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Trichotillomania—psychopathological correlates and associations with health-related quality of life in a large sample

Published online by Cambridge University Press:  08 April 2020

Andre P. Bezerra ,
Myrela O. Machado ,
Michel Maes Open the ORCID record for Michel Maes [Opens in a new window] ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window] ,
Paulo R. Nunes-Neto ,
Marco Solmi ,
Joseph Firth ,
M. Ishrat Husain ,
Andre R. Brunoni  and
Paul Kurdyak
...Show all authors
Andre P. Bezerra
Affiliation:
Unichristus Medical School, Fortaleza, Brazil
Myrela O. Machado
Affiliation:
Division of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada
Michel Maes
Affiliation:
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Paulo R. Nunes-Neto
Affiliation:
Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Brazil
Marco Solmi
Affiliation:
Department of Neurosciences, University of Padova, Padova, Italy Padova Neuroscience Center, University of Padua, Padua, Italy
Joseph Firth
Affiliation:
NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
M. Ishrat Husain
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
Andre R. Brunoni
Affiliation:
Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil Department of Clinical Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
Paul Kurdyak
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
Lee Smith
Affiliation:
Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
Afsaneh Alavi
Affiliation:
Division of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada
Vincent Piguet
Affiliation:
Division of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
André F. Carvalho*
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
*
Author for correspondence: Andre F. Carvalho, MD Email: [email protected]; [email protected]
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Abstract

Background

Relatively few studies have assessed the prevalence, correlates, and independent impact on quality of life (QoL) of trichotillomania (TTM) in large samples.

Methods

Consecutive participants (N = 7639) were recruited from a cross-sectional web-based study. Sociodemographic data were collected and several validated self-reported mental health measures were completed (Minnesota Impulsive Disorders Interview, Hypomania checklist, Fagerström Test for Nicotine Dependence, Alcohol Use Disorders Identification Test, Early Trauma Inventory Self Report–Short Form, and the Symptom Checklist-90–Revised Inventory). Health-related QoL was assessed with the World Health Organization QoL abbreviated scale (WHOQOL-Bref). Multivariable models adjusted associations to potential confounders.

Results

The sample was predominantly composed of young females (71.3%; mean age: 27.2 ± 7.9 years). The prevalence of probable TTM was 1.4% (95% confidence intervals [CI]: 1.2-1.7), and was more common among females. Participants with probable TTM had a greater likelihood of having co-occurring probable depression (adjusted odds ratio [ORadj] = 1.744; 95% CI: 1.187-2.560), tobacco (ORadj = 2.250; 95% CI: 1.191-4.250), and alcohol (ORadj = 1.751; 95% CI: 1.169-2.621) use disorders. Probable TTM was also independently associated with suicidal ideation (ORadj = 1.917; 95% CI: 1.224-3.003) and exposure to childhood sexual abuse (ORadj = 1.221; 95% CI: 1.098-1.358). In addition, a positive screen for TTM had more impaired physical and mental QoL.

Conclusions

TTM was associated with a positive screen for several psychiatric comorbidities as well as impaired physical and psychological QoL. Efforts towards the recognition and treatment of TTM across psycho-dermatology services are warranted.

Keywords

Trichotillomaniabehavioral addictionsquality of lifecomorbiditiespsychiatry
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 3 , June 2021 , pp. 282 - 289
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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Footnotes

Andre P. Bezerra and Myrela O. Machado contributed equally to this manuscript.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Pub; 2013.CrossRefGoogle Scholar
Grant, JE, Chamberlain, SR. Trichotillomania. Am J Psychiatry. 2016;173(9):868–874.CrossRefGoogle ScholarPubMed
Bottesi, G, Cerea, S, Razzetti, E, Sica, C, Frost, RO, Ghisi, M. Investigation of the phenomenological and psychopathological features of Trichotillomania in an Italian Sample. Front Psychol. 2016;7:256.CrossRefGoogle Scholar
Carr, JM, Mortimer, H, Martin, K, Kaur, M, Goulding, JMR. A retrospective review of 12 patients with trichotillomania treated in a psychodermatology service. Clin Exp Dermatol. 2019;44(6):658–660.CrossRefGoogle Scholar
Panza, KE, Pittenger, C, Bloch, MH. Age and gender correlates of pulling in pediatric trichotillomania. J Am Acad Child Adolesc Psychiatry. 2013;52(3):241–249.CrossRefGoogle ScholarPubMed
Grzesiak, M, Reich, A, Szepietowski, JC, Hadrys, T, Pacan, P. Trichotillomania among young adults: prevalence and comorbidity. Acta Dermato-Venereol. 2017;97(4):509–512.CrossRefGoogle ScholarPubMed
Keuthen NJ, DD, Franklin, ME, Bohne, A, Loh, R, Levy, J, Deckersbach, T. Quality of life and functional impairment in individuals with trichotillomania. J Appl Res. 2004;4:186–197.Google Scholar
Houghton, DC, Maas, J, Twohig, MP, et al. Comorbidity and quality of life in adults with hair pulling disorder. Psychiatry Res. 2016;239:12–19.CrossRefGoogle ScholarPubMed
Odlaug, BL, Kim, SW, Grant, JE. Quality of life and clinical severity in pathological skin picking and trichotillomania. J Anxiety Disord. 2010;24(8):823–829.CrossRefGoogle ScholarPubMed
Nunes-Neto, PR, Kohler, CA, Schuch, FB, et al. Food addiction: prevalence, psychopathological correlates and associations with quality of life in a large sample. J Psychiatric Res. 2018;96:145–152.CrossRefGoogle ScholarPubMed
Lima, AB, Kohler, CA, Stubbs, B, et al. An exploratory study of the heterogeneity of the jealousy phenomenon and its associations with affective temperaments and psychopathological dimensions in a large Brazilian sample. J Affective Disord. 2017;212:10–16.CrossRefGoogle Scholar
Machado, MO, Kohler, CA, Stubbs, B, et al. Skin picking disorder: prevalence, correlates, and associations with quality of life in a large sample. CNS Spectr. 2018;23(5):311–320.CrossRefGoogle ScholarPubMed
Schwartz, CE, Zhang, J, Stucky, BD, Michael, W, Rapkin, BD. Is the link between socioeconomic status and resilience mediated by reserve-building activities: mediation analysis of web-based cross-sectional data from chronic medical illness patient panels. BMJ Open. 2019;9(5):e025602.CrossRefGoogle ScholarPubMed
Hori, D, Takao, S, Kawachi, I, et al. Relationship between workplace social capital and suicidal ideation in the past year among employees in Japan: a cross-sectional study. BMC Public Health. 2019;19(1):919.CrossRefGoogle ScholarPubMed
Grant, JE. Impulse control disorders: a clinician's guide to understanding and treating behavioral addictions. In: Impulse Control Disorders:A Clinician's Guide to Understanding and Treating Behavioral Addictions. New York, NY: W W Norton & Co; 2008:xii, 209.Google Scholar
Lawshe, CH. A quantitative approach to content validity. Personnel Psychol. 1975;28(4):563–575.CrossRefGoogle Scholar
Camara, RA, Kohler, CA, Frey, BN, Hyphantis, TN, Carvalho, AF. Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life. Rev Bras Psiquiatr. 2017;39(2):140–146.CrossRefGoogle ScholarPubMed
Angst, J, Adolfsson, R, Benazzi, F, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affective Disord. 2005;88(2):217–233.CrossRefGoogle ScholarPubMed
Soares, OT, Moreno, DH, Moura, EC, Angst, J, Moreno, RA. Reliability and validity of a Brazilian version of the Hypomania Checklist (HCL-32) compared to the Mood Disorder Questionnaire (MDQ). Rev Bras Psiquiatr. 2010;32(4):416–423.CrossRefGoogle Scholar
Carvalho, AF, Takwoingi, Y, Sales, PM, et al. Screening for bipolar spectrum disorders: a comprehensive meta-analysis of accuracy studies. J Affective Disord. 2015;172:337–346.CrossRefGoogle ScholarPubMed
Santos, IS, Tavares, BF, Munhoz, TN, et al. Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population. Cad Saude Publica. 2013;29(8):1533–1543.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.CrossRefGoogle ScholarPubMed
Choi, YJ, Lee, WY. The prevalence of suicidal ideation and depression among primary care patients and current management in South Korea. Int J Ment Health Syst. 2017;11:18CrossRefGoogle ScholarPubMed
de Meneses-Gaya, C, Zuardi, AW, de Azevedo Marques, JM, Souza, RM, Loureiro, SR, Crippa, JA. Psychometric qualities of the Brazilian versions of the Fagerstrom Test for Nicotine Dependence and the Heaviness of Smoking Index. Nicotine Tobacco Res . 2009;11(10):1160–1165.CrossRefGoogle ScholarPubMed
Heatherton, TF, Kozlowski, LT, Frecker, RC, Fagerstrom, KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addiction. 1991;86(9):1119–1127.CrossRefGoogle ScholarPubMed
Lima, CT, Freire, AC, Silva, AP, Teixeira, RM, Farrell, M, Prince, M. Concurrent and construct validity of the audit in an urban brazilian sample. Alcohol Alcoholism. 2005;40(6):584–589.CrossRefGoogle Scholar
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—II. Addiction . 1993;88(6):791–804.CrossRefGoogle Scholar
Osorio, FL, Salum, GA, Donadon, MF, Forni-Dos-Santos, L, Loureiro, SR, Crippa, JA. Psychometrics properties of early trauma inventory self report—short form (ETISR-SR) for the Brazilian context. PloS ONE. 2013;8(10):e76337.CrossRefGoogle ScholarPubMed
Bremner, JD, Bolus, R, Mayer, EA. Psychometric properties of the early trauma inventory-self report. J Nervous Ment Dis. 2007;195(3):211–218.CrossRefGoogle ScholarPubMed
Carissimi, A. Examinando fatores causais de sintomas psicológicos através do SCL-90-R em pacientes com apneia do sono grave 2011.Google Scholar
Derogatis, LR, Melisaratos, N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13(3):595–605.CrossRefGoogle Scholar
Fleck, MP, Louzada, S, Xavier, M, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34(2):178–183.CrossRefGoogle ScholarPubMed
The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551–558.CrossRefGoogle Scholar
Cohen, J. A power primer. Psychol Bull. 1992;112(1):155–159.CrossRefGoogle Scholar
Christenson, GA, Pyle, RL, Mitchell, JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. 1991;52(10):415–417.Google ScholarPubMed
King, RA, Zohar, AH, Ratzoni, G, et al. An epidemiological study of trichotillomania in Israeli adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1212–1215.CrossRefGoogle ScholarPubMed
Solley, K, Turner, C. Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Compr Psychiatry. 2018;86:9–18.CrossRefGoogle Scholar
Christenson, GA, MacKenzie, TB, Mitchell, JE. Adult men and women with trichotillomania. A comparison of male and female characteristics. Psychosomatics. 1994;35(2):142–149.CrossRefGoogle ScholarPubMed
Christenson, GA, Mackenzie, TB, Mitchell, JE. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry. 1991;148(3):365–370.Google ScholarPubMed
Grant, JE, Redden, SA, Medeiros, GC, et al. Trichotillomania and its clinical relationship to depression and anxiety. Int J Psychiatry Clin Pract. 2017;21(4):302–306.CrossRefGoogle ScholarPubMed
Chamberlain, SR, Lochner, C, Stein, DJ, et al. Behavioural addiction—a rising tide? Eur Neuropsychopharmacol. 2016;26(5):841–855.CrossRefGoogle ScholarPubMed
Grant, JE, Atmaca, M, Fineberg, NA, et al. Impulse control disorders and "behavioural addictions" in the ICD-11. World Psychiatry. 2014;13(2):125–127.CrossRefGoogle ScholarPubMed
Olive, MF, Cleva, RM, Kalivas, PW, Malcolm, RJ. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacol Biochem Behav. 2012;100(4):801–810.CrossRefGoogle ScholarPubMed
Asevedo, E, Mendes, AC, Berk, M, Brietzke, E. Systematic review of N-acetylcysteine in the treatment of addictions. Rev Bras Psiquiat. 2014;36(2):168–175.CrossRefGoogle ScholarPubMed
Turecki, G, Brent, DA. Suicide and suicidal behaviour. Lancet. 2016;387(10024):1227–1239.CrossRefGoogle ScholarPubMed
Ozten, E, Sayar, GH, Eryilmaz, G, Kagan, G, Isik, S, Karamustafalioglu, O. The relationship of psychological trauma with trichotillomania and skin picking. Neuropsychiatric Dis Treat. 2015;11:1203–1210.CrossRefGoogle ScholarPubMed
Gershuny, BS, Keuthen, NJ, Gentes, EL, et al. Current posttraumatic stress disorder and history of trauma in trichotillomania. J Clin Psychol. 2006;62(12):1521–1529.CrossRefGoogle ScholarPubMed
Herman, JL. Trauma and recovery. New York, NY: Basic Books; 1997.Google Scholar
Hollander, E, Doernberg, E, Shavitt, R, et al. The cost and impact of compulsivity: a research perspective. Eur Neuropsychopharmacol. 2016;26(5):800–809.CrossRefGoogle ScholarPubMed