CHILDHOOD TRICHOTILLOMANIA - CLINICAL PHENOMENOLOGY, COMORBIDITY, ANDFAMILY GENETICS

Objective: DSM-IV defines trichotillomania as an impulse disorder with rising tension followed by relief or gratification. Alternative formu lations view trichotillomania as an internalizing disorder or variant of obsessive-compulsive disorder (OCD). This study addresses this cont roversy by examining the phenomenology, comorbidity, and family geneti cs of childhood trichotillomania. Method: Fifteen chronic hair-pullers (13 girls), aged 9 through 17 years (mean 12.3 +/- 2.3 years), were s ystematically assessed. Child Behavior Checklist (CBCL) profiles of th e hair-pulling girls were compared with those of 37 girls from a gener al child psychiatry clinic and of 15 girls with OCD. Results: All the hair-pullers had impairing cosmetic disfigurement; however, 4 subjects (26.7%) denied rising tension or relief. All three groups had compara ble global CBCL problem scores. The CBCL symptom profile of the hair-p ulling group differed significantly from that of the general clinic gr oup but strongly resembled that of the OCD group. The hair-pulling gro up, however, had few obsessions or compulsions aside from hair-pulling ; two (13%) subjects met criteria for OCD. As a group, hair-pulling su bjects had substantial comorbid psychopathology, and a parental histor y of ties, habits, or obsessive-compulsive symptoms was common. Conclu sions: These findings lend only partial support to the notion of trich otillomania as an OCD-spectrum disorder. Rising tension followed by re lief or gratification may not be an appropriate diagnostic criterion f or trichotillomania.