TY - JOUR
T1 - Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome
AU - The Tourette Association of America International Consortium for Genetics
AU - Greenberg, Erica
AU - Tung, Esther S.
AU - Gauvin, Caitlin
AU - Osiecki, Lisa
AU - Yang, Kelly G.
AU - Curley, Erin
AU - Essa, Angela
AU - Illmann, Cornelia
AU - Sandor, Paul
AU - Dion, Yves
AU - Lyon, Gholson J.
AU - King, Robert A.
AU - Darrow, Sabrina
AU - Hirschtritt, Matthew E.
AU - Budman, Cathy L.
AU - Grados, Marco
AU - Pauls, David L.
AU - Keuthen, Nancy J.
AU - Mathews, Carol A.
AU - Scharf, Jeremiah M.
N1 - Funding Information:
Acknowledgements The authors thank the families, patients, and control volunteers who participated in this research, and the members of the Tourette Association for America International Genetics Consortium. This work was supported by the National Institutes of Health, Grant numbers R01MH096767 (PI: Carol Mathews), U01NS040024 (PI: David Pauls/Jeremiah Scharf), K23MH085057 (PI: Jeremiah Scharf), and grants from the TLC Foundation for Body-Focused Repetitive Behaviors and from the Tourette Association of America.
Funding Information:
the Tourette Association of America (TAA). Dr. Budman reports funding for clinical research studies from Neurocrine Pharmaceuticals, Psyadon Pharmaceuticals, Otsuka Pharmaceuticals, Synchroneuron Pharmaceuticals, Teva Pharmaceuticals, and Auspex Pharmaceuticals. She has also been a speaker for the TAA and the Center for Disease Control Partnership and a consultant to Bracket. Dr. Sandor reports unrestricted educational grants from Purdue and Shire, a speaker fee from Purdue, and support for clinical research from Otsuka Pharmaceuticals. Dr. Sandor was also a member of the data safety monitoring committee for Psyadon Pharmaceuticals. Drs. Pauls, Keuthen and Scharf have received grant support from the TLC Foundation for Body-Focused Repetitive Behaviors (BFRBs). Drs. Keuthen and Scharf are members of the Scientific Advisory Board of the TLC Foundation for BFRBs. Dr. Scharf has also received consulting fees from Nuvelation Pharma, travel and grant support from the TAA, and is a member of the Scientific Advisory Board for the TAA. Dr. Mathews has received research support, honoraria, and travel support from the TAA and is the co-chair of the TAA Scientific Advisory Board. Drs. Greenberg, Illmann, Darrow, Hirschtritt, and Ms. Tung, Gauvin, Osiecki, Yang, Curley and Essa report no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2017, Springer-Verlag GmbH Germany.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive–compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive–compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.
AB - Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive–compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive–compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.
KW - Body-focused repetitive behaviors
KW - Excoriation disorder/skin picking disorder
KW - Obsessive–compulsive disorder
KW - Tourette syndrome
KW - Trichotillomania/hair pulling disorder
UR - http://www.scopus.com/inward/record.url?scp=85032899094&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032899094&partnerID=8YFLogxK
U2 - 10.1007/s00787-017-1074-z
DO - 10.1007/s00787-017-1074-z
M3 - Article
C2 - 29098466
AN - SCOPUS:85032899094
SN - 1018-8827
VL - 27
SP - 569
EP - 579
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 5
ER -