CLINICAL REPORT
509 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Trichotillomania Among Young Adults: Prevalence and Comorbidity
Magdalena GRZESIAK 1, Adam REICH 2, Jacek C. SZEPIETOWSKI 2, Tomasz HADRYŚ 1 and Przemysław PACAN 1
1
Department of Psychiatry, and 2 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
Trichotillomania is an impulse control disorder characterized by repetitive pulling out of one’ s hair. The aim of this study was to estimate the prevalence of trichotillomania in young adults and its association with anxiety and obsessive-compulsive disorders( OCD). A total of 339 individuals completed a questionnaire to determine the presence of trichotillomania. OCD and anxiety disorders were diagnosed according to the diagnostic criteria of the International Classification of Diseases 10 th Revision( ICD-10), based on the Composite International Diagnostic Interview. Twelve persons( 3.5 %) reported hair pulling during their lifetime, but only 8 of them met the criteria of trichotillomania according to the ICD-10. Four individuals had stopped their behaviour prior to the study participation. The lifetime anxiety disorders were diagnosed in 5 participants with trichotillomania( 62.5 %), while in the group without trichotillomania, 67 persons( 20.2 %) met the diagnostic criteria for anxiety disorders( p < 0.01). OCD were not diagnosed in individuals with trichotillomania, among participants without trichotillomania, 14 persons( 4.2 %) reported symptoms of OCD.
Key words: trichotillomania; hair pulling; CIDI. Accepted Nov 8, 2016; Epub ahead of print Nov 9, 2016 Acta Derm Venereol 2017; 97: 509 – 512.
Corr: Jacek C. Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Ul. Chalubinskiego 1, PL-50- 368 Wroclaw, Poland. E-mail: jacek. szepietowski @ umed. wroc. pl
Trichotillomania( TTM) is an impulse control disorder characterized by repetitive pulling out of one’ s hair, usually from the scalp and / or eyebrows, eyelashes or elsewhere, that results in noticeable hair loss( 1). TTM is more commonly observed in younger patients; the mean age of onset is 12 years. It can, however, begin at any age( 2, 3). Many authors suggest that TTM in children, especially at pre-school age, is relatively benign and self-limiting( 4, 5) and may be seen as analogous to nailbiting or thumb-sucking; however, less is known about the clinical relevance of TTM in older patients.
The prevalence of TTM has not been studied in systematic epidemiological surveys. In the past, TTM was considered as a relatively rare disorder with the prevalence assessed as low as 0.05 %( 6). More recent research indicates that TTM is much more common. A survey among 2,534 students found a 0.6 % lifetime prevalence of TTM for both male and female respondents. Hair pulling resulting in visible hair loss, but failing to meet diagnostic criteria, was identified in 1.5 % of males and 3.4 % of females( 7). King et al.( 8) assessed hair pulling and associated psychopathology in a group of 794 adolescents. They reported a lifetime prevalence of hair pulling of 1 %( n = 8; 5 males, 3 females) and a point prevalence of hair pulling of 0.5 %( n = 4). In 3 out of 4 current hair pullers, obsessive-compulsive symptoms were described, i. e. a significantly higher rate compared with the general population. Two subjects with obsessive-compulsive disorder( OCD) also had generalized anxiety disorder( 8). In a group of 210 children with hair loss and scalp disorders from dermatology clinics, TTM was diagnosed in 15 cases( 7.1 %). The mean age of presentation was 10 years, with female predominance( 10 females). In addition to the scalp, 3 cases had eyebrows involvement( 9).
The prevalence of non-clinical hair pulling behaviour appears to be higher; up to 11.0 % or even 15.3 %, in university surveys( 10, 11). These studies indicate that hair pulling is quite common. TTM is more frequently diagnosed in women. A female: male ratio varied in different epidemiological studies from as much as 2:1 to 7:1( 8, 12 – 14).
Psychiatric comorbidity in TTM appears to be common, with anxiety disorders, mood disorders, substance use disorders, eating disorders and personality disorders being the most common associated conditions in adults( 15, 16). Anxiety disorders are observed in youths( 7, 16). Some data also support a relationship between OCD and TTM. A higher frequency of OCD in patients with TTM has been reported( 8, 17), as well as higher rates of hair pulling in patients with OCD( 18, 19). As TTM is characterized by repetitive behaviours limited to hair pulling, it is considered as an OCD spectrum disorder. According to this approach, TTM was moved from the group of“ impulse control disorders not elsewhere classified” in the previous version of the American Psychiatric Association Classification DSM-IV to the group of disorders of obsessive compulsive spectrum in recent DSM-V( 20), although in International Classification of Diseases 10 th Revision( ICD-10) classification it still belongs to an impulse control disorders( 21).
MATERIALS AND METHODS
The aim of the study was to assess the prevalence of TTM among young adults and its association with anxiety and OCD. The study was approved by the ethics committee of Wroclaw Medical University, Poland.
A total of 343 medical students of Wroclaw Medical University were initially recruited in the study. Four of them( 1.2 %) decli-
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2565 Acta Derm Venereol 2017; 97: 509 – 512