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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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Improvement of restless legs syndrome and trichotillomania with aripiprazole
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“, schizophrenia, dermatitis) and must cause clinically significant distress, impaired social or occupational functioning (3).”
BackgroundBehavioral and Pharmacological Treatment of Trichotillomania
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Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms
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Automatic and Focused Hair Pulling in Trichotillomania: Valid and Useful Subtypes?
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“, remove a kinky hair that feels “not right”) (Christenson et al., 1991; du Toit et al., 2001).”
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An ethological analysis of barbering behavior
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Trichotillomania: A Case of Response to Valproic Acid
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“However, more recent studies have estimated the prevalence of clinically significant hair pulling in adolescents ranges between 1% and 3.5%, which is comparable to the overall population rate of 0.6–3.4%, if not slightly higher (Christenson et al. 1991; Roth-baum et al. 1993).”
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Himle, J. A., Perlman, D. M., & Lokers, L. M. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.06.013 · Cited by 18
“Unfortunately, the majority of persons with TTM experience a significant amount of pulling that is outside of awareness (Christenson et al., 1991; van Minnen et al., 2003; du Toit, van Kradenburg, Niehaus, & Stein, 2001).”
BackgroundThe eclipse naevus: tan centre with stellate brown rim
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Examination of Gender in Pathologic Grooming Behaviors
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“The inclusion of an OCRD chapter in DSM-5 was based on results from previous studies showing clinical relatedness of these disorders in terms of high comorbidity rate and phenomenological similarities.(1,2) OCD is a common and chronic anxiety disorder associated with considerable morbidity and socioeconomic burden.”
ResultRecurrent trichobezoar due to trichophagia: a case report.
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“%) in a clinical sample of children with TTM than has been reported previously in several studies examining adults with TTM (e.g., 13–19%; Christenson et al., 1991; Cohen et al., 1995; Stewart et al., 2005).”
ResultFunctional analysis of hair manipulation: a replication and extension
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“Across studies, prevalence rates of hair-pulling disorder ranged from .6% to 15% (Christenson et al., 1991; Duke et al., 2009; Duke et al., 2010; Graber, & Arndt, 1993; Mansueto et al., 2007; Rothbaum, Shaw, Morris, & Ninan, 1993; Stanley et al., 1994, 1995; Woods and Miltenberger, 1995), depending…”
BackgroundInfluentialCharacteristics of Trichotillomania
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Longitudinal Course of Body-Focused Repetitive Behaviors in Obsessive-Compulsive Disorder
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Extensive Tonsure Pattern Trichotillomania-Trichoscopy and Histopathology Aid to the Diagnosis
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“[2] In less severe forms, patients may have only small areas of baldness, whereas in the more severe forms, tonsure pattern of baldness results, involving the entire scalp sparing the hair at the margins.”
Trichotillomania: Women's reports of treatment efficacy
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Treatment of hair pulling and hair manipulation maintained by digital-tactile stimulation
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Cravings and Irresistible Impulses: Similarities Between Addictions and Impulse Control Disorders
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Trichotillomania: ophthalmic presentation.
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Badenoch, J., Searle, T., Watson, I., & Cavanna, A. E. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.10.008 · Cited by 20
Ricketts, E., Snorrason, I., Rozenman, M., Colwell, C., McCracken, J., & Piacentini, J. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.006 · Cited by 14
Emotional regulation cycles in trichotillomania (hair-pulling disorder) across subtypes
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The effects of severity and causal explanation on social perceptions of hair loss
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Trichotillomania or alopecia areata?
Shelleh, H., Khan, S., & Al-Hatiti, H. S. (2006) · International Journal of Dermatology · doi:10.1111/j.1365-4632.2006.02764.x · Cited by 14
SPECT scans in identical twins with trichotillomania.
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The Diagnosis and Psychopharmacological Treatment of Trichotillomania: a Review
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Trichotillomania: Presentation and Treatment
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Disorders of impulsivity in trichotillomania and skin picking disorder.
Grant, J., Collins, M., Chamberlain, S., & Chesivoir, E. K. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.12.011 · Cited by 13
Psychometric Properties of Trichotillomania Severity Measures
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“In addition, because a significant portion of adults with TTM have had a childhood onset (Christenson et al., 1991; Duke et al., 2009), better understanding of the developmental course of TTM is needed to foster improved recognition, treatment access, and illness trajectory.”
Trichotillomania associated with dementia: a case report.
Mittal, D., O'Jile, J., Kennedy, R. E., & Jimerson, N. (2001) · General Hospital Psychiatry · doi:10.1016/s0163-8343(01)00138-4 · Cited by 13
Challenges in the Classification and Treatment of Trichotillomania
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“Most often, the comorbidity include depressive disorders (37%–65%), anxiety disorders (55–60%), addiction (over 30%) and eating disorders [2].”
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Grant, J., & Chamberlain, S. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.05.001 · Cited by 12
Clinical presentation of body-focused repetitive behaviors in minority ethnic groups
Grant, J. E., Valle, S., Aslan, I. H., & Chamberlain, S. R. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152272 · Cited by 13
“Pulling and picking from multiple sites is common and pulling and picking episodes are usually daily and can last from a few minutes to several hours [5].”
BackgroundInfluentialClarifying 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 32
Sex Differences in Trichotillomania
Grant, J., Redden, S., Leppink, E. W., Chamberlain, S., Curley, E. E., Tung, E. S., & Keuthen, N. (2016) · Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists · doi:10.1177/104012371602800205 · Cited by 12
Where on the obsessive impulsive–compulsive spectrum does hair-pulling sisorder belong?
Odlaug, B. L., Chamberlain, S. R., Schreiber, L. R. N., & Grant, J. E. (2013) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2013.828079 · Cited by 15
“…of HPD comes from a study by Christenson and Mansueto (1999) who found that 68% of subjects with HPD reported problems with tension or anxiety and from a study by Christenson et al. (1991) which found that HPD subjects reported elevated rates of co-occurring anxiety disorders (58%).”
BackgroundPharmacological strategies for trichotillomania
Walsh, K. H., & McDougle, C. (2005) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.6.6.975 · Cited by 12
“TTM patients commonly report that hair-pulling is not associated with pain [2], although pain sensation in these patients is normal [6].”
BackgroundInfluentialGiant trichophytobezoar in a pediatric patient with trichotillomania
Ciampa, A., Moore, B. E., Listerud, R., Kydd, D., & Kim, R. D. (2003) · Pediatric Radiology · doi:10.1007/s00247-002-0847-8 · Cited by 12
“Trichotillomania is most commonly seen in young adolescent girls and has significant comorbidity with mood and anxiety disorders [2, 3, 4].”
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Cocaine-induced trichotillomania.
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Body focused repetitive behavior disorders and perceived stress: Clinical and cognitive associations
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Clinical Management of Trichotillomania With Bimatoprost
Peabody, T. D., Reitz, S. C., Smith, J., & Teti, B. (2013) · Optometry and Vision Science · doi:10.1097/opx.0b013e318294c158 · Cited by 10
“Common sites for hair pulling include the scalp, pubic regions, eyebrows, and eyelashes.(19) Trichotillomania is shown to have a prevalence rate of 0.”
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The efficacy of low-dose aripiprazole treatment for trichotillomania.
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“Untreated TTM can result in impaired social and occupational functioning.(3) The medications typically used to treat TTM are antidepressants with serotonergic properties, which are also used to treat OCD.”
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Acute generalized exanthematous pustulosis induced by icodextrin
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Fluvoxamine in the Treatment of Trichotillomania: An 8-Week, Open-Label Study
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“The most commonly involved hair- pulling sites, in descending order of frequency, are the scalp (75%), eyelashes (53%), eyebrows (42%), pubic region (17% ), arm (10%), beard/face (10%), mustache (7%), leg (7%), chest (3%), and abdomen (2%).(2) TTM typically develops in later childhood or early adolescence, with a mean…”
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Salivary sex hormones in adolescent females with trichotillomania
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“In the case of adults with trichotillomania, Christenson and colleagues noted that 20% of a sample of 56 adults with trichotillomania reported symptom fluctuation depending on time in the ovarian cycle (Christenson et al., 1991).”
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“…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 .”
Barber, K. E., Capel, L., Merl, N., Twohig, M., Saunders, S., Compton, S., Franklin, M., & Woods, D. W. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10419-z · Cited by 9
“Some pull hair from pets or other people, although this is relatively rare (Christenson et al., 1991; Woods et al., 2006).”
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Alopecia in rhesus macaques (Macaca mulatta): Association with pregnancy and chronic stress
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Trauma and trichotillomania: A tenuous relationship
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Trichotillomania and Skin-Picking Disorder: Different Kinds of OCD
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The genetics of trichotillomania and excoriation disorder: A systematic review
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“These conditions typically onset in childhood with an average onset age of 11–15 years [7–11], although for some individuals they may present later in adulthood [10,11].”
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Gastric perforation secondary to a trichobezoar: A case report and review of the literature
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The Use and Misuse of Exposure Therapy for Obsessive-Compulsive and Related Disorders
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“Christenson, Mackenzie, and Mitchell [40] reported that among a sample of 60 adults with hair pulling problems, 5% did not endorse feelings of tension prior to pulling, and 12% did not endorse gratification or release of tension following pulling episodes.”
BackgroundTrichotillomania and post-traumatic stress disorder: a case study.
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Venlafaxine Treatment of Trichotillomania: An Open Series of Ten Cases
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Affective regulation in trichotillomania before and after self-help interventions.
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The Phenomenology of Hair Pulling Urges in Trichotillomania: A Comparative Approach
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Gastric trichobezoar associated with perforated peptic ulcer and Candida glabrata infection.
Morales, H. L., Catalán, C., Demetrio, R., Rivas, M., Parraguez, N. C., & Alvarez, M. (2014) · World Journal of Clinical Cases · doi:10.12998/wjcc.v2.i12.918 · Cited by 7
Adam, P., Richoux, C., & Lejoyeux, M. (2008) · The Open Psychiatry Journal · doi:10.2174/1874354400802010030 · Cited by 9
Trichotillomania: Behavioral Assessment and Treatment Interventions
Kell, B. L., & Kress, V. (2006) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100767 · Cited by 7
Ambulante Verhaltenstherapie bei Trichotillomanie: Überblick, Störungsmodell und Fallbeispiel
Neudecker, A., & Rufer, M. (2004) · Verhaltenstherapie (Basel) · doi:10.1159/000079427 · Cited by 7
“Christenson GA, Popkin MK, Mackenzie TB, Realmuto GM: Lithium treatment of chronic hair pulling.”
BackgroundInfluentialWhy ultraviolet protection with clothing makes sense
Kaskel, P. (2001) · British Journal of Dermatology · doi:10.1046/j.1365-2133.2001.04537.x · Cited by 7
Trichotillomania: A Social Worker's Guide to Practice
Bordnick, P. (1997) · Research on Social Work Practice · doi:10.1177/104973159700700205 · Cited by 7
“Christenson, Mackenzie, and Mitchell (1991) propose that the low rate of TCM among males may be due to the ability of men to conceal or disguise their hair plucking as natural balding or male-pattern baldness.”
BackgroundSensory and physiological dimensions of cold pressor pain in trichotillomania
Blum, A. W., Redden, S. A., & Grant, J. E. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.12.001 · Cited by 7
Stress and Impulsive Behaviors
Donahue, C. B., & Grant, J. (2007) · Elsevier eBooks · doi:10.1016/b978-012370632-4/50012-7 · Cited by 7
Adès, J., & Lejoyeux, M. (1999) · EMC - Psychiatrie · doi:10.1016/s0246-1072(19)30022-7 · Cited by 7
Watson, S., & Winter, D. A. (2000) · doi:10.1080/13642530050178140 · Cited by 6
“The disorder is typically associated with diminished self-esteem (Soriano et al. 1996), depression and anxiety (Christenson et al. 1991), and excessive grooming behaviours related to obsessive-compulsive disorder (OCD) (Stein et al. 1995).”
BackgroundSignificance of family history in understanding and subtyping trichotillomania
Zhang, J., & Grant, J. E. (2022) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2022.152349 · Cited by 6
Natural Recovery in Trichotillomania
Grant, J., & Chamberlain, S. (2021) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1177/00048674211066004 · Cited by 6
Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention
Weidt, S., Bruehl, A., Delsignore, A., Zai, G., Kuenburg, A., Klaghofer, R., & Rufer, M. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s128592 · Cited by 6
“6 Additionally, TTM often interferes with work performance and health-related quality of life (HRQoL), 3,7 and it is frequently comorbid with other psychiatric disorders such as anxiety, mood, eating, 8,9 and personality disorders.”
Skin disorders in patients with primary psychiatric conditions
Qadir, A., Butt, G., Aamir, I., & Asad, F. (2016) · Journal of Pakistan Association of Dermatologists · doi:10.66344/jpad.v25i4.147 · Cited by 6
“Trichotillomania has a bimodal age of presentation and 43% of the patients deny that their alopecia is induced by themselves.(12) In our study trichotillomania was seen 3.”
BackgroundBn, A. K., Narendra Kumar, L., Thippeswamy, J., & Rangaswamaiah, L. N. (2016) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2016.07.008 · Cited by 6
Current issues in the treatment of OC-spectrum conditions
Wetterneck, C. T., Teng, E. J., & Stanley, M. A. (2010) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2010.74.2.141 · Cited by 6
Rapunzel Syndrome as a Rare Presentation of Trichobezoar
Wani, B., Shinde, A., & Wani, N. (2008) · doi:10.5580/2404 · Cited by 6
Advances in the Behavior Analytic Treatment of Trichotillomania and Tourette's Syndrome.
Himle, M., Flessner, C., & Woods, D. W. (2004) · Journal of Early and Intensive Behavior Intervention · doi:10.1037/h0100282 · Cited by 6
“Anxiety problems are also reported to co-occur with both TS and TTM (Carter et al. 2000; Coffey et al. 2000; Pierre, Nolan, Gadow, Sverd, & Sprafkin,1999; Christenson et al. 1991).”
Pubic trichotillomania in an adult man
Mazuecos, J., Rodriguez-Pichardo, A., & Camacho, F. (2001) · British Journal of Dermatology · doi:10.1046/j.1365-2133.2001.04484.x · Cited by 6
Conceptual issues in trichotillomania, a prototypical impulse control disorder
Ninan, P. (2000) · Current Psychiatry Reports · doi:10.1007/s11920-000-0046-y · Cited by 6
Adaletli, H., Gunes, H., Tanıdır, C., Mutlu, C., Aytemiz, T., Kilicoglu, A. G., Bahali, K., Kurban, S., & Üneri, Ö. (2016) · Anatolian Journal of Psychiatry · doi:10.5455/apd.191791 · Cited by 6
Non-suicidal self-injury in trichotillomania and skin picking disorder
Grant, J., & Collins, M. (2024) · CNS Spectrums · doi:10.1017/s1092852924000294 · Cited by 5
Metadata
- 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 › Dermatology › 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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