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The Child and Adolescent Trichotillomania Impact Project: Descriptive Psychopathology, Comorbidity, Functional Impairment, and Treatment Utilization

Franklin, Martin E., PhD*; Flessner, Christopher A., MA; Woods, Douglas W., PhD; Keuthen, Nancy J., PhD; Piacentini, John C., PhD§; Moore, Phoebe, PhD; Stein, Dan J., PhD; Cohen, Sara B., BA*; Wilson, Michelle A., BA* Trichotillomania Learning Center-Scientific Advisory Board

Journal of Developmental & Behavioral Pediatrics: December 2008 - Volume 29 - Issue 6 - p 493-500
doi: 10.1097/DBP.0b013e31818d4328
Original Article

Objective: Trichotillomania (TTM) is associated with significant morbidity, comorbidity, and functional impairment in adults. Despite the fact that TTM is typically a pediatric onset disorder, important questions remain about its phenomenology, comorbid symptoms, functional impact, and treatment utilization in youth. The current study was designed to provide an initial description of these factors using a convenience sample.

Method: An internet-based survey.

Results: Surveys completed by 133 youth ages 10 to 17 were analyzed. Scalp hair was the most common pulling site, followed by eyelashes and eyebrows. The majority reported tension before pulling and gratification/relief immediately after pulling. Severity of anxiety and depressive symptoms were somewhat elevated, as measured by standard instruments, and correlated positively with the severity of TTM symptoms. Moderate impairment in social and academic functioning was reported. For those who had received treatment specifically for TTM, parent ratings indicated that few (17%) children and adolescents were either very much improved or much improved after intervention.

Conclusions: This study represents the largest survey of youth with TTM conducted thus far, and thus provides the most comprehensive description of TTM in youth to date.

Limitations: Data was obtained from an anonymous, Internet-based sample, and thus may not be generalizable to all youth with TTM.

From the *University of Pennsylvania School of Medicine, Philadelphia, PA; †University of Wisconsin-Milwaukee, Milwaukee, WI; ‡Harvard University, Massachusetts General Hospital, Boston, MA; §University of California Los Angeles, Los Angeles, CA; ¶Duke University Medical Center, Durham, NC; ∥University of Cape Town and Mt. Sinai School of Medicine, New York, NY; **Santa Cruz, CA.

Received June 2007; accepted September 2008.

Drs. Franklin, Woods, Keuthen, Moore, and Mr. Flessner have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services to disclose relative to this article. Dr. Piacentini has received research support from Pfizer. Dr. Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth.

Of the advisory board, Dr. Walkup is a consultant for Eli Lilly, Pfizer, Jazz, and Cephalon; has received research grant support from Eli Lilly, Pfizer, and Abbott; has received honoraria from Eli Lilly, Pfizer, and Cephalon; and is a member of the speakers/advisory boards for Pfizer and Eli Lilly. Drs. Mansueto, Penzel, Novak, Pauls, and Wright have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services to disclose relative to this article.

Address for reprints: Martin E. Franklin, Ph.D., Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, 6th floor, Philadelphia, PA 19104; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.