Comorbidity in Trichotillomania (hair-pulling Disorder): A Cluster Analytical Approach

Overview

Journal Brain Behav

Specialty Psychology

Date 2019 Nov 7

PMID 31692297

Citations 12

Authors

Christine Lochner

Nancy J Keuthen

Erin E Curley

Esther S Tung

Sarah A Redden

Emily J Ricketts

Christopher C Bauer

Douglas W Woods

Jon E Grant

Dan J Stein

Affiliations

Soon will be listed here.

Abstract

Background: A promising approach to reducing the phenotypic heterogeneity of psychiatric disorders involves the identification of homogeneous subtypes. Careful study of comorbidity in obsessive-compulsive disorder (OCD) contributed to the identification of the DSM-5 subtype of OCD with tics. Here we investigated one of the largest available cohorts of clinically diagnosed trichotillomania (TTM) to determine whether subtyping TTM based on comorbidity would help delineate clinically meaningful subgroups.

Methods: As part of an ongoing international collaboration, lifetime comorbidity data were collated from 304 adults with pathological hair-pulling who fulfilled criteria for DSM-IV-TR or DSM-5 TTM. Cluster analysis (Ward's method) based on comorbidities was undertaken.

Results: Three clusters were identified, namely Cluster 1: cases without any comorbidities (n = 63, 20.7%) labeled "simple TTM," Cluster 2: cases with comorbid major depressive disorder only (N = 49, 16.12%) labeled "depressive TTM," and Cluster 3: cases presenting with combinations of the investigated comorbidities (N = 192, 63.16%) labeled "complex TTM." The clusters differed in terms of hair-pulling severity (F = 3.75, p = .02; Kruskal-Wallis [KW] p < .01) and depression symptom severity (F = 5.07, p = <.01; KW p < .01), with cases with any comorbidity presenting with increased severity. Analysis of the temporal nature of these conditions in a subset suggested that TTM onset generally preceded major depressive disorder in (subsets of) Clusters 2 and 3.

Conclusions: The findings here are useful in emphasizing that while many TTM patients present without comorbidity, depression is present in a substantial proportion of cases. In clinical practice, it is crucial to assess comorbidity, given the links demonstrated here between comorbidity and symptom severity. Additional research is needed to replicate these findings and to determine whether cluster membership based on comorbidity predicts response to treatment.

Citing Articles

Family Functioning and Parenting Styles in Adolescents Diagnosed with Trichotillomania.

Okumus H, Kasak M, Celik Y, Menderes A, Sivri I, Temelturk R Child Psychiatry Hum Dev. 2025; .

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Borderline personality disorder in Trichotillomania and skin picking disorder: a survey study.

Grant J, Collins M, Chamberlain S BMC Psychol. 2024; 12(1):745.

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Bridging the Gap between Dermatology and Psychiatry: A Review on Quality of Life in Trichotillomania and Special Considerations in Management.

Onyemachi J, Nguyen C, Nguyen L, Chukwuma O, Munoz-Gonzalez A Skin Appendage Disord. 2024; 10(6):463-469.

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Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania.

Barber K, Woods D, Ely L, Saunders S, Compton S, Neal-Barnett A Psychiatry Res. 2024; 333:115767.

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Impulsivity in adolescent girls diagnosed with trichotillomania: an evaluation of clinical and neuropsychological characteristics.

Okumus H, Akdemir D, Temelturk R, Esen Oksuzoglu M Eur Child Adolesc Psychiatry. 2024; 33(2):617-627.

PMID: 38194080 PMC: 10869386. DOI: 10.1007/s00787-023-02354-x.

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