Childhood Trichotillomania: Clinical Phenomenology, Comorbidity, and Family Genetics

ROBERT A. KING, LARRY SCAHILL, LAWRENCE A. VITULANO, MARY SCHWAB-STONE, KENNETH P. TERCYAK, MARK A. RIDDLE

Research output: Contribution to journalArticlepeer-review

Abstract

DSM-IV defines trichotillomania as an impulse disorder with rising tension followed by relief or gratification. Alternative formulations view trichotillomania as an internalizing disorder or variant of obsessive-compulsive disorder (OCD). This study addresses this controversy by examining the phenomenology, comorbidity, and family genetics of childhood trichotillomania. Fifteen chronic hair-pullers (13 girls), aged 9 through 17 years (mean 12.3 ± 2.3 years), were systematically assessed. Child Behavior Checklist (CBCL) profiles of the hair-pulling girls were compared with those of 37 girls from a general child psychiatry clinic and of 15 girls with OCD. All the hair-pullers had impairing cosmetic disfigurement; however, 4 subjects (26.7%) denied rising tension or relief. All three groups had comparable global CBCL problem scores. The CBCL symptom profile of the hair-pulling group differed significantly from that of the general clinic group but strongly resembled that of the OCD group. The hair-pulling group, however, had few obsessions or compulsions aside from hair-pulling; two (13%) subjects met criteria for OCD. As a group, hair-pulling subjects had substantial comorbid psychopathology, and a parental history of tics, habits, or obsessive-compulsive symptoms was common. These findings lend only partial support to the notion of trichotillomania as an OCD-spectrum disorder. Rising tension followed by relief or gratification may not be an appropriate diagnostic criterion for trichotillomania.

Original languageEnglish (US)
Pages (from-to)1451-1459
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume34
Issue number11
DOIs
StatePublished - 1995

Keywords

  • comorbidity
  • family studies
  • hair-pulling
  • obsessive-compulsive disorder
  • trichotillomania

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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