Characteristics of 60 adult chronic hair pullers
Abstract
Objective This study was constructed to detail the demographic and phenomenological features of chronic hair pullers as well as to assess psychiatric comorbidity in a sizable study group. Method Subjects were drawn from an outpatient population of chronic hair pullers who had been referred to a trichotillomania clinic or had responded to a newspaper advertisement announcing a treatment study of adults who pull out their hair. Sixty adult chronic hair pullers completed a semistructured interview that focused on their hair-pulling behavior and demographic characteristics and that incorporated screening questions for DSM-III-R axis I disorders. The data were tabulated to derive a comprehensive picture of this group. Results The typical subject was a 34-year-old woman who had pulled hair from two or more sites for 21 years. All subjects described either tension before or relief/gratification after pulling hair from the primary site, but 17% (N = 10) failed to describe both of these characteristics and thus failed to fulfill the DMS-III-R criteria for trichotillomania. Forty-nine subjects (82%) qualified for past or current axis I diagnoses other than trichotillomania. Several characteristics of the study group suggested phenomenological differences between obsessive-compulsive disorder and trichotillomania. Conclusions Adult trichotillomania is a chronic disorder, frequently involving multiple hair sites, and is associated with high rates of psychiatric comorbidity. Its relation…
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Diefenbach, G. J., Tolin, D. F., Hannan, S., Maltby, N., & Crocetto, J. (2006) · Behavior Therapy · doi:10.1016/j.beth.2006.01.006 · Cited by 73 · see citing works
Stein, D. J., Flessner, C., Franklin, M., Keuthen, N., Lochner, C., & Woods, D. W. (2008) · Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists · doi:10.1080/10401230802435625 · Cited by 73 · see citing works
Trichotillomania ± trichobezoar: revisited
Sehgal, V. N., & Srivastava, G. (2006) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2006.01590.x · Cited by 73 · see citing works
Negative Peer Evaluation in Adolescents: Effects of Tic Disorders and Trichotillomania
Boudjouk, P. J., Woods, D. W., Miltenberger, R., & Long, E. (2000) · Child & Family Behavior Therapy · doi:10.1300/j019v22n01_02 · Cited by 73 · see citing works
The Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C)
Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., Piacentini, J. C., Cashin, S. E., & Moore, P. S. (2007) · Behavior Modification · doi:10.1177/0145445507302521 · Cited by 88 · see citing works
“Nevertheless, both of these estimates were based on either informal assessment (Christenson et al., 1991) or anecdotal information (Christenson & Mackenzie, 1994) rather than on data gathered using a psychometrically sound instrument.”
BackgroundResultInfluentialNonclinical hair-pulling: affective correlates and comparison with clinical samples.
Stanley, M. A., Borden, J. W., Mouton, S., & Breckenridge, J. K. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)e0018-e · Cited by 70 · see citing works
“However, phenomenological reports of patients with chronic hair-pulling indicate that 17% of these individuals deny a tension-reduction cycle (Christenson et al., 1991a).”
BackgroundResultFeather picking disorder and trichotillomania: an avian model of human psychopathology.
Bordnick, P., Thyer, B., & Ritchie, B. (1994) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(94)90019-1 · Cited by 70 · see citing works
Depression, anxiety, and functional impairment in children with trichotillomania
Lewin, A. B., Piacentini, J., Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., Moore, P., Khanna, M., March, J. S., Stein, D. J., et al. (2008) · Depression and Anxiety · doi:10.1002/da.20537 · Cited by 68 · see citing works
“Mood, anxiety, substance use, and personality disorders are among the most common co-occurring psychopathologies in adults.([5]) Although under-researched in comparison to adults with TTM, studies of children suggest TTM in this age group is associated with significant distress and impairment.”
Reinhardt, V. (2005) · Laboratory Animals. Journal of the Laboratory Animal Science Association · doi:10.1258/002367705774286448 · Cited by 68 · see citing works
“1986), chronic hair pulling (Christenson et al. 1991) or compulsive hair pulling (Schlosser et al.”
BackgroundA comprehensive model for behavioral treatment of trichotillomania
Mansueto, C., Golomb, R., Thomas, A. M., & Stemberger, R. M. T. (1999) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(99)80038-8 · Cited by 68 · see citing works
Flessner, C., Woods, D. W., Franklin, M., Keuthen, N., & Piacentini, J. (2009) · Child Psychiatry and Human Development · doi:10.1007/s10578-008-0118-5 · Cited by 67 · see citing works
“Although research suggests that TTM often begins in late childhood/early adolescence [8, 15] relatively little is known about how the disorder presents across the age spectrum.”
BackgroundPrevalence 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
The relation of psychogenic excoriation with psychiatric disorders: a comparative study.
Çalıkuşu, C., Yücel, B., Polat, A., & Baykal, C. (2003) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(03)00041-5 · Cited by 65 · see citing works
A twin concordance study of trichotillomania
Novak, C. E., Keuthen, N., Stewart, S. E., & Pauls, D. (2009) · American Journal of Medical Genetics Part B: Neuropsychiatric Genetics · doi:10.1002/ajmg.b.30922 · Cited by 64 · see citing works
“Trichotillomania (TTM) can affect between 1% and 3% of the population depending on the stringency of diagnostic criteria used [Christenson et al., 1991a; Rothbaum et al., 1993].”
BackgroundInfluentialTrichotillomania: behavioral symptom or clinical syndrome?
O'Sullivan, R. L., Keuthen, N., Christenson, G., Mansueto, C., Stein, D., & Swedo, S. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.10.1442 · Cited by 63 · see citing works
“Such activities include watching television, reading, driving, speaking on the telephone, and lying in bed at night in a state of contemplation or anticipation (5, 6).”
BackgroundInfluentialSelf-citationThe neuropsychology of trichotillomania.
Stanley, M. A., Hannay, H., & Breckenridge, J. K. (1997) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(97)00024-8 · Cited by 61 · see citing works
Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: a pilot study
Grant, J., Odlaug, B., Chamberlain, S., & Kim, S.-W. (2011) · Psychopharmacology · doi:10.1007/s00213-011-2347-8 · Cited by 60 · see citing works
“(Koran et al. 1992; Winchel et al. 1992) which were not confirmed by double-blind, placebo-controlled studies (Christenson et al. 1991a, b; Streichenwein and Thornby 1995) and so these promising results must be viewed cautiously.”
BackgroundChronic 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
Nonclinical hair pulling: Phenomenology and related psychopathology
Stanley, M., Borden, J., Bell, G. E., & Wagner, A. L. (1994) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(94)90010-8 · Cited by 60 · see citing works
- Authors
- Christenson, G., Mackenzie, T. B., & Mitchell, J. E.
- Affiliations
- University of Minnesota (US)
- ORCID
- James Earl Mitchell
- Venue
- American Journal of Psychiatry
- Published
- 1991-03-01
- Volume
- 148
- Issue
- 3
- Pages
- 365-370
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2205524029
- Cited by
- 570
- References
- 0
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 37 · 2022: 15 · 2021: 10 · 2020: 12 · 2019: 9 · 2018: 12 · 2017: 26 · 2016: 22 · 2015: 16 · 2014: 11 · 2013: 12 · 2012: 48
- FWCI
- 19.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Urology › Hair Growth and Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- trichotillomania, hair pulling, psychiatric comorbidity, obsessive-compulsive disorder, DSM-III-R criteria
- MeSH terms
- Adult, Age Factors, Mental Disorders, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Self Mutilation, Trichotillomania, Comorbidity
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