Characteristics and phenomenology of hair-pulling: An exploration of subtypes

This study was designed to detail the demographic and phenomenological feat ures of adult chronic hairpullers. Key possible subtypes were identified a priori. On the basis of the phenomenological data, differences between the following possible subtypes were investigated: hair-pullers with and withou t DSM-IV trichotillomania (TTM), oral habits, automatic versus focused hair -pulling, positive versus negative affective cues prior to hair-pulling, co morbid self-injurious habits, obsessive-compulsive disorder (OCD), and ties . Forty-seven participants were drawn from an outpatient population of chro nic adult hair-pullers. A structured interview that focused on hair-pulling and associated behaviors was administered to participants. Six of the part icipants (12.8%) were male, and 41 (87.7%) were female. A large number of h air-pullers (63.8%) had comorbid self-injurious habits. A greater proportio n of male hair-pullers had comorbid ties when compared with females. Certai n subgroups of chronic hair-pullers (e.g., hairpullers with or without auto matic/focused hair-pulling, comorbid self-injurious habits, and oral habits ) were found to differ on a number of phenomenological and hair-pulling cha racteristics. However, differences between other possible subgroups (e.g., hair-pullers with or without DSM-IV TTM, comorbid OCD, and negative versus positive affective cues) may reflect greater severity in hair-pulling sympt omatology rather than distinct subtypes of chronic hair-pulling. The findin gs of the present study also indicated that chronic hair-pulling (even in c ases where DSM-IV criteria for TTM were not met) has a significant impact o n quality of life. The present study provided limited support for the exist ence of possible subtypes of chronic hair-pulling. Recommendations are made for further investigations into such subtypes. Copyright (C) 2001 by W.B. Saunders Company.