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Statistical predictors of psychosocial impairment in body-focused repetitive behaviors

Published online by Cambridge University Press:  30 April 2021

Jon E. Grant Open the ORCID record for Jon E. Grant [Opens in a new window] ,
Ibrahim H. Aslan  and
Samuel R. Chamberlain
Jon E. Grant*
Affiliation:
Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
Ibrahim H. Aslan
Affiliation:
Department of Psychiatry, University of Southampton, Southampton, United Kingdom
Samuel R. Chamberlain
Affiliation:
Department of Psychiatry, University of Southampton, Southampton, United Kingdom Department of Psychiatry, University of Cambridge & Cambridgeshire/Peterborough NHS Foundation Trust, Cambridge, United Kingdom
*
*Author for correspondence: Jon E. Grant, JD, MD, MPH Email: [email protected]
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Abstract

Background

Skin picking disorder and trichotillomania, also characterized as body-focused repetitive behaviors (BFRBs), often lead to functional impairment. Some people with BFRBs, however, report little if any psychosocial dysfunction. There has been limited research as to which clinical aspects of BFRBs are associated with varying degrees of functional impairment.

Methods

Adults (n = 98), ages 18 to 65 with a current diagnosis of trichotillomania (n = 37), skin picking disorder (n = 32), trichotillomania plus skin picking disorder (n = 10), and controls (n = 19) were enrolled. Partial least squares regression (PLS) was used to identify variables associated with impairment on the Sheehan Disability Scale.

Results

PLS identified an optimal model accounting for 45.8% of variation in disability. Disability was significantly related to (in order of descending coefficient size): severity of picking, perceived stress, comorbid disorders (specifically, anxiety disorders / obsessive–compulsive disorder), trait impulsivity, family history of alcohol use disorder, atypical pulling/picking sites, and older age.

Conclusions

At present mental disorders are viewed as unitary entities; however, the extent of impairment varies markedly across patients with BFRBs. These data suggest that whereas symptom nature/severity is important in determining impairment, so too are other variables commonly unmeasured in clinical practice. Outcomes for patients may thus be maximized by rigorously addressing comorbid disorders; as well as integrating components designed to enhance top-down control and stress management. Interestingly, focused picking and emotional pulling were linked to worse disability, hinting at some differences between the two types of BFRBs, in terms of determinants of impairment.

Keywords

Trichotillomaniaskin pickingdisabilitydysfunctionimpairmentpredictors
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 5 , October 2022 , pp. 621 - 625
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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