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Eur Child Adolesc Psychiatry. 2018 May;27(5):569-579. doi: 10.1007/s00787-017-1074-z. Epub 2017 Nov 2.

Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome.

Author information

1
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
2
Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6254, Boston, MA, 02114, USA.
3
Department of Psychiatry, Youthdale Treatment Centers, University of Toronto and University Health Network, Toronto, ON, Canada.
4
Department of Psychiatry, University of Montreal, Montreal, QC, Canada.
5
Cold Spring Harbor Laboratory, Stanley Institute for Cognitive Genomics, Cold Spring Harbor, NY, USA.
6
Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
7
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
8
Hofstra Northwell School of Medicine, Hempstead, NY, USA.
9
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
10
Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA.
11
Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, FL, USA.
12
Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6254, Boston, MA, 02114, USA. jscharf@partners.org.
13
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. jscharf@partners.org.
14
Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. jscharf@partners.org.

Abstract

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.

KEYWORDS:

Body-focused repetitive behaviors; Excoriation disorder/skin picking disorder; Obsessive–compulsive disorder; Tourette syndrome; Trichotillomania/hair pulling disorder

PMID:
29098466
PMCID:
PMC5932289
DOI:
10.1007/s00787-017-1074-z
[Indexed for MEDLINE]
Free PMC Article

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