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

• Published in: European child & adolescent psychiatry 2018-05, Vol.27 (5), p.569-579
• Main Authors: Greenberg, Erica, Tung, Esther S., Gauvin, Caitlin, Osiecki, Lisa, Yang, Kelly G., Curley, Erin, Essa, Angela, Illmann, Cornelia, Sandor, Paul, Dion, Yves, Lyon, Gholson J., King, Robert A., Darrow, Sabrina, Hirschtritt, Matthew E., Budman, Cathy L., Grados, Marco, Pauls, David L., Keuthen, Nancy J., Mathews, Carol A., Scharf, Jeremiah M.
• Format: Article
• Language: English
• Subjects: Age of onset; Attention deficit hyperactivity disorder; Child; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Children; Comorbidity; Female; Females; Genetic susceptibility; Gilles de la Tourette syndrome; Hair; Humans; Male; Medicine; Medicine & Public Health; Morbidity; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - etiology; Original Contribution; Pathophysiology; Patients; Prevalence; Psychiatry; Questionnaires; Repetitive behaviour; Risk factors; Self report; Self-Injurious Behavior - etiology; Severity; Skin; Surveys and Questionnaires; Susceptibility; Tourette syndrome; Tourette Syndrome - diagnosis; Tourette Syndrome - pathology; Treatment methods; Trichotillomania; Trichotillomania - etiology
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-017-1074-z

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.