Trichotillomania and Pathologic Skin Picking: Clinical Comparison with an Examination of Comorbidity

Background: Pathologic Skin Picking (PSP) and trichotillomania (TTM) are repetitive behaviors presumed to share clinical characteristics. However, no studies have been conducted examining the clinical and phenomenological differences between PSP, TTM, and those persons with a comorbid PSP + TTM diagnosis. We sought to examine the similarities and differences between these three groups from a clinical viewpoint.

Methods: Seventy-seven subjects with PSP, TTM, or PSP + TTM were analyzed for this study. They are comprised of both research subjects and outpatient clinic patients who voluntarily presented for treatment at a large, public university medical center.

Results: There were far more similarities than differences in subjects with TTM, PSP, and PSP + TTM. Significant differences, however, were found in time spent picking/pulling, triggers to the behaviors, rates of comorbid depressive disorders, and family history of PSP.

Conclusions: This represents the first comparison of PSP, TTM, and comorbid PSP + TTM in the literature. It appears that the three groups are quite similar in their overall clinical presentation and severity. However, further research is needed to validate our findings and should focus on ways in which effective treatment may be achieved.