The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.
The Trichotillomania Impact Project (TIP): Exploring Phenomenology, Functional Impairment, and Treatment Utilization
Abstract
Background Trichotillomania (TTM) occurs in 0.6% to 3.4% of adults. Questions remain about phenomenological features of the disorder, its impact on functioning, and treatment utilization. The current study (i.e., The Trichotillomania Impact Project) was designed to provide initial information regarding these issues. Method An Internet-based survey was completed by 1697 individuals who self-reported symptoms consistent with a diagnosis of TTM (DSM-IV-TR). The survey assessed phenomenological experiences; social, occupational, academic, and psychological impact; as well as treatment-seeking experiences. The survey link operated from April 2005 through May 2005. Results Survey results suggest considerable variability in TTM phenomenology. Individuals with more severe TTM symptoms endorsed more frequent phenomenological experiences of physical or mental anxiety prior to pulling and relief, pleasure, or gratification after pulling. Mild to moderate life impairment in social, occupational, academic, and psychological functioning was reported for the entire study sample. These impairments were more pronounced as TTM symptoms became more severe. A summary of treatment seeking in the sample suggests that pharmacotherapy was the most commonly received treatment, followed by behavior therapy. Unfortunately, treatment in general was perceived as relatively ineffective. Conclusion This study underscores the clinical significance of severe hair pulling and highlights the need for research…
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“Cues to pulling may include stress, boredom, or “downtime.””
From Trichotillomania (hair pulling disorder) (2019) · cites this paper as [2]
In the citing paper
“In addition, many people not being fully aware of their pulling behaviors also referred to as “automatic” pulling and comprise a more habitual form of the disorder.[2]”
From Trichotillomania (hair pulling disorder) (2019) · cites this paper as [2]
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“Abbreviation: MGH-HS = Massachusetts General Hospital Hairpulling Scale.”
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“Recent research has indicated that TTM is more common than previously believed,(2) may serve an affect regulation function,(3) is associated with functional impairment and psychiatric comorbidity, and appears to be responsive to cognitive-behavioral treatment, at least in the short run.(8,9) These developments notwith…”
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“Despite the limitations, these results provide initial and compelling evidence of the potential importance of including TTM in large-scale psychiatric epidemiologic studies in order to assess the public health impact of this disorder in the general population, as such studies have done for major depression(40,41) and…”
ResultA placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania
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“Recent research has indicated that TTM is more common than previously believed,(2) may serve an affect regulation function,(3) is associated with functional impairment and psychiatric comorbidity, and appears to be responsive to cognitive-behavioral treatment, at least in the short run.(8,9) These developments notwith…”
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“and include significantly reduced quality of life, reduced work productivity, and impaired social functioning.(2,3)”
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“Consistent with other internet studies, the majority of the current sample was female and Caucasian.”
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“This characteristic age at onset appears to be consistent across different cultural settings (2, 13).”
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“First, the authors modeled the format and structure of the TSIS-C upon the Trichotillomania Impact Survey and the Trichotillomania Impact Survey for Children, which are Internet-based surveys designed to examine similar research questions in different community samples [ 28 , 31].”
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“Similarly, in the Trichotillomania Impact ProjectAdults (TIP-A) survey of 2,268 persons with selfreported pulling,([4]) 1,711 reported pulling to the point of noticeable hair loss and resultant impairment, and of these individuals, 4% (n 5 67) did not endorse both 613 Review: Trichotillomania (Hair Pulling Disorder)”
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Self-citationPrevalence, gender correlates, and co-morbidity of trichotillomania
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“Although functional impairment has been well documented in many people with trichotillomania (Woods et al., 2006), previous studies, however, have not systematically assessed the relative impact of trichotillomania versus the co-occurring disorder.”
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“…it was not possible to verify the SM diagnoses of the Internet group, recent research has shown that clinical samples obtained via the Internet can be similar to those obtained from those using traditional clinic-based methods (Gosling, Vazire, Srivastava, & Oliver, 2004; Woods et al., 2006).”
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Self-citationThe Impact of Tourette Syndrome in Adults: Results from the Tourette Syndrome Impact Survey
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Trichotillomania and its treatment: a review and recommendations
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Self-citationAffective regulation in trichotillomania: Evidence from a large-scale internet survey
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“For example, in a large study of 1697 individuals, 40% reported experiencing anxiety or an uncomfortable urge prior to pulling and that they wished to reduce these unpleasant feelings by the act of pulling (Woods et al., 2006a).”
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Self-citationStänder, S., Stumpf, A., Osada, N., Wilp, S., Chatzigeorgakidis, E., & Pfleiderer, B. (2013) · British Journal of Dermatology · doi:10.1111/bjd.12267 · Cited by 137
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Flessner, C., Woods, D. W., Franklin, M., Cashin, S. E., Keuthen, N., & Trichotillomania Learning Center Scientific Advisory Board (2008) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-007-9073-x · Cited by 115
“Still others with TTM experiencing a combination of both “automatic” and “focused” pulling may be best served by a combined treatment approach, such as acceptanceenhanced habit reversal training (e.g., Woods et al. 2006).”
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“SSRIs are frequently effective in open-label studies, but have not proved clearly effective in controlled studies (Woods et al., 2006b).”
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“One study reported that over a third of adults with TTM sought treatment for another psychological disorder, with mood and anxiety disorders being the most frequent of those complaints (Woods et al., 2006).”
BackgroundInfluentialSelf-citationExperiential avoidance as a mediator of relationships between cognitions and hair-pulling severity
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“Furthermore, impairments in occupational, academic, social, and psychological functioning have been found to be more pronounced in individuals with more severe TTM (Woods et al., 2006).”
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Self-citationBehavior Therapy for Pediatric Trichotillomania: A Randomized Controlled Trial
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Self-citationPilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania
Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., Timpano, K., Meunier, S., Fama, J., et al. (2010) · Depression and Anxiety · doi:10.1002/da.20732 · Cited by 81
“INTRODUCTION Empirical research has recently documented the phenomenology and psychosocial impairment associated with trichotillomania (TTM).([1,2]) Unfortunately, though, treatment options are limited, with clinical outcomes modest at best, even with first-line interventions such as cognitive–behavioral treatment (CB…”
BackgroundSelf-citationReduced Brain White Matter Integrity in Trichotillomania
Chamberlain, S. R., Hampshire, A., Menzies, L. A., Garyfallidis, E., Grant, J. E., Odlaug, B. L., Craig, K. J., Fineberg, N. A., & Sahakian, B. J. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.109 · Cited by 79
Addicted to Hair Pulling? How an Alternate Model of Trichotillomania May Improve Treatment Outcome
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The Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C)
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“Surveymonkey.com is an Internet-based company designed to aide researchers in the development and storage of Web-based surveys, such as the Trichotillomania Impact Survey for Children.”
BackgroundInfluentialSelf-citationFactor analysis of the Massachusetts General Hospital Hairpulling Scale.
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Self-citationDepression, anxiety, and functional impairment in children with trichotillomania
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“The comorbidity in the current sample was less than that reported in adolescent and adult samples [2, 3] and less among younger preschool-aged children than school-aged children.”
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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
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“Similarly, psychosocial interventions, particularly cognitive behavioral therapy, have become established treatments for trichotillomania (Keuthen et al. 2011; Woods et al. 2006a, b; Diefenbach et al. 2006), but few individuals seek these treatments or can find trained therapists.”
BackgroundA phenomenological investigation of women with Tourette or other chronic tic disorders.
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“This research group has had success using internet-based surveys to examine the phenomenology and functional impact of tic disorders in adults [38], youth [39], as well as in trichotillomania in adults [40] and youth [41,42].”
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Self-citationAcceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial
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Self-citationSkin picking and trichotillomania in adults with obsessive-compulsive disorder
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Self-citationMovement decoupling: A self-help intervention for the treatment of trichotillomania.
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“Hence, functional impairment and decreased quality of life associated with TTM receive increased recognition in current research (Diefenbach, Reitman, & Williamson, 2000; Duke et al., 2010; Franklin et al., 2008; Woods et al., 2006).”
BackgroundTrichotillomania 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
“1991) and frequently associated with clinically significant psychosocial impairment (Woods et al. 2006).”
BackgroundSelf-citationAcceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania
Crosby, J. M., Dehlin, J. P., Mitchell, P. R., & Twohig, M. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.02.002 · Cited by 48
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“usually display limited knowledge of the conditions (Woods et al. 2006; Tucker et al. 2011).”
BackgroundHabit reversal training in trichotillomania: guide for the clinician
Morris Sarah, H., Zickgraf, H. F., Dingfelder, H. E., & Franklin Martin, E. (2013) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2013.827477 · Cited by 62
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“Internet studies offer many benefits, including providing anonymity and access to a severely ill populationwhomay lack nearby clinical care or who may avoid seeking treatment due to embarrassment about the condition [41]; however, the medium may be prone to selection bias by including only those individualswhohave com…”
BackgroundCurrent Treatment Practices for Children and Adults With Trichotillomania: Consensus Among Experts
Flessner, C. A., Penzel, F., & Keuthen, N. J. (2010) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2009.10.006 · Cited by 42
“Recent adult TTM research suggests that CBT is superior to wait-list (Van Minnen et al., 2003; Woods et al., 2006), pharmacotherapy (Ninan et al., 2000; Van Minnen et al., 2003), pill placebo (Ninan et al.)”
BackgroundResultSelf-citationCharacteristics 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 49
Trichotillomania across the life span.
Kratochvil, C., & Bloch, M. (2009) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/chi.0b013e3181ae09f3 · Cited by 42
Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum
Anderson, S., & Clarke, V. (2019) · Journal of Health Psychology · doi:10.1177/1359105317700254 · Cited by 40
“Shame has previously been shown to inhibit direct disclosure within the phenomenologically similar condition of trichotillomania (Woods et al., 2006), so it is not surprising that some of the more painful details of skin picking’s emotional experience are revealed by a more anonymous and…”
BackgroundThe Phenomenology of Hairpulling in College Students
Duke, D. C., Keeley, M. L., Ricketts, E. J., Geffken, G. R., & Storch, E. A. (2009) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-009-9150-4 · Cited by 63
Striatal abnormalities in trichotillomania: a multi-site MRI analysis
Isobe, M., Redden, S. A., Keuthen, N. J., Stein, D. J., Lochner, C., Grant, J. E., & Chamberlain, S. R. (2018) · NeuroImage: Clinical · doi:10.1016/j.nicl.2017.12.031 · Cited by 37
“The condition has lifetime prevalence of 0.5–1% based on surveys, yet is often hidden, undiagnosed and untreated (Grant et al., 2016; Woods et al., 2006).”
BackgroundInfluentialSelf-citationLee, E. B., Haeger, J., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.04.003 · Cited by 45
Nutritional up-regulation of serotonin paradoxically induces compulsive behavior.
Dufour, B., Adeola, O., Cheng, H.-W., Donkin, S., Klein, J. D., Pajor, E., & Garner, J. (2010) · Nutritional neuroscience · doi:10.1179/147683010x12611460764688 · Cited by 36
Trichotillomania (hair pulling disorder)
Grant, J. (2019) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_529_18 · Cited by 35
“” In addition, many people not being fully aware of their pulling behaviors also referred to as “automatic” pulling and comprise a more habitual form of the disorder.[2] Approximately 10%–20% of people with trichotillomania eat their hair after pulling it (“trichophagia”), which can result in gastrointestinal obstruct…”
Abnormal perceptual sensitivity in body-focused repetitive behaviors
Houghton, D. C., Alexander, J. R., Bauer, C. C., & Woods, D. W. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.12.005 · Cited by 58
Self-citationRahman, O., McGuire, J., Storch, E., & Lewin, A. (2017) · Journal of child and adolescent psychopharmacology · doi:10.1089/cap.2016.0085 · Cited by 35
“Overall, 76% of participants responded to treatment, which was superior to TAU and consistent with findings among adults with TTM (e.g., van Minnen et al. 2003; Woods et al. 2006b) and the limited available data among youth.”
InfluentialPsychosocial dysfunction associated with skin picking disorder and trichotillomania
Grant, J. E., Redden, S. A., Leppink, E. W., Odlaug, B. L., & Chamberlain, S. R. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.03.004 · Cited by 61
“Skin picking disorder (SPD) and trichotillomania (TTM) and are often debilitating conditions (Christenson et al., 1991; Woods et al., 2006; Grant et al., 2012).”
BackgroundResultLong-Term Outcome in Pediatric Trichotillomania
Schumer, M. C., Panza, K. E., Mulqueen, J. M., Jakubovski, E., & Bloch, M. (2015) · Depression and Anxiety · doi:10.1002/da.22390 · Cited by 34
“[1] Individuals afflicted with trichotillomania suffer hair loss and irritation from repetitively pulling hair from parts of their body such as the scalp, eyelashes, eyebrows, pubic, etc.[2] Psychological and physical effects of trichotillomania severely interfere with individuals’ social, occupational, and/or academi…”
Acceptance-Enhanced Behavior Therapy for Trichotillomania in Adolescents
Fine, K. M., Walther, M. R., Joseph, J. M., Robinson, J. S., Ricketts, E., Bowe, W. E., & Woods, D. W. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.10.002 · Cited by 34
“TTM predominantly occurs in women by a ratio of approximately 8:1 (Christenson, Mackenzie, & Mitchell, 1991; Cohen et al., 1995; Woods et al., 2006), although this gender discrepancy may be less pronounced in children (Chang, Lee, Chiang, & Lü, 1991; Muller, 1987).”
BackgroundSelf-citationOpen-Label Trial of Aripiprazole in the Treatment of Trichotillomania
White, M. P., & Koran, L. (2011) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e318221b1ba · Cited by 34
Trichotillomania and co-occurring anxiety
Grant, J. E., Redden, S. A., Leppink, E. W., & Chamberlain, S. R. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.09.005 · Cited by 35
“In fact, one study of 894 individuals with trichotillomania found that 83% reported anxiety associated with pulling (Woods et al., 2006).”
Recent Advances in the Understanding and Treatment of Trichotillomania
Walther, M. R., Ricketts, E. J., Conelea, C. A., & Woods, D. W. (2010) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.24.1.46 · Cited by 34
Self-citationWeidt, S., Klaghofer, R., Kuenburg, A., Bruehl, A. B., Delsignore, A., Moritz, S., & Rufer, M. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000431290 · Cited by 32
Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders
Woods, D. W., & Houghton, D. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1055860 · Cited by 32
“Psychosocial difficulties due to TTM might increase in severity over the course of development (Franklin et al., 2008; Walther et al., 2014; Woods et al., 2006), possibly because hair pulling and its affects might become less socially acceptable as one matures.”
BackgroundSelf-citationThe Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications
Lagacé, F., D’Aguanno, K., Prosty, C. J., Laverde‐Saad, A., Cattelan, L., Ouchene, L., Oliel, S., Genest, G., Doiron, P., Richer, V., et al. (2023) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/12034754231177582 · Cited by 38
Age of Onset of Trichotillomania Symptoms
Flessner, C. A., Löchner, C., Stein, D. J., Woods, D. W., Franklin, M. E., & Keuthen, N. J. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181fe7423 · Cited by 31
“We used data obtained with the internet-based Trichotillomania Impact Project (TIP; Woods et al., 2006).”
BackgroundMethodInfluentialSelf-citationBehavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome
Franklin, M., Edson, A. L., & Freeman, J. (2010) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-4-18 · Cited by 31
“The concept of urge plays an important role, as most participants in TTM studies to date have reported tension or some other unpleasant sensation that precedes pulling [12].”
BackgroundSelf-citationKeuthen, N., Tung, E. S., Woods, D. W., Franklin, M., Altenburger, E. M., Pauls, D., & Flessner, C. (2015) · Behavior Modification · doi:10.1177/0145445515580533 · Cited by 30
Self-citationTrichotillomania, stereotypic movement disorder, and related disorders
Stein, D., Garner, J., Keuthen, N., Franklin, M., Walkup, J., Woods, D. W., & the Board (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0036-4 · Cited by 30
Self-citationDSM‐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
“This is consistent with previous data.[7, 8] That said, it is notable that participants who do endorse an urge to pull may have more severe hair-pulling symptoms than those without.”
ResultSelf-citationMoattari, C. R., & Jafferany, M. (2021) · Skin Appendage Disorders · doi:10.1159/000519817 · Cited by 28
Twohig, M. P., Petersen, J. M., Fruge, J. E., Ong, C. W., Barney, J. L., Krafft, J., Lee, E. B., & Levin, M. E. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.01.004 · Cited by 46
Affective and Sensory Correlates of Hair Pulling in Pediatric Trichotillomania
Meunier, S. A., Tolin, D., & Franklin, M. (2009) · Behavior Modification · doi:10.1177/0145445508326260 · Cited by 28
“…in both adults and children with significant avoidance and distress related to public activities, sexual intimacy, and athletic endeavors reported (Diefenbach, Tolin, Hannan, Crocetto, & Worhunsky, 2005; Franklin et al., 2007; Stemberger, Thomas, Mansueto, & Carter, 2000; Woods et al., 2006).”
BackgroundSelf-citationPredictors of relapse following treatment of trichotillomania
Falkenstein, M. J., Rogers, K., Malloy, E. J., & Haaga, D. A. F. (2014) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.09.001 · Cited by 29
“It is associated with significant distress and impaired psychosocial functioning in many domains (Diefenbach, Reitman, & Williamson, 2000; Woods et al., 2006a).”
Diagnostic Accuracy of Trichoscopy in Trichotillomania: A Systematic Review
Kaczorowska, A., Rudnicka, L., Stefanato, C., Waśkiel-Burnat, A., Warszawik-Hendzel, O., Olszewska, M., & Rakowska, A. (2021) · Acta Dermato-Venereologica · doi:10.2340/00015555-3859 · Cited by 26
“It consists of round haemorrhages around hair shafts and, according to the authors, can be very suggestive of trichotillomania (4, 36).”
BackgroundSlikboer, R., Nedeljkovic, M., Bowe, S. J., & Moulding, R. (2015) · Clinical Psychologist · doi:10.1111/cp.12074 · Cited by 30
Asplund, M., Lenhard, F., Andersson, E., & Ivanov, V. Z. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100573 · Cited by 25
“In addition, occupational interference was experienced by almost 80 % of the participants with TTM and 35 % of individuals with SPD (Diefenbach et al., 2005; Flessner and Woods, 2006).”
BackgroundResultCapel, L., Petersen, J. M., Woods, D. W., Marcks, B. A., & Twohig, M. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10381-w · Cited by 25
“Social impairment can include difficulties in close relationships, declining to pursue occupational or educational advancements, and interference in schooling (Grant et al., 2017; Woods et al., 2006a, b, c).”
Self-citation
Metadata
- Authors
- Woods, 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
- Affiliations
- University of Wisconsin–Milwaukee (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2006-12-15
- Volume
- 67
- Issue
- 12
- Pages
- 1877-1888
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2042276786
- Cited by
- 317
- References
- 0
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 15 · 2023: 25 · 2022: 16 · 2021: 19 · 2020: 10 · 2019: 9 · 2018: 16 · 2017: 25 · 2016: 20 · 2015: 29 · 2014: 11 · 2013: 9 · 2012: 14
- FWCI
- 13.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Health Sciences › Medicine › Dermatology › Hair Growth and Disorders
- Keywords
- trichotillomania, hair pulling, phenomenology, symptom severity, functional disability, social functioning, occupational functioning, academic functioning, psychological functioning, treatment seeking, pharmacotherapy, behavior therapy, treatment effectiveness, perceived treatment effectiveness
- MeSH terms
- Activities of Daily Living, Adolescent, Adult, Aged, Behavior Therapy, Drug Therapy, Female, Health Surveys, Humans, Male, Mental Health, Mental Health Services, Middle Aged, Severity of Illness Index, Trichotillomania
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