November/December 2015
ORIGINAL CONTRIBUTION
diagnosed TTM cases from an epidemiologically representative sample, the unweighted number of cases is still low given the size of the database. In many of the analyses assessing psychiatric comorbidity (Table II), the unweighted number of patient visits was <30 and did not meet the criteria for reliability39; therefore, the results of such analyses had to be considered provisional. Conclusions Our findings from an epidemiologically representative sample underline the importance of psychiatric comorbidity in TTM. It is important for the dermatologist to have a high index of suspicion for comorbid psychiatric disorders in the TTM patient, as untreated psychiatric disorders especially starting during childhood, can have an adverse impact on the long-term psychosocial and vocational functioning of the patient. References
12 Hajcak G, Franklin ME, Simons RF, Keuthen NJ. Hairpulling and skin picking in relation to affective distress and obsessive-compulsive symptoms. J Psychopathol Behav. 2006;28:179–187. 13 Mansueto CS, Thomas AM, Brice AL. Hair pulling and its affective correlates in an African-American university sample. J Anxiety Disord. 2007;21:590–599. 14 Mazhari S. Association between problematic Internet use and impulse control disorders among Iranian university students. Cyberpsychol Behav Soc Netw. 2012;15:270– 273. 15 Odlaug BL, Grant JE. Impulse-control disorders in a college sample: results from the self-administered Minnesota Impulse Disorders Interview (MIDI). Prim Care Companion J Clin Psychiatry. 2010;12. 16 Siddiqui EU, Naeem SS, Naqvi H, Ahmed B. Prevalence of body-focused repetitive behaviors in three large medical colleges of Karachi: a cross-sectional study. BMC Res Notes. 2012;5:614.
1 Lee CS, Koo JYM. Psychocutaneous Diseases. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. Vol 1. 3rd ed. Amsterdam, Netherlands: Elsevier; 2012:127–134.
17 Stanley MA, Borden JW, Mouton SG, Breckenridge JK. Nonclinical hair-pulling: affective correlates and comparison with clinical samples. Behav Res Ther. 1995;33:179–186.
2 American Psychiatric Association. Diagnostic and Statical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
18 Stanley MA, Borden JW, Bell GE, Wagner AL. Nonclinical hair pulling––phenomenology and related psychopathology. J Anxiety Disord. 1994;8:119–130.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
19 Sulkowski ML, Mariaskin A, Storch EA. Obsessive-compulsive spectrum disorder symptoms in college students. J Am Coll Health. 2011;59:342–348.
4 Gupta MA. Emotional regulation, dissociation, and the self-induced dermatoses: clinical features and implications for treatment with mood stabilizers. Clin Dermatol. 2013;31:110–117. 5 Gupta MA, Gupta AK. Current concepts in psychodermatology. Curr Psychiatry Rep. 2014;16:449. 6 Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: a current review. Clin Psychol Rev. 2010;30:181– 193. 7 Wong JW, Nguyen TV, Koo JY. Primary psychiatric conditions: dermatitis artefacta, trichotillomania and neurotic excoriations. Indian J Dermatol. 2013;58:44–48. 8 Christenson GA, Mackenzie TB, Mitchell JE, Callies AL. A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry. 1991;148:1566–1571. 9 Odlaug BL, Grant JE. Trichotillomania and pathologic skin picking: clinical comparison with an examination of comorbidity. Ann Clin Psychiatry. 2008;20:57–63. 10 Walther MR, Snorrason I, Flessner CA, et al. The trichotillomania impact project in young children (TIP-YC): clinical characteristics, comorbidity, functional impairment and treatment utilization. Child Psychiatry Hum Dev. 2013;45:24–31. 11 Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. 1991;52:415–417.
SKINmed. 2015;13:455–460
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20 Woods DW, Miltenberger RG, Flach AD. Habits, tics, and stuttering. Prevalence and relation to anxiety and somatic awareness. Behav Modif. 1996;20:216–225. 21 Bohne A. Impulse-control disorders in college students. Psychiatry Res. 2010;176:91–92. 22 Duke DC, Keeley ML, Ricketts EJ, Geffken GR, Storch EA. The phenomenology of hairpulling in college students. J Psychopathol Behav. 2010;32:281–292. 23 Rothbaum BO, Shaw L, Morris R, Ninan PT. Prevalence of trichotillomania in a college freshman population. J Clin Psychiatry. 1993;54:72–73. 24 Torresan RC, Ramos-Cerqueira AT, Shavitt RG, et al. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res. 2013;209:186–195. 25 Lejoyeux M, Arbaretaz M, McLoughlin M, Ades J. Impulse control disorders and depression. J Nerv Ment Dis. 2002;190:310–314. 26 Karakus G, Tamam L. Impulse control disorder comorbidity among patients with bipolar I disorder. Compr Psychiatry. 2011;52:378–385. 27 Lejoyeux M, Feuché N, Loi S, Solomon J, Adès J. Study of impulse-control disorders among alcohol-dependent patients. J Clin Psychiatry. 1999;60:302–305. 28 Zucker N, Von Holle A, Thornton LM, et al. The significance of repetitive hair-pulling behaviors in eating disorders. J Clin Psychol. 2011;67:391–403.
Trichotillomania: Demographic and Clinical Features