Where on the obsessive impulsive-compulsive spectrum does hair-pulling sisorder belong

Objective. Hair-pulling disorder (HPD) is a putative obsessive-compulsive spectrum disorder, but proper categorization is challenging. Distinct subgroups of HPD may exist, depending on the primary motivation in the act of pulling. Two notable proposed subgroups are "relief pullers" (pulling primarily to reduce anxiety-a "compulsive" subgroup) and "pleasure/ gratification pullers" (pulling primarily for reward-an "impulsive" subgroup) which we sought to examine in order to contribute to conversations on the categorization of HPD. Methods. A total of 111 HPD subjects (mean age 33.7 ± 10.7 [range 18-61] years; 87.4% female) were included. Demographic and clinical characteristics were compared between subgroups (pleasure: n = 51; relief: n = 60); and cognitive performance where data were available (n = 29 per group) and 32 matched healthy controls. Results. No significant demographic differences were noted between groups. Pleasure pullers were significantly more conscious of their pulling. Response inhibition and set shifting deficits were noted in HPD versus controls; however, pleasure and relief pullers did not differ significantly from each other on neurocognitive measures. Conclusions. The results suggest common clinical features and associated neural dysfunction between relief and pleasure/gratification pullers, rather than supporting their existence as discrete clinical entities. Selection of appropriate treatment may focus on other aspects of hair pulling, including family history and comorbidity.

Cognition, Comorbidity, Hair-pulling disorder, Impulse control, Trichotillomania

10.3109/13651501.2013.828079

1365-1501

279-285

Odlaug, Brian Lawrence

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Chamberlain, Samuel Robin

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Schreiber, Liana Renee Nelson

5d659814-23de-4dec-b9d4-5341ad99738b

Grant, Jon Edgar

07372bd5-8a0d-42b4-b41b-e376c652acf3

October 2013