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Trichotillomania, Obsessive-Compulsive Disorder, and Tourette Syndrome: Comorbid Relationships and Risks for Expression

Published online by Cambridge University Press:  07 November 2014

Richard L. O'Sullivan ,
Euripedes C. Miguel ,
Barbara Coffey ,
Scott L. Rauch ,
Cary Savage ,
Nancy J. Keuthen ,
Lee Baer  and
Michael A. Jenike
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Abstract

Trichotillomania (TTM, repetitive hair pulling) is a complex underdiagnosed syndrome that often causes considerable psychological distress and physical disfigurement. Although many aspects of hair pulling bear similarity to compulsions of obsessive-compulsive disorder (OCD), TTM lacks obsessions associated with OCD. The phenomenology of TTM also is similar to tics in Tourette Syndrome (TS) and overlaps with TS in both limited structural neuroimaging data and in terms of treatment response to pharmacotherapy with dopamine antagonists.

In order to study potential comorbid relationships between TTM, TS, and OCD, a total of 61 patients with either TS, OCD, or OCD comorbid with TS were assessed using structured interviews as part of a phenomenological study of these groups. Post hoc analyses indicated significantly higher proportions of hair pulling in those subjects with OCD comorbid with TS compared to subjects with either OCD or TS alone.

These data, in conjunction with clinical phenomenology, neuroimaging results, and response to pharmacotherapy suggest the possibility that some forms of TTM may be more closely related to tic disorders than OCD. Futher research is needed to clarify and confirm these observations of putative relationships between TTM and TS and potential treatment implications.

Type
Feature Articles
Information
CNS Spectrums , Volume 3 , Issue 10 , December 1998 , pp. 49 - 51
Copyright
Copyright © Cambridge University Press 1998

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References

REFERENCES

1.Christenson, GA, Mackenzie, TB, Mitchell, JE. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry. 1991;148:365–370.Google Scholar
2.Minichiello, WE, O'Sullivan, RL, Osgood-Hynes, D, Baer, L. Trichotillomania: clinical aspects and treatment strategies. Harv Rev Psychiatry. 1994;1:336–344.Google Scholar
3.Keuthen, NJ, O'Sullivan, RL, Sprich-Buckminster, S. Trichotillomania: current issues in conceptualization and treatment. Psychother Psychosom. 1998;67:202–213.CrossRefGoogle ScholarPubMed
4.American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
5.Swedo, SE, Leonard, HL. Trichotillomania: an obsessive compulsive spectrum disorder? Psychiatr Clin North Am. 1992;151:777–790.Google Scholar
6.Jenike, MA. Trichotillomania (hair pulling). N Engl J Med. 1990;322:472Google Scholar
7.Hollander, E. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press; 1993.Google Scholar
8.Stein, DJ, Simeon, D, Cohen, LJ, et al.Trichotillomania and obsessive-compulsive disorder. J Clin Psychiatry. 1995;56(suppl):28–34.Google ScholarPubMed
9.Stein, DJ, Mullen, L, Islam, M, et al.Compulsive and impulsive symptomatology in trichotillomania. Psychopathology. 1995;28:208–213.CrossRefGoogle ScholarPubMed
10.Stein, DJ, Hollander, E. Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry. 1992;53:123–126.Google ScholarPubMed
11.Leckman, JF, Walker, DE, Cohen, DJ. Premonitory urges in Tourett's syndrome. Am J Psychiatry. 1993;150:98–102.Google Scholar
12.O'Sullivan, RL, Keuthen, NJ, Christenson, GA, Manseuto, CM, Stein, DJ, Swedo, SE. Trichotillomania: clinical symptom or behavioral syndrome. Am J Psychiatry. 1997;154:1442–1449.Google Scholar
13.Miguel, EC, Coffey, BJ, Baer, L, Savage, CR, Rauch, SL, Jenike, MA. Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's syndrome. J Clin Psychiatry. 1995;56:246–255.Google Scholar
14.Miguel, EC, Baer, L, Coffey, B, et al.Phenomenological differences appearing with repetitive behaviors in obsessive compulsive disorders and Gilles de la Tourette's syndrome. Br J Psychiatry. 1997;170:140–145.Google Scholar
15.O'Sullivan, RL, Rauch, SL, Breiter, HC, et al.Reduced basal ganglia volumes in trichotillomania measured via morphometric MRI. BM Psychiatry. 1997;95:379–384.Google Scholar
16.Rauch, SL, Jenike, MA, Whalen, PJ, Dougherty, D. Neurobiologic models of obsessive-compulsive disorder. In: Jenike, MA, Baer, L, Minichiello, WE, eds. Obsessive-Compulsive Disorders: Practical Management. 3rd ed. St. Louis, MO. Mosby Inc; 1998:222–253.Google Scholar
17.Stein, D, O'Sullivan, RL, Hollander, E, et al.The neurobiology of trichotillomania. CNS Spectrum. 1998;(7):47–51.Google Scholar
18.Singer, HS, Reiss, A, Brown, JE, et al.Volumetric MRI changes in basal ganglia of children with Tourette's syndrome. Neurology. 1993;43:950–956.Google Scholar
19.Rauch, SL, Baxter, LR. Neuroimaging in obsessive-compulsive disorder and related disorders. In: Jenike, MA, Baer, L, Minichiello, WE, eds. Obsessive-Compulsive Disorders: Practical Management. 3rd ed. St. Louis, MO. Mosby Inc; 1998:289–317.Google Scholar
20.Stein, DJ, Coetzer, R, Lee, M, Davids, B, Bouwer, C. Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Res. 1997;74:177–182.Google Scholar
21.Swedo, SE, Rappoport, JL, Leonard, HL, Schapiro, MB, Rappoport, SI, Grady, CL. Regional cerebral glucose metabolism of women with trichotillomania. Arch Gen Psychiatry. 1991;48:828–833.Google Scholar
22.Stein, DJ, van Heerden, B, Wessels, C, et al.Functional imaging and medication in hair pulling. Presented at the Annual Meeting of the American Psychiatric Association; May 17-22, 1997; San Diego, CA.Google Scholar
23.O'Sullivan, RL, Christenson, GA, Stein, DJ. Pharmacotherapy of trichotillomania. In: Stein, DJ, Christenson, GA, Hollander, E, eds. Trichotillomania: Current Developments. Washington, DC: American Psychiatric Press; 1998.Google Scholar
24.Stein, DJ, Bower, C, Hawkridge, S, Emaley, RA. Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders. J Clin Psychiatry. 1997;68:119–122.Google Scholar
25.Potenza, MN, Wasylink, S, Epperson, CN, McDougle, CJ. Olanzapine augmentation of fluoxetine in the treatment of trichotillomania. Am J Psychiatry. 1998;155:1299–1300.Google Scholar
26.Epperson, CN, Fasula, D, Wasylink, S, Price, LH, McDougle, CJ. Risperidone addition in serotonin uptake inhibitor-resistant trichotillomania: three cases. J Child Adolesc Psychopharmacology. In press.Google Scholar
27.Van Amerigan, M, Mancini, C. Treatment of trichotillo-mania with haloperidol. Presented at the Anxiety Disorders Association of America Annual Meeting; March 28-31, 1996; Orlando, FL.Google Scholar
28.Ghaziudin, M, Tsai, LY, Ghaziuddin, N. Haloperidol treatment of trichotillomania in a boy with autism and mental retardation. J Autism Dev Disord. 1991;49:365–371.Google Scholar
29.Childers, RT. Report of two cases of trichotillomania of longstanding duration and their response to chlorpromazine. J Clin Exp Psychopathol. 1958;19:141–144.Google Scholar
30.McDougle, CJ, Goodwin, WK, Price, LH, et al.Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry. 1990;147:652–654.Google Scholar
31.McDougle, CJ, Goodman, WK, Leckman, JF, Lee, NC, Heninger, GR, Price, LH. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 1994;51:302–308.Google Scholar
32.Pauls, DL, Towbin, KE, Lechman, JF, Zahuer, GE, Cohen, DJ. Gilles de la Tourette's syndrome and obsessive-compulsive disorder: evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986;43:1180–1182.Google Scholar
33.Lenane, MC, Swedo, SE, Rappoport, JL, Leonard, H, Sosery, W, Gurrod, JJ. Rates of obsessive-compulsive disorder in first degree relatives of patients with trichotillomania: a research note. J Child Psychol Psychiatry. 1992;33:925–933.Google Scholar
34.King, RA, Scahill, L, Vitulano, LA, et al.Childhood trichotillomania: clinical phenomenology, comorbidity, and family genetics. J Am Acad Child Adolesc Psychiatry. 1995;34:1451–1459.Google Scholar