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Am J Psychiatry 1991; 148:365-370
Copyright © 1991 by American Psychiatric Association
Characteristics of 60 adult chronic hair pullers
GA Christenson, TB Mackenzie and JE Mitchell
Department of Psychiatry, University of Minnesota, Minneapolis 55455.
OBJECTIVE: This study was constructed to detail the demographic and
phenomenological features of chronic hair pullers as well as to assess
psychiatric comorbidity in a sizable study group. METHOD: Subjects were
drawn from an outpatient population of chronic hair pullers who had been
referred to a trichotillomania clinic or had responded to a newspaper
advertisement announcing a treatment study of adults who pull out their
hair. Sixty adult chronic hair pullers completed a semistructured interview
that focused on their hair-pulling behavior and demographic characteristics
and that incorporated screening questions for DSM-III-R axis I disorders.
The data were tabulated to derive a comprehensive picture of this group.
RESULTS: The typical subject was a 34-year-old woman who had pulled hair
from two or more sites for 21 years. All subjects described either tension
before or relief/gratification after pulling hair from the primary site,
but 17% (N = 10) failed to describe both of these characteristics and thus
failed to fulfill the DMS-III-R criteria for trichotillomania. Forty- nine
subjects (82%) qualified for past or current axis I diagnoses other than
trichotillomania. Several characteristics of the study group suggested
phenomenological differences between obsessive-compulsive disorder and
trichotillomania. CONCLUSIONS: Adult trichotillomania is a chronic
disorder, frequently involving multiple hair sites, and is associated with
high rates of psychiatric comorbidity. Its relation to obsessive-compulsive
disorder requires further clarification. The tension-reduction requirement
in DSM-III-R for the diagnosis of trichotillomania may be overly
restrictive.
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