a previous-study average of 24.2%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claim - Findingcitation
The current study's rates of lifetime and current psychopathology (78.8% and 38.8%) are elevated compared with community norms (46% lifetime, 26% 12-month).
“In the current study, rates of both lifetime and current psychopathology were high, at 78.8% and 38.8%, respectively. These rates are elevated as compared to community norms, as studies have shown that, in a representative community U.S. adult sample, we should expect to find 46% lifetime and 26% twelve-month prevalence of at least one psychiatric disorder (Kessler et al., 2005a, b).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kessler et al., 2005a, b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Rests on an assumption: Despite selection bias from screening out some comorbidities and using a treatment-seeking sample, the study's comorbidity and quality-of-life findings are sufficiently informative about HPD to contribute to the literature.
- Findingreasoning
The differences between the current study and the HPD literature were largely lower estimates of current and lifetime comorbidity in the current study.
“The direction of those differences was largely in the direction of lower estimates of current and lifetime comorbidity in the current study as compared to those reported in previous studies.”
Quote in the paperNot a substantial claim- Rests on an assumption: Despite selection bias from screening out some comorbidities and using a treatment-seeking sample, the study's comorbidity and quality-of-life findings are sufficiently informative about HPD to contribute to the literature.
- Interpretationown data
In persons with HPD, current depressive symptom severity is the best predictor of current quality-of-life ratings.
“This suggests that, in persons with HPD, current depressive symptom severity is the best predictor of current ratings of quality of life.”
Quote in the paperSubstantial claim - Study design and conductcitation
The QOLI may not be a highly valid measure for use in HPD.
“Another potential limitation of the current study is that the QOLI may not be a highly valid measure for use in HPD.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The primary limitation of this study is that potential participants were screened out for some comorbidities that might impact treatment, creating selection bias that affects the results.
“The primary limitation of this study is that potential participants were screened out for some comorbidities that might impact treatment (e.g., mania, psychosis, primary major depression), which creates selection bias that undoubtedly affects the results of this study.”
Quote in the paperSubstantial claim - Interpretationown data
The current study's findings contrast with arguments that shared comorbidity supports an OCD-spectrum relationship for HPD.
“One finding that has notable implications is that comorbid OCD was shown in 7.1% of individuals over their lifetime. Proponents of the OCD-spectrum, including HPD, have proposed that shared comorbidity is evidence of this relationship, yet our findings stand in contrast to such arguments.”
Quote in the paperSubstantial claim - Interpretationreasoning
The QOLI norms might not accurately reflect quality of life in a sample consisting primarily of middle-aged females.
“Thus, the QOLI norms might not accurately reflect quality of life in a sample consisting primarily of middle-aged females.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The lack of a psychiatric control group limits the ability to determine if the psychosocial patterns (QOL, depression, anxiety) are specific to those with HPD.
“Other limitations to the current study include the lack of a psychiatric control group, which limits the ability to determine if these psychosocial patterns (i.e., QOL, depression, anxiety) are specific to those with HPD.”
Quote in the paperNot a substantial claim - Study design and conductcitation
The QOLI contains no age- or gender-based norms, factors which impact quality of life.
“Moreover, the QOLI contains no age- or gender-based norms, factors which impact quality of life (Hjermstad et al., 1998).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hjermstad et al., 1998 source
- May combine two claims. 11
- Classified as probably not a substantial claim. 1
May combine two claims.
Findingown dataThe current study's current comorbidity rate for Excoriation Disorder was 12.9%, versus a previous-study average of 21.6%.
“The most notable differences between data from this study and average current comorbidity rates from previous studies (See Tables 2, 3, and 4; current study data reported first) were on Excoriation Disorder (12.9% vs. 21.6%), Major Depression (3.5% vs. 17.1%), and Obsessive-Compulsive Disorder (4.7% vs. 9.3%).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe current study's current comorbidity rate for OCD was 4.7%, versus a previous-study average of 9.3%.
“The most notable differences between data from this study and average current comorbidity rates from previous studies (See Tables 2, 3, and 4; current study data reported first) were on Excoriation Disorder (12.9% vs. 21.6%), Major Depression (3.5% vs. 17.1%), and Obsessive-Compulsive Disorder (4.7% vs. 9.3%).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe current study's current comorbidity rate for Major Depression was 3.5%, versus a previous-study average of 17.1%.
“The most notable differences between data from this study and average current comorbidity rates from previous studies (See Tables 2, 3, and 4; current study data reported first) were on Excoriation Disorder (12.9% vs. 21.6%), Major Depression (3.5% vs. 17.1%), and Obsessive-Compulsive Disorder (4.7% vs. 9.3%).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataMean BDI and BAI scores were in the minimal-to-mild range (12.92, SD 10.19; 13.35, SD 13.25), with large standard deviations.
“Mean BDI and BAI scores were in the minimal to mild range at 12.92 (SD = 10.19) and 13.35 (SD = 13.25), respectively, and both had large standard deviations.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe current study's lifetime comorbidity rate for OCD was 7.1%, versus a previous-study average of 15.3%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe current study's lifetime comorbidity rate for Alcohol Abuse Disorder was 17.7%, versus a previous-study average of 8.9%.
“Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%), GAD (14.1% vs. 25.6%), Alcohol Abuse Disorder (17.7% vs. 8.9%), and Substance Abuse Disorder (4.7% vs. 16.8%).”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationPersons with HPD in this study reported quality of life in the upper part of the low range, similar to three previous studies using the same measure (QOLI means 41.20 vs 43.00, 44.31, 42.77).
“In this study, persons with HPD reported quality of life in the upper part of the low range, which was very similar to that reported by three previous studies utilizing the same measure (Raw score means on the QOLI = 41.20 vs. 43.00, 44.31, 42.77; Diefenbach et al., 2005b; Odlaug et al., 2010; E. Tung, personal communication, October 4, 2015).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Diefenbach et al., 2005b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Odlaug et al., 2010 source
- cites E. Tung, personal communication, October 4, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Findingown dataThe most frequent current comorbid conditions were Excoriation Disorder and Generalized Anxiety Disorder, followed by Specific Phobia and Obsessive-Compulsive Disorder.
“The most common current comorbid conditions were Excoriation Disorder and Generalized Anxiety Disorder, followed by Specific Phobia and Obsessive-Compulsive Disorder.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductcitationThe QOLI contains no question regarding appearance, which can be particularly relevant for persons with HPD.
“As noted by Odlaug et al. (2010), although the QOLI assesses a range of topics including self-esteem, it contains no question regarding appearance, which can be particularly relevant for persons with HPD.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Odlaug et al. (2010) source
May combine two claims.
Study design and conductcitationAll individuals in the current study were seeking treatment for HPD, which could result in an over-estimation of the amount of comorbidities.
“A related concern is that all individuals in the current study were seeking treatment for HPD, which could result in an over-estimation of the amount of comorbidities, as these persons are more likely to seek help (Alexander et al., 1986).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Alexander et al., 1986
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationThe rate of Excoriation disorder in this study might be below average but not outside the range of other studies (10-34%, average 20.8%).
“Differences in the rates of Excoriation Disorder between our study and that of Tung et al. (2015) might seem large, but a review by Snorrason et al. (2012) showed that comorbidity rates between HPD and Excoriation fall between 10 to 34% (average = 20.8%). Thus, our rate of Excoriation disorder might be below average, but not outside the range of other studies.”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
Study design and conductreasoningThe variable correlating significantly with quality of life, depression, was measured continuously and allowed to vary freely, whereas some other variables were constrained by inclusion criteria (MGH ≥ 12), which could have attenuated the correlation between hair pulling severity and quality of life.
“It must, however, be noted that the variable correlating significantly with quality of life, depression, was measured continuously and allowed to freely vary, whereas some other variables were constrained due to inclusion criteria (i.e., MGH ≥ 12). This practice could have attenuated the correlation between hair pulling severity as measured by the MGH.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Current depressive symptoms causally reduce quality of life in HPD, rather than merely correlating with it.
“Data from the current study suggest SSRIs may help improve QOL by reducing depressive symptoms, even if the medications do little to the pulling symptoms.”
The paper relies on this without support.
Despite selection bias from screening out some comorbidities and using a treatment-seeking sample, the study's comorbidity and quality-of-life findings are sufficiently informative about HPD to contribute to the literature.
“These caveats notwithstanding, this study contributes substantially to the existing literature regarding comorbidity patterns in HPD.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Specific phobia cannot rank ahead of major depression among current diagnoses
MinorSpecific Phobia is listed among the most common current conditions, but its lifetime rate is only 2.4%, so its current rate cannot exceed 2.4%. The reported current Major Depression rate is 3.5%.
“The most common current comorbid conditions were Excoriation Disorder and Generalized Anxiety Disorder, followed by Specific Phobia and Obsessive-Compulsive Disorder.”
“Major Depression (3.5% vs. 17.1%), and Obsessive-Compulsive Disorder (4.7% vs. 9.3%). Additionally, notable differences for our data and the average lifetime comorbidity rates from previous studies were on Excoriation Disorders (12.9% vs. 24.2%), OCD (7.1% vs. 15.3%), Specific Phobia (2.4% vs. 12.1%)”
Quality-of-life mean is labeled both a t-score and a raw score
MinorThe results identify 41.2 as the mean QOLI t-score, but the discussion identifies the same study mean, 41.20, as a raw score.
“The average Quality of Life t-score was near the upper bound of the low range (M = 41.2, SD = 14.7).”
“Raw score means on the QOLI = 41.20 vs. 43.00, 44.31, 42.77”
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,769 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052 · see citing works
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
(1995) · Cited by 6,909 · see citing works
Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J. (2011) · Psychological Science · doi:10.1177/0956797611418350 · Cited by 1,435 · see citing works
Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.4.631 · Cited by 1,212 · see citing works
Frisch, M. B., Cornell, J., Villanueva, M., & Retzlaff, P. J. (1992) · Psychological Assessment · doi:10.1037/1040-3590.4.1.92 · Cited by 1,075 · see citing works
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.1.151 · Cited by 1,048 · see citing works
Self-citationReliability and validity of the Beck anxiety inventory
Fydrich, T., Dowdall, D., & Chambless, D. L. (1992) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(92)90026-4 · Cited by 776 · see citing works
Swedo, S. E., Leonard, H. L., Rapoport, J. L., Lenane, M. C., Goldberger, E. L., & Cheslow, D. L. (1989) · New England Journal of Medicine · doi:10.1056/nejm198908243210803 · Cited by 601 · see citing works
Characteristics of 60 adult chronic hair pullers
(1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.3.365 · Cited by 570 · see citing works
The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and Factor Analyses
Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289003 · Cited by 444 · see citing works
Grant, J. E., Odlaug, B. L., & Won Kim, S. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.60 · Cited by 424 · see citing works
(1991) · PubMed · Cited by 398 · see citing works
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.05.006 · Cited by 381 · see citing works
Self-citationWoods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., Walther, M. R., & Trichotillomania Learning Center-Scientific Advisory Board (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n1207 · Cited by 317 · see citing works
Self-citationHjermstad, M. J., Fayers, P. M., Bjordal, K., & Kaasa, S. (1998) · European Journal of Cancer · doi:10.1016/s0959-8049(98)00136-1 · Cited by 282 · see citing works
Systematic Review: Pharmacological and Behavioral Treatment for Trichotillomania
Bloch, M. H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R., Nudel, J., Pittenger, C., Leckman, J. F., & Coric, V. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.05.019 · Cited by 280 · see citing works
van Minnen, A., Hoogduin, K. A. L., Keijsers, G. P. J., Hellenbrand, I., & Hendriks, G.-J. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.5.517 · Cited by 234 · see citing works
Trichotillomania: An Obsessive Compulsive Spectrum Disorder?
Swedo, S. E., & Leonard, H. L. (1992) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(18)30208-9 · Cited by 218 · see citing works
DU FORT, G. G., NEWMAN, S. C., & BLAND, R. C. (1993) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199308000-00001 · Cited by 210 · see citing works
Trichotillomania: A current review.
Duke, D., Keeley, M. L., Geffken, G., & Storch, E. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.10.008 · Cited by 205 · see citing works
The Massachusetts General Hospital (MGH) hairpulling scale: 2. Reliability and validity
O’Sullivan, R. L., Keuthen, N. J., Hayday, C. F., Ricciardi, J. N., Buttolph, L., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289004 · Cited by 191 · see citing works
The Demography, Phenomenology, and Family History of 22 Persons with Compulsive Hair Pulling
Schlosser, S., Black, D., Blum, N., & Goldstein, R. (1994) · Annals of Clinical Psychiatry · doi:10.3109/10401239409148996 · Cited by 178 · see citing works
Snorrason, I., Belleau, E. L., & Woods, D. W. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.05.008 · Cited by 174 · see citing works
Self-citationTrichotillomania: impact on psychosocial functioning and quality of life
Diefenbach, G. J., Tolin, D. F., Hannan, S. E., Crocetto, J., & Worhunsky, P. D. (2004) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.06.010 · Cited by 161 · see citing works
McGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.07.015 · Cited by 142 · see citing works
Affective correlates of trichotillomania.
Diefenbach, G., Mouton-Odum, S., & Stanley, M. A. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00006-2 · Cited by 139 · see citing works
Obsessive-compulsive disorder and trichotillomania: a phenomenological comparison
Löchner, C., Seedat, S., du Toit, P. L., Nel, D. G., Niehaus, D. J. H., Sandler, R., & Stein, D. J. (2005) · BMC Psychiatry · doi:10.1186/1471-244x-5-2 · Cited by 139 · see citing works
The assessment of trichotillomania.
Rothbaum, B., & Ninan, P. (1994) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)90022-1 · Cited by 138 · cited 1× · see citing works
“The Trichotillomania Diagnostic Interview (TDI; Rothbaum and Ninan, 1994) is a six-item interview that is modeled after the Structured Clinical Interview for the DSM-III-R.”
MethodDbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial
Keuthen, N. J., Rothbaum, B. O., Fama, J., Altenburger, E., Falkenstein, M. J., Sprich, S. E., Kearns, M., Meunier, S., Jenike, M. A., & Welch, S. S. (2012) · Journal of Behavioral Addictions · doi:10.1556/jba.1.2012.003 · Cited by 124 · see citing works
Where does obsessive–compulsive disorder belong in DSM-V?
Storch, E. A., Abramowitz, J. S., & Goodman, W. K. (2008) · Depression and Anxiety · doi:10.1002/da.20488 · Cited by 122 · see citing works
Quality of life and clinical severity in pathological skin picking and trichotillomania
Odlaug, B. L., Kim, S. W., & Grant, J. E. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.06.004 · Cited by 118 · see citing works
Personal toll of trichotillomania: behavioral and interpersonal sequelae.
Stemberger, R. M. T., Thomas, A. M., Mansueto, C., & Carter, J. (2000) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(99)00028-6 · Cited by 114 · see citing works
Trichotillomania : Descriptive characteristics and phenomenology
Ga, C. (1999) · Medical Entomology and Zoology · Cited by 110 · see citing works
Assessment of trichotillomania: A psychometric evaluation of hair-pulling scales
Diefenbach, G. J., Tolin, D. F., Crocetto, J., Maltby, N., & Hannan, S. (2005) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-005-0633-7 · Cited by 109 · see citing works
Tolin, D. F., Franklin, M. E., Diefenbach, G. J., Anderson, E. R., & Meunier, S. A. (2007) · Cognitive Behaviour Therapy · doi:10.1080/16506070701223230 · Cited by 108 · see citing works
Self-citationPregnancy and Obsessive-Compulsive Disorder
Stein, D. J., Hollander, E., Simeon, D., COHEN, L., & Hwang, M. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.7.1131-a · Cited by 104 · see citing works
Single Modality Versus Dual Modality Treatment for Trichotillomania
Dougherty, D. D., Loh, R., Jenike, M. A., & Keuthen, N. J. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0711 · Cited by 101 · see citing works
Emotion regulation and trichotillomania: a comparison of clinical and nonclinical hair pulling.
Diefenbach, G., Tolin, D., Meunier, S. A., & Worhunsky, P. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2006.09.002 · Cited by 94 · see citing works
The phenomenology of hairpulling in a community sample.
Duke, D., Bodzin, D., Tavares, P., Geffken, G., & Storch, E. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.015 · Cited by 94 · see citing works
Behavior Therapy for Pediatric Trichotillomania: A Randomized Controlled Trial
Franklin, M., Edson, A. L., Ledley, D. A., & Cahill, S. (2011) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1016/j.jaac.2011.05.009 · Cited by 84 · see citing works
Self-citationTrichotillomania and Pathologic Skin Picking: Clinical Comparison with an Examination of Comorbidity
Odlaug, B. L., & Grant, J. E. (2008) · Annals of Clinical Psychiatry · doi:10.1080/10401230802017027 · Cited by 80 · see citing works
Behavioural treatment of trichotillomania: two-year follow-up results
Keijsers, G. P. J., van Minnen, A., Hoogduin, C. A. L., Klaassen, B. N. W., Hendriks, M. J., & Tanis-Jacobs, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.03.004 · Cited by 76 · see citing works
Woods, D. W., Miltenberger, R. G., & Flach, A. D. (1996) · Behavior Modification · doi:10.1177/01454455960202005 · Cited by 74 · see citing works
Self-citationFactor analysis of the Massachusetts General Hospital Hairpulling Scale.
Keuthen, N., Flessner, C., Woods, D. W., Franklin, M., Stein, D., & Cashin, S. E. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.12.003 · Cited by 70 · see citing works
Self-citationRetrospective Review of Treatment Outcome for 63 Patients With Trichotillomania
Keuthen, N. J., O'Sullivan, R. L., Goodchild, P., Rodriguez, D., Jenike, M. A., & Baer, L. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.4.560 · Cited by 65 · see citing works
Chronic hair-pulling: phenomenology-based subtypes.
Lochner, C., Seedat, S., & Stein, D. J. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.10.008 · Cited by 60 · see citing works
Longitudinal Follow-Up of Naturalistic Treatment Outcome in Patients With Trichotillomania
Keuthen, N. J., Fraim, C., Deckersbach, T., Dougherty, D. D., Baer, L., & Jenike, M. A. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n0205 · Cited by 53 · see citing works
Woods, D. W., Fuqua, R., & Outman, R. C. (1999) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1022839609859 · Cited by 50 · see citing works
Self-citationClinician-Rated Measures of Hair Pulling: A Preliminary Psychometric Evaluation
Stanley, M., Breckenridge, J. K., Snyder, A. G., & Novy, D. M. (1999) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1022160522908 · Cited by 44 · see citing works
DSM‐5 FIELD SURVEY: HAIR‐PULLING DISORDER (TRICHOTILLOMANIA)
Lochner, C., Grant, J., Odlaug, B., Woods, D. W., Keuthen, N., & Stein, D. J. (2012) · Depression and Anxiety · doi:10.1002/da.22011 · Cited by 29 · see citing works
Self-citation(2004) · Cited by 23 · see citing works
Self-citationPredictors of life disability in trichotillomania
Tung, E. S., Flessner, C. A., Grant, J. E., & Keuthen, N. J. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.09.018 · Cited by 23 · see citing works
Examination of Gender in Pathologic Grooming Behaviors
Grant, J., & Christenson, G. (2007) · Psychiatric quarterly · doi:10.1007/s11126-007-9045-z · Cited by 17 · see citing works
The Relationship between Hair Pulling Style and Quality of Life
Tung, E. S., Tung, M. G., Altenburger, E. M., Pauls, D. L., & Keuthen, N. J. (2014) · Annals of Clinical Psychiatry · doi:10.1177/104012371402600306 · Cited by 12 · see citing works
Body Focused Repetitive Behaviors (BFRBs) and Personality Features
Chamberlain, S., & Odlaug, B. (2014) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-013-0003-9 · Cited by 11 · see citing works
Body-Focused Repetitive Behaviors
Miltenberger, R., & Spieler, C. A. (2016) · Evidence-based practices in behavioral health · doi:10.1007/978-3-319-27297-9_6 · Cited by 4 · see citing works
Raj, A. K. (2016) · Cited by 1 · see citing works
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Prevalence, gender correlates, and co-morbidity of trichotillomania
Grant, J. E., Dougherty, D. D., & Chamberlain, S. R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112948 · Cited by 190 · see citing works
“E urope PM C Funders A uthor M anuscripts E urope PM C Funders A uthor M anuscripts study are in keeping with previous studies showing that trichotillomania is frequently comorbid with multiple other mental health conditions, particularly OCD, anxiety, ADHD and PTSD (Christenson et al., 1991; Keuthen et al., 2016; Hou…”
BackgroundResultInfluentialFarhat, L. C., Olfson, E., Nasir, M., Levine, J. L. S., Li, F., Miguel, E. C., & Bloch, M. H. (2020) · Depression and Anxiety · doi:10.1002/da.23028 · Cited by 133 · see citing works
Solley, K., & Turner, C. M. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.06.014 · Cited by 72 · see citing works
Trichotillomania and its clinical relationship to depression and anxiety
Grant, J., Redden, S., Medeiros, G. C., Odlaug, B., Curley, E. E., Tavares, H., & Keuthen, N. (2017) · International journal of psychiatry in clinical practice · doi:10.1080/13651501.2017.1314509 · Cited by 49 · see citing works
“(Christenson et al. 1991; Houghton et al. 2016) and anxiety disorders (60”
BackgroundResultInfluentialPrevalence and gender distribution of trichotillomania: A systematic review and meta-analysis.
Thomson, H., Farhat, L., Olfson, E., Levine, J. L. S., & Bloch, M. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.06.058 · Cited by 65 · see citing works
França, K., Kumar, A., Castillo, D., Jafferany, M., Hyczy da Costa Neto, M., Damevska, K., Wollina, U., & Lotti, T. (2019) · Dermatologic Therapy · doi:10.1111/dth.12622 · Cited by 51 · see citing works
Comorbidity in trichotillomania (hair‐pulling disorder): A cluster analytical approach
Löchner, C., Keuthen, N. J., Curley, E. E., Tung, E. S., Redden, S. A., Ricketts, E. J., Bauer, C. C., Woods, D. W., Grant, J. E., & Stein, D. J. (2019) · Brain and Behavior · doi:10.1002/brb3.1456 · Cited by 45 · see citing works
“…diagnostic criteria for DSM‐IV‐TR (American Psychiatric Association, 2000) or DSM‐5 (American Psychiatric Association, 2013) for TTM. Participant data were drawn from different clinical sites, some of whom have previously published comorbidity findings (Keuthen et al., 2014; Lochner et al., 2010).”
BackgroundSelf-citationConnor, C. J. (2017) · Clinical Cosmetic and Investigational Dermatology · doi:10.2147/ccid.s111041 · Cited by 46 · see citing works
“For instance, the most common underlying cause of trichotillomania (incomplete hair loss secondary to impulsive pulling of one’s own hair) is obsessive–compulsive behavior, but other possibilities include mental retardation, anxiety, depression, reaction to situational stress, and trichophobia, a rare disorder in whic…”
Characteristics of trichotillomania and excoriation disorder across the lifespan
Lin, A., Farhat, L. C., Flores, J. M., Levine, J. L. S., Fernandez, T. V., Bloch, M. H., & Olfson, E. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115120 · Cited by 47 · see citing works
Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder
Gerstenblith, T., Jaramillo-Huff, A., Ruutiainen, T., Nestadt, P., Samuels, J., Grados, M., Cullen, B., Riddle, M., Liang, K.-Y., Greenberg, B., et al. (2019) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2019.152123 · Cited by 23 · see citing works
Snorrason, I., Ricketts, E., Stein, A. T., & Björgvinsson, T. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100680 · Cited by 16 · see citing works
Trichotillomania and Co-occurring Anxiety
Grant, J., Redden, S., Leppink, E. W., & Chamberlain, S. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.09.005 · Cited by 33 · see citing works
“Not mutually exclusively, hair pulling which results in alopecia may course not all studies have found an association between anxiety disorders and hair pulling severity (Houghton et al., 2016).”
InfluentialTrichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder
Lamothe, H., Baleyte, J., Mallet, L., & Pélissolo, A. (2019) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2019-0471 · Cited by 31 · see citing works
Trichopsychodermatology: The Psychiatric and Psychosocial Aspects of Hair Disorders
Jafferany, M., & Patel, A. (2019) · Dermatologic Therapy · doi:10.1111/dth.13168 · Cited by 32 · see citing works
“Additionally, this disorder is associated with increased risks of other focused repetitive behaviors (BFRP) such as skin picking, hair pulling, and nail biting, in addition to depression, anxiety, mood, and addictive disorders (Houghton et al., 2016).”
BackgroundTrauma and trichotillomania: A tenuous relationship
Houghton, D., Mathew, A., Twohig, M., Saunders, S., Franklin, M., Compton, S., Neal-Barnett, A., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.09.003 · Cited by 9 · see citing works
“(Boughn and Holdom, 2003, Gershuny et al., 2006), have higher scores than healthy individuals on self-report scales measuring lifetime trauma severity (Lochner et al., 2002, Özten et al., 2015), and show abnormally high rates of lifetime posttraumatic stress disorder (PTSD) (e.g., 15.3%; Houghton et al., 2016).”
InfluentialSelf-citationClarifying the relationship between Trichotillomania and anxiety
Alexander, J. R., Houghton, D. C., Twohig, M. P., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Woods, D. W. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.02.004 · Cited by 31 · see citing works
“Information about the sample and recruitment can be found in Houghton et al. (2016).”
BackgroundSelf-citationSelles, R. R., Buissonnière-Ariza, V. L., McBride, N. M., Dammann, J. E., Whiteside, S. P. H., & Storch, E. A. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.11.001 · Cited by 30 · see citing works
Krooks, J., Weatherall, A., & Holland, P. (2018) · Journal of dermatological treatment (Print) · doi:10.1080/09546634.2017.1395389 · Cited by 21 · see citing works
“Most patients have a significant current and/or past psychiatric history (90,100).”
Background“Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating
Houazene, S., Leclerc, J. B., O’Connor, K. P., & Aardema, F. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103804 · Cited by 27 · see citing works
A double-blind, placebo-controlled study of inositol in trichotillomania
Leppink, E. W., Redden, S., & Grant, J. (2017) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000156 · Cited by 23 · see citing works
“Psychosocial problems are common among individuals with trichotillomania and may include significantly reduced quality of life, reduced work productivity, and impaired social functioning (Diefenbach et al., 2005; Odlaug et al., 2010; Houghton et al., 2016).”
BackgroundRicketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., Lochner, C., Stein, D. J., Dougherty, D. D., O’Neill, J., et al. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01458-w · Cited by 23 · see citing works
“This is partially supported by prior research showing associations between anxiety and depression with impairment in children and adults with BFRBDs [78, 84–86].”
Self-citationGreenberg, E. H., Grant, J., Curley, E. E., Lochner, C., Woods, D. W., Tung, E. S., Stein, D. J., Redden, S., Scharf, J., & Keuthen, N. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.06.008 · Cited by 18 · see citing works
Self-citationObinwa, O., Cooper, D. N., Khan, F. A., et al. (2017) · World Journal of Clinical Cases · doi:10.12998/wjcc.v5.i2.50 · Cited by 20 · see citing works
Moritz, S., Scheunemann, J., Jelinek, L., Penney, D., Schmotz, S., Hoyer, L. N., Grudzień, D., & Aleksandrowicz, A. (2023) · Psychological Medicine · doi:10.1017/s0033291723003392 · Cited by 23 · see citing works
Snorrason, Í., Ricketts, E. J., Ólafsson, R. P., Rozenman, M. S., Colwell, C. S., & Piacentini, J. C. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9712-4 · Cited by 16 · see citing works
“Individuals with TTM typically experience cravings or urges to pull hair and are unable to resist the behavior despite negative consequences such as hair loss/disfigurement, social impairments, emotional distress and medical complications (Houghton et al. 2016; Odlaug et al. 2010).”
BackgroundTrichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling
Anwar, S., & Jafferany, M. (2019) · Acta Dermatovenerologica Alpina Pannonica et Adriatica · doi:10.15570/actaapa.2019.7 · Cited by 15 · see citing works
“In addition, a positive correlation has been shown between worse trichotillomania symptoms and more intense depressive symptoms (17).”
BackgroundReliability and validity of the Trichotillomania Dimensional Scale (TTM-D)
Cheyne, J. E., de Bolger, A. D. P., & Wootton, B. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.08.004 · Cited by 14 · see citing works
Bezerra, A. P., Machado, M., Maes, M., Marazziti, D., Nunes-Neto, P. R., Solmi, M., Firth, J., Husain, M. I., Brunoni, A., Kurdyak, P., et al. (2020) · CNS Spectrums · doi:10.1017/s109285292000111x · Cited by 11 · see citing works
“In addition, the independent impact of TTM on healthrelated quality of life (QoL) has been a matter of debate with a study reporting no impact of TTM on QoL relative to healthy controls,(7) while two other studies verified that people with TTM may have more impaired QoL than nonpsychiatric controls.(8,9) Moreover, the…”
ResultPlacebo Response in Trichotillomania
Grant, J., Chamberlain, S., Redden, S., Odlaug, B., van Ameringen, M. V., Dougherty, D., Keuthen, N., & Kim, S.-W. (2017) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000185 · Cited by 10 · see citing works
“, 1991; Odlaug and Grant, 2010) and the associated reduced quality of life in those who struggle with this disorder (Odlaug et al., 2010; Tung et al., 2014; Houghton et al., 2016), further exploration of placebo response will be crucial for developing better pharmacological interventions.”
BackgroundGrant, J., Redden, S., & Chamberlain, S. (2019) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001005 · Cited by 10 · see citing works
Barber, K. E., Cram, I. F., Smith, E. C., Capel, L., Snorrason, I., & Woods, D. W. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.11.062 · Cited by 10 · see citing works
Self-citationCautious Optimism for a New Treatment Option for Body-Focused Repetitive Behavior Disorders
Greenberg, E., & GELLER, D. A. (2023) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230226 · Cited by 10 · see citing works
Snorrason, Í., Keuthen, N. J., Beard, C., & Björgvinsson, Þ. (2023) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001593 · Cited by 9 · see citing works
“Several studies have documented high rates of comorbid anxiety and depressive disorders in some HPD or SPD samples, although results are quite variable across studies (Houghton et al., 2016; Keuthen et al., 2014).”
ResultSnorrason, Í., Kuckertz, J. M., Swisher, V. S., Pendo, K., Rissman, A. J., & Ricketts, E. J. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102743 · Cited by 9 · see citing works
Farhat, L. C., Isomura, K., de la Cruz, L. F., Sidorchuk, A., Kuja‐Halkola, R., Brikell, I., Chang, Z., D'Onofrio, B. M., Larsson, H., Lichtenstein, P., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-95416-w · Cited by 8 · see citing works
“…high rate of co-occurring eating disorders among individuals with trichotillomania, which is in line with previous studies in the field, including evidence from a sample of hundreds of individuals with clinically relevant hair-pulling recruited through five centers in two countries 9,26,45 .”
Natural Recovery in Trichotillomania
Grant, J., & Chamberlain, S. (2021) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1177/00048674211066004 · Cited by 6 · see citing works
“Such research is needed in light of findings indicating that trichotillomania results in a heavy psychosocial burden of suffering (Franklin et al., 2008; Grant et al., 2016; Houghton et al., 2016; Tung et al., 2015).”
BackgroundRisk and maintenance factors in body‐focused repetitive behaviours
Moritz, S., Penney, D., Hoyer, L. N., & Schmotz, S. (2024) · JEADV Clinical Practice · doi:10.1002/jvc2.405 · Cited by 7 · see citing works
Electroconvulsive therapy for trichotillomania in a bipolar patient
Fontenelle, L. F., dos Santos‐Ribeiro, S., Kalaf, J., & Yücel, M. (2019) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2019.83.1.97 · Cited by 7 · see citing works
Trichobezoar without a clear manifestation of trichotillomania
Tripathi, A., Jain, A., Agrawal, A., Bansod, R., Jain, G., & Yadav, K. S. K. (2020) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_11_20 · Cited by 6 · see citing works
“Trichophagia associated with trichotillomania results in lowered self‐esteem, reduced quality of life and impaired social functioning of the individual.[6] Surgical intervention is often needed in the management of large trichobezoars.”
BackgroundEskeland, S. O., Moen, E. M., & Hummelen, B. (2018) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.17.0599 · Cited by 6 · see citing works
Capel, L. K., Petersen, J. M., Levin, M. E., & Twohig, M. P. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10418-0 · Cited by 5 · see citing works
“Previous researchers suggested that anxiety had a significant impact on trichotillomania severity and likely would impact treatment outcomes (Grant et al., 2017b; Houghton et al., 2016).”
Self-citationBorderline personality disorder in Trichotillomania and skin picking disorder: a survey study
Grant, J. E., Collins, M., & Chamberlain, S. R. (2024) · BMC Psychology · doi:10.1186/s40359-024-02258-8 · Cited by 6 · see citing works
Trichotillomania and its treatment: an updated review and recommendations
DuBois, M. C., Feler, B., Flessner, C., & Franklin, M. E. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2557395 · Cited by 5 · see citing works
“The most common comorbid diagnoses in samples of adults with TTM are skin-picking, anxiety, depression, OCD, attention-deficit hyperactivity disorder, post-traumatic stress disorder, and alcohol-use disorder [21,22].”
Self-citationHazardous Alcohol Use in Trichotillomania
Grant, J. E., Collins, M., Chesivoir, E. K., & Chamberlain, S. R. (2023) · Psychiatric Quarterly · doi:10.1007/s11126-023-10042-x · Cited by 4 · see citing works
“16–19% lifetime rates of substance use disorders)[2, 3].”
Buissonnière-Ariza, V. L., Alvaro, J. L., Cavitt, M. A., Rudy, B. M., Cepeda, S. L., Schneider, S. C., McIngvale, E., Goodman, W. K., & Storch, E. A. (2020) · International Journal of Mental Health · doi:10.1080/00207411.2020.1824111 · Cited by 4 · see citing works
Trichotillomania: Therapist Guide
Twohig, M. P., & Woods, D. W. (2023) · doi:10.1093/med-psych/9780197670309.001.0001 · Cited by 4 · see citing works
Self-citationMaas, J., Keijsers, G. P. J., Rinck, M., & Becker, E. S. (2018) · Journal of Cognitive Psychology · doi:10.1080/20445911.2018.1503278 · Cited by 4 · see citing works
Self-citationInvestigating the familiality of trichotillomania and excoriation disorder
Chen, D., Farhat, L., Lebowitz, E. R., Silverman, W., Bloch, M. H., Fernandez, T., & Olfson, E. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116560 · Cited by 4 · see citing works
Epidemiology and Comorbidities of Psychodermatologic Conditions
Abdi, P., Turk, T., Haq, Z., Diaz, M. J., & Dytoc, M. T. (2025) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/12034754251347569 · Cited by 5 · see citing works
“,33-37 Conditions such as dermatitis artefacta and body dysmorphic disorder were strongly associated with OCDs and personality disorders, while also manifesting substantial co-occurrence with depressive and anxiety disorders.”
Kłosowska, J., Sznajder, D., Antosz-Rekucka, R., Tuleja, A., & Prochwicz, K. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10428-y · Cited by 3 · see citing works
“…with the results of previous studies showing the link between trichotillomania and obsessive–compulsive symptoms, as well as with theoretical assumptions that TTM and OCD appear to be strongly comorbid and genetically related (Houghton et al., 2016; Keuthen et al., 2014; Monzani et al., 2014).”
Prevalence and Influencing Factors of Body-focused Repetitive Behaviors in Turkish Medical Students
Korkmaz, Ş. A. (2024) · Genel Tıp Dergisi · doi:10.54005/geneltip.1505724 · Cited by 2 · see citing works
Untroubled Pullers: An Examination of Nonclinical Hair-Pulling
Flannery, M. K., Falkenstein, M. J., Boyd, M., & Haaga, D. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100821 · Cited by 2 · see citing works
Bhat, R. R., Vellekkat, F., Goutama, I. L., Gill, P. S., Kakar, G., Jabeen, H., Gireesh, K., Sanker, V., & Gupta, U. (2023) · Clinical Case Reports · doi:10.1002/ccr3.7800 · Cited by 2 · see citing works
Quality of Life in Trichotillomania: An Assessment of Specific Life Domains
Valle, S., & Grant, J. E. (2022) · Annals of Clinical Psychiatry · doi:10.12788/acp.00s2 · Cited by 2 · see citing works
“12 The concept of QOL, however, may be too broad to be useful in understanding many psychiatric disorders.”
Mouton-Odum, S., & Houghton, D. (2018) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2018.82.4.288 · Cited by 1 · see citing works
Self-citationAlonazi, S. D., Alhnake, A. W., Alahmari, F. S., Abahussain, E., Alkahtani, A. H., Alharbi, K. A., & Alasiri, A. B. (2023) · Cureus · doi:10.7759/cureus.51128 · Cited by 2 · see citing works
“In a study conducted in the United States [17], results indicated that males were less likely to seek treatment for TTM, suggesting that sex differences might have to be considered when treating a patient with TTM.”
BackgroundTrichotillomania (Hair-Pulling Disorder)
Torales, J. C., Melgarejo, O. J., Barrios, I., Castaldelli-Maia, J. M., & Ventriglio, A. (2023) · Autism and child psychopathology series · doi:10.1007/978-3-031-24926-6_39 · Cited by 1 · see citing works
Barber, K. E., Cram, I. C., Smith, E. C., Woods, D. W., & Lee, H. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.02.020 · Cited by 1 · see citing works
Self-citationBaños-Chaparro, J., Franco-Jimenez, R. A., Caycho-Rodríguez, T., Valencia-Pecho, D., Sarmiento-Suarez, E., Bernabel-Tarazona, D., & Rivera-Álvarez, G. (2026) · Psychological Reports · doi:10.1177/00332941261442734 · Cited by 1 · see citing works
Case 36-2024: A 16-Year-Old Girl with Abdominal Pain
Zella, G. C., Pourvaziri, A., Greenberg, E., & Leonard, M. M. (2024) · New England Journal of Medicine · doi:10.1056/nejmcpc2402499 · Cited by 1 · see citing works
Trichotillomania and Risk of Alcohol- and Drug-Related Problems
Farhat, L., Isomura, K., Kuja-Halkola, R., Brikell, I., Chang, Z., D'Onofrio, B., Larsson, H., Lichtenstein, P., de la Cruz, L. F., Sidorchuk, A., et al. (2025) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2025.100605 · Cited by 1 · see citing works
“Our results complement those of some previous cross-sectional studies based on population-based or help-seeking samples (10,16,17,36,37), which reported conflicting findings regarding an increased risk of SUDs or harmful and substance-related problems in the entire cohort (top) and in a subcohort…”
Çoban, M. C. (2021) · Turk Turizm Arastirmalari Dergisi · doi:10.26677/tr1010.2021.901 · Cited by 1 · see citing works
Case series of trichotillomania presenting with three different DSM entities
Modi, N., Chaudhary, P., Mehta, R. Y., & Dave, K. R. (2021) · Neuropsychiatria i Neuropsychologia · doi:10.5114/nan.2021.113321 · Cited by 1 · see citing works
“Current presence of depressive symptoms in patients with TTM is a predictor of quality of life (QOL) deficits and QOL may be improved by SSRIs (Houghton et al .”
InfluentialAn investigation of attitudes and attentional biases in trichotillomania
Stevenson, J. L. (2018) · Enlighten: Theses (The University of Glasgow) · Cited by 1 · see citing works
Introduction: Unique manifestations of obsessive-compulsive spectrum disorders
Buissonnière-Ariza, V. L., & Storch, E. A. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.06.012
Supporting children and young people with trichotillomania
Thornton, S. (2018) · British Journal of School Nursing · doi:10.12968/bjsn.2018.13.8.406
Tricotilomanía: un trastorno psicodermatológico incapacitante
García-Cárdenas, C., Carrasco-Cancino, C., & Arceu-Ojeda, M. (2020) · Piel · doi:10.1016/j.piel.2020.05.004
THE RELATIONSHIP BETWEEN BOREDOM AND BODY FOCUSED REPETITIVE BEHAVIOR DISORDERS AMONG ADOLESCENTS
Yasir, W., & Kazmi, S. F. (2021) · Pakistan Journal of Social Research · doi:10.52567/pjsr.v3i4.417
Transtornos psiquiátricos que causam tricotilomania
de Aguiar, A. F., Wada, A., Pimenta, F. S., Oliveira, H. M., & Freitas, H. A. D. S. (2022) · Research Society and Development · doi:10.33448/rsd-v11i15.37220
Session 8: Practicing Acceptance and Commitment Therapy (ACT)
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0008
Self-citationClient Forms, Graphs, and Worksheets
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0002
Self-citationModifications for Working with Adolescents
Petersen, J. M. (2023) · doi:10.1093/med-psych/9780197670309.003.0011
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0005
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0002
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0004
Self-citationSession 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0003
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0001
Self-citationSession 5: Acceptance of Pulling-Related Inner Experiences
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0006
Self-citationSessions 6 and 7: Defusion from Your Inner Experiences: You Are Not Your Urges to Pull
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0007
Self-citationSession 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0009
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0003
Self-citationSession 10: Review and Relapse Prevention
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0010
Self-citationSession 3: Increasing Motivation for Treatment Through Values
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0004
Self-citationBhat, R. R., Vellekkat, F., Goutama, I. L., Gill, P. S., Kakar, G., Jabeen, H., Gireesh, K., Sanker, V., & Gupta, U. (2023) · doi:10.22541/au.168475026.61460806/v1
Phenomenology and Epidemiology of Trichotillomania and Skin-Picking Disorder
Ricketts, E. J., Stiede, J. T., Woods, D. W., Antinoro, D., & Franklin, M. E. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.5 · Cited by 1 · see citing works
Self-citationInformation Processing in Obsessive-Compulsive and Related Disorders
Alcolado, G. M., Giraldo-O’Meara, M., Krause, S. C., Leonhart, M. W., & Radomsky, A. S. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.8
Theory of mind in trichotillomania: A cross-sectional comparison with healthy controls
Kaçar, A. G., Demirci, H., & Aydın, E. P. (2025) · Applied Neuropsychology Adult · doi:10.1080/23279095.2025.2453492
Rates and Clinical Correlates of Cannabis Use in Trichotillomania and Skin Picking Disorder
Collins, M., & Grant, J. E. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001832
“For example, Houghton et al. (2016) found that approximately 4.7% of adults with trichotillomania met life-time criteria for a substance use disorder, whereas Odlaug et al. (2013) found that this number was even higher for individuals with skin picking disorder (7.5%).”
InfluentialThe prevalence and clinical correlates of body-focused repetitive behaviors in eating disorders
Barber, K. E., Woolley, M. G., Knudsen, F. M., Lensegrav-Benson, T., Quakenbush, B., & Twohig, M. P. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2519902
“Other studies in adults with trichotillomania reported lifetime ED prevalence rates ranging from 3.6% to 11.9% (Aydin et al., 2021; Houghton et al., 2016; Tung et al., 2015).”
InfluentialSelf-citationMayerson, T. F., Mackay, C., & Waite, P. (2025) · JCPP Advances · doi:10.1002/jcv2.70041 · Cited by 2 · see citing works
“…was significantly associated with symptoms of both depression and anxiety in our sample, which is consistent with other studies using clinical and proxy - clinical samples of youth who hair - pull (Houghton et al., 2016; Ricketts et al., 2022; Schumer et al., 2015; Woods, Flessner, et al., 2006).”
Zhang, Y., Feng, M., Ma, R., Xue, Q., Li, X., & Liu, F. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1867350
Villar, C. F., Zhou, R. J., Perez-Stable, C. T., Merritt, A. A., Oh, K., & Asempa, O. (2026) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2026.90.3.269
- Authors
- Houghton, D. C., Maas, J., Twohig, M. P., Saunders, S. M., Compton, S. N., Neal-Barnett, A. M., Franklin, M. E., & Woods, D. W.
- Affiliations
- Texas A&M University (US)
- Radboud University Nijmegen (NL)
- Utah State University (US)
- Marquette University (US)
- Duke University (US)
- Kent State University (US)
- University of Pennsylvania (US)
- Corresponding author
- Woods, Douglas W.
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 239
- Pages
- 12-19
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC4855296
- OpenAlex
- W2289915271
- Cited by
- 97
- References
- 67
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 5 · 2023: 34 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 10 · 2017: 8 · 2016: 3
- FWCI
- 12.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- Tilburg University Research Portal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- e-Publications@Marquette (Marquette University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- NIMH (R01MH080966)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Health Sciences › Medicine › Urology › Hair Growth and Disorders
- Keywords
- trichotillomania, psychiatric comorbidity, quality of life, depressive symptoms, anxiety symptoms, addiction, body-focused repetitive behaviors, psychosocial functioning, adults
- MeSH terms
- Adult, Anxiety, Depression, Female, Humans, Male, Middle Aged, Quality of Life, Trichotillomania, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders, Acceptance and Commitment Therapy
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