2020 Scilit Zine: Click to View PDF
Table of Contents / Reference List : Scientific Literacy (SciLit) : 100% Sci, 100% Lit
2019 TLC Conference Poster Session Scientific Literacy (SciLit) is a committee in The TLC Foundation’s Young Ashkawn Ehsan, D., Valle, S., Cavic, E., & Grant, J. E. (2019, May). Nonmedical Cannabis Use in Trichotillo- Adult Action Council. Our mission is to make scientific research about BFRBs mania. Poster presented at The TLC Foundation for BFRBs Annual Conference, Chantilly, VA. accessible and understandable to the general public. Houghton, D. C., Tommerdahl, M., & Woods, D. W. (2019, May). Increased Tactile Sensitivity and Deficient Feed-Forward Inhibition in Pathological Hair Pulling and Skin Picking. Poster presented at The TLC 2019 was a banner year for the SciLit team. We made our official debut at the 2019 conference in Foundation for BFRBs Annual Conference, Chantilly, VA. Washington, D.C., leading a panel on how to pursue a career in BFRB research, distributing our full-color zine of literature summaries, and networking with our scientific community members. eW also welcomed a Valle, S., Cavic, E., & Grant, J. E. (2019, May). Nutrition in Skin Picking Disorder and Trichotillomania. Poster new member to our little team. We continued our well-received empirical literature summaries every quarter presented at The TLC Foundation for BFRBs Annual Conference, Chantilly, VA. afterward, and included some of our favorite poster presentations from last year’s conference as a bonus.
During BFRB Awareness Week (#DidYouKnowBFRB), we created a set of infographics featuring our good March-May 2019 friend Professor YAAC, hosted a livestream on Facebook, and collaborated with our partners at American University, the Yale University School of Medicine, and HabitAware to showcase their ongoing research. Culver, A. L., Hernandez, A., & Paek, S. Y. (2019). Neurosis and true dermatosis: a case of ossified pilomatricoma developing within a self-inflicted ulcer. Dermatology Online Journal, 25(2). This year, we are back, and better than ever. We are hosting another panel discussion at BFRBCon in Chicago, this time about how to be an active consumer of BFRB research (with some excellent guests). Demetriou, S. (2019). Emotion regulation in trichotillomania (hair-pulling disorder): The role of stress and We aim to continue improving our literature summaries and taking on new projects based on feedback from trauma. Master’s thesis, Stellenbosch University. the BFRB community, and we ultimately want to generate some of our own data on research questions that interest our team. Thank you to everyone who has offered us their support and collaboration this past year, Farhat, L. C, Olfson, E., Li, F., Telang, S., & Bloch, M. H. (2019). Identifying standardized definitions of and we look forward to educating the BFRB community for another year ! treatment response in trichotillomania: A meta-analysis. Progress in Neuropsychopharmacology & Biological Psychiatry, 89, 446-455.
June-August 2019 Meet the Team Dixon, L. J., & Snorrason, I. (2019). Prevalence and clinical characteristics of skin picking among adults with skin disease symptoms. Journal of Obsessive-Compulsive and Related Disorders, 22(100454). Kimi Vesel Hannah Doyle Age : 25 Age : 23 Slikboer, R., Rehm, I. C., Lam, S., Maloney, A., & Nedeljkovic, M. (2019). A brief, residential peer support retreat for trichotillomania: A mixed methods evaluation. Australian Psychologist, 1-12. Location : Boston, MA Location : Durham, NC Occupation : biotech Occupation : post-bac Uhlmann, A., Dias, A., Taljaard, L., Stein, D. J., Brooks, S. J., & Lochner C. (2019). White matter volume clinical trial manager fellow at NIH alterations in hair-pulling disorder (trichotillomania). Brain Imaging and Behavior, 1-8. Favorite Movie : Favorite Movie : The Godfather Baby Driver
September-November 2019
Lamothe, H., Baleyte, J. M., Mallet, L., & Pelissolo, A. (2019). Trichotillomania is more related to Tourette Tyler Costello Kenna disorder than to obsessive-compulsive disorder. Brazilian Journal of Psychiatry, 42(1), 87-104. Marblestone Age : 27 Lochner, C., Keuthen, N. J., Curley, E. E., Tung, E. S., Redden, S. A., Ricketts, E. J., ... & Stein, D. J. (2019). Location : Eugene, OR Age : 19 Comorbidity in trichotillomania (hair-pulling disorder): A cluster analytical approach. Brain and Behavior, 9(12), Location : Ohio e01456. Occupation : draftsman Favorite Movie : Occupation : student Peris, T. S., Rozenman, M., Gonzalez, A., Vreeland, A., Piacentini, J., Tan, P., & Ricketts, E. (2019). Family Seven Pounds Favorite Movie : functioning in pediatric trichotillomania, obsessive compulsive disorder, and healthy comparison youth. Little Miss Sunshine Psychiatry Research, 281, 112578.
Acknowledgments : the SciLit team would like to thank Leslie Lee, Kathleen Griffith, Rebecca 1 Richter, and Amee Patel for their contributions to this zine ! 2 Nonmedical Cannabis Use in Trichotillomania D. Ashkawn Ehsan, S. Valle, E. Cavic, & J.E. Grant Nonmedical Cannabis
This pilot study found that the use of dromabinol, a cannabinoid Use in Trichotillomania derivative containing delta-9-tetrahydrocannabinal (THC) significantly reduced trichotillomania (TTM) symptoms in a majority of subjects. The purpose of this follow-up study was to explore whether there is an identifiable difference in symptom severity of TTM between those who use cannabis recreationally and those who do not.
This study compared the TTM symptoms of 47 adult subjects, consisting of 9 cannabis users and 38 non-users, using various 9 38 accredited scales for measuring TTM symptom severity. Ultimately, no Cannabis Non- significant differences were observed between the two different test Users groups. No measurements of participants’ cannabis consumption were Users included in this study outside of identifying each test subject as a user or non-user.
Although no correlations were found, the pilot study’s results warrant additional studies with more structured consumption of cannabis to This study compared The quantity and corroborate or discredit any findings. trich symptom severity method of THC between cannabis users consumption was not and non users. regulated in this study.
No significant correlations were found.
Ashkawn Ehsan, D., Valle, S., Cavic, E., & Grant, J.E. (2019, May). Nonmedical Cannabis Use in Trichotillomania. Poster presented at The TLC Foundation for BFRBs Annual Conference, Chantilly, VA. bfrb.org
3 Young Adult Action Council Increased Tactile Sensitivity & Increased Tactile Sensitivity & Deficient Feed-Forward Deficient Feed-Forward Inhibition in Pathological Hair Pulling and Skin Picking Inhibition in Pathological D.C. Houghton, M. Tommerdahl, & D.W. Woods
Hair Pulling and Skin Picking Recent research has suggested that heightened sensitivity to touch plays a role in BFRBs. This study tested sensory experiences using Recent research suggests heightened both questionnaires and physical tests of tactile sensitivity (aka sensitivity to touch plays a role in BFRBs. sensitivity to touch), in 46 subjects with skin-picking or hair pulling disorder and 46 healthy controls.
This study tested Subjects with a BFRB scored higher than controls on all the subscales of the sensory questionnaire, and the tactile tests demonstrated 46 people with sensitivity to touch with 46 people with people with BFRBs have a decreased tactile threshold, meaning they skin picking or are faster to detect when an object is touching them. questionnaires no BFRBs hair pulling and physical Future research should test hair pulling and skin picking separately tests. to see if there is a difference, and determine if BFRBs cause tactile sensitivity (or vice versa).
Subjects with a BFRB Future research should test scored higher on the hair-pulling and skin-picking separately, and determine if sensory questionnaire BFRBs cause tactile sensitivity (or vice versa). The tactile tests demonstrated people with BFRBs have a decreased tactile threshold, meaning Houghton, D.C., Tommerdahl, M., & Woods, they are faster to D.W. (2019, May). Increased Tactile Sensitivity detect when an object and Deficient Feed-Forward Inhibition in is touching them. Pathological Hair Pulling and Skin Picking. Poster presented at The TLC Foundation for BFRBs Annual Conference, 2019.
6 Nutrition in Skin Picking Disorder Nutrition in Skin Picking Disorder and Trichotillomania S. Valle, E. Cavic, & J.E. Grant and Trichotillomania Little research has explored the role of diet in the Although diet choice is implicated in the severity of other disorders, little research has explored the role of diet in severity of skin picking severity of skin picking disorder and trichotillomania. disorder (SPD) and hair pulling disorder (trichotillomania; TTM). Participants completed surveys on eating In this study, 32 adults with SPD, 37 with TTM, and 19 healthy control behaviors*, BFRB severity, and participants completed a survey for eating behavior (MEBS), scales to fat/sugar intake. assess hair pulling and skin picking severity, and a subset of the group completed the Dietary Questionnaire. 32 adults with 37 adults with skin picking trichotillomania No significant correlations were found between fat and sugar intake disorder and TTM and SPD severity. Higher scores on some subsets of the MEBS (binge eating, body dissatisfaction, weight preoccupation, compensatory behavior) correlated with higher scores on the nutrition No significant Higher scores for scale, but these were not significant relationships with symptom correlations were certain eating severity. found between behaviors* are fat/sugar intake and associated with sugar Although the study suggests no correlation between dietary choices trichotillomania and 19 healthy and fat intake, but not and TTM and SPD severity, future studies further examining the role skin picking disorder control of diet and BFRB severity may help guide treatment intervention within BFRB severity. participants the community. severity.
Although the study suggests no correlation between dietary choices and trichotillomania and skin picking disorder severity, future studies further examining the role of diet and BFRB severity may help guide treatment.
*binge eating, body dissatisfaction, weight preoccupation, compensatory behavior Valle, S., Cavic, E., & Grant, J.E. (2019, May). Nutrition in Skin Picking Disorder and Trichotillomania. Poster presented at 7 TLC Foundation for BFRBs Annual Conference, 2019. Uncharted Territories : 5 BFRB-Focused Topics In Need of Further Study Cross-Cultural Studies
In any given year, researchers from over 30 countries publish research on BFRBs. Some countries The yearly TLC Conference is truly a one-of-a-kind environment when it comes to commingling only publish one or two case reports, while a small minority (including Australia, Brazil, India, between producers and consumers of scientific research. In no other environment do providers and Iran, South Korea, and Turkey) publish a larger amount. This suggests not only that doctors in patients interact on such a personal level. Renowned researchers may be sitting at one’s breakfast these countries are generally becoming more aware of BFRBs, but also that there are groups table, parents can pose questions directly to expert clinicians during workshop sessions, and of specialized scientists all over the world that would willingly collaborate with groups in the US. students can talk shop with the scientists (if they have the courage). Results from the US, especially on clinical features and treatments of BFRBs, need to be validated in different countries in order to be considered more robust. Over the past few years, in our endeavor to keep a close watch on peer-reviewed journal articles about BFRBs, we noticed some remarkable trends, and also some areas that have, to date, been Studies in Minority Groups seriously neglected. On the whole, our conclusion from observing the empirical literature at a bird’s-eye view was that the current output of novel BFRB research is not proportional to Similarly, we just don’t know how easily existing research translates to the general population, the real-world prevalence of these disorders. That is to say, for the large number of people because these studies were oftentimes done with very homogeneous, un-representative samples. worldwide struggling with a BFRB, scientific advancements are not happening quickly enough to Groups like people of color, older adults, men, and LGBTQ folks may have different treatment keep up. The volume of new publications is small (averaging ~150 empirical journal articles in a needs, symptom profiles, or predispositions to BFRBs, so each group warrants further study in given year), driven mainly by a small group of dedicated scientists including The TLC Foundation’s order to confirm what we think we already know. Scientific Advisory Board, and the majority of publications do not use experimental methods (i.e., they do not test a new hypothesis). By comparison, thousands of articles may be published yearly Medically-Focused Studies about more common mental disorders, such as depression or OCD. About two-thirds of BFRB studies are conducted by psychologists or psychiatrists, but the other For this reason, we look forward to data readouts from the BFRB Precision Medicine Initiative one-third are carried out by other medical professionals, who may only peripherally interact with with excitement and impatience, but the need for research extends far beyond the BPM. So, for BFRB patients but still take interest. These physicians include dermatologists, dentists, surgeons, seasoned investigators and incipient scientists alike, here are a few humble suggestions about and more. An especially exciting sub-specialty is psychodermatology, because appearance is such what kinds of studies ought to be done to continue to advance BFRB research : a big part of the nature of BFRBs, and borrowing methods from dermatologists (like trichoscopy) would help physicians characterize BFRBs in a language that makes more sense to them.
Psychophysiological Studies
People sometimes forget that the human brain doesn’t act in a vacuum, but rather perpetually communicates and cooperates with other body systems. It may not be immediately apparent, but BFRB symptoms may intersect with the muskuloskeletal, immune, nervous, or endocrine systems. These are golden opportunities for study, since much of the work defining the nature of these relationships between systems has yet to be done. Since the body as a target of BFRBs is a central feature of these disorders (it’s even in the name), it’s time to stop thinking of their effects as isolated to the brain.
Studies on Lesser-Known BFRBs
It has been interesting to see what new behaviors become grouped under the BFRB umbrella in some of the more recent studies. Some of these include bruxism (teeth grinding), trichoteiromania (hair rubbing), and onychotillomania (picking at nails). Some of these behaviors are scientifically more worthy of the BFRB label than others, so there is a real need for the scientific community to declare once and for all which behaviors are BFRBs, and which are truly just benign “bad habits”.
9 10 Neurosis and True Dermatosis: Neurosis and True Dermatosis : a case of ossified A case of ossified pilomatricoma developing pilomatricoma developing within a self-inflicted ulcer A.L. Culver, A. Hernandez, & S.Y. Paek within a self-inflicted ulcer
Skin Picking Disorder (SPD) is complex in the sense that it has both physical and A 30-year-old woman who was previously psychological aspects. This case study aims to reiterate the importance of fully diagnosed with skin picking disorder (SPD) screening patients with SPD for other dermatological issues before proceeding went to a dermatologist for treatment of a with standard treatment. "spot" on her skin. A 30-year old woman presented at a dermatology clinic as a new patient for evaluation of a “spot” on her left cheek. Prior to coming into the dermatology clinic, the patient had been prescribed multiple medications with little to no success. For 18 years the patient suffered from Upon further physical examination, it was determined that the spot was an ulcer 3cm in length, with a central subcutaneous (i.e., located under the skin) nodule. a lesion that was assumed to be The care provider inquired about the disrupted location on the skin; the patient related to her SPD. In fact, the lesion said that she had the lesion for 18 years, and that she picked at it because she felt a bump under the skin which drove her to constantly pick at it, opening the was a benign tumor. wound and causing drainage of pus. The subcutaneous nodule is suspected to be a calcified cyst, resulting from the chronic trauma of SPD-based picking in the area. Histopathology testing of the suspected cyst revealed that it was actually a The non-cancerous tumor required pilomatricoma with partial ossification: a non-cancerous skin tumor associated with extraction. hair follicles. In conclusion, the patient, who has been diagnosed with SPD, had been living with an actual tumor underneath the skin, resulting in picking episodes in the area for 18 years. This case is a perfect example for showing the necessity of doing It is important that medical a full examination on new dermatology patients, even if they have already been diagnosed with SPD. Skin Picking Disorder does not eliminate the possibility providers always investigate new of the presence of other dermatological issues, and earlier treatment of the medical issues or presentations, pilomatricoma could have assisted in managing the skin picking episodes over the length of time it went untreated. and thoroughly examine new patients, despite any previous diagnosis.
Culver, A. L., Hernandez, A., & Paek, S. Y. (2019). Neurosis and true dermatosis: a case of ossified pilomatricoma developing within a self-inflicted ulcer. Dermatology online journal, 25(2). 12 Emotion Regulation in Trichotillomania Emotion Regulation in Trichotillomania (Hair Pulling (hair pulling disorder): Disorder) : The role of stress and trauma S. Demetriou The role of stress and trauma
Prior to this research, the relationship between Previous literature has explained hair pulling as an attempt to regulate emotions, putting forth the so-called ‘emotion regulation model’. Other studies have shown stress, childhood trauma, and emotion evidence for significantly greater severity of childhood trauma in people with regulation was unclear. TTM compared to healthy controls. However, the relationship between childhood trauma, stress, and emotion regulation in TTM remains unclear. To explore this, There were three aims in this study: to compare the rates of these three factors in TTM compared to healthy controls; to investigate if there is a relationship between 56 36 hair pulling severity and difficulties in emotion regulation; and to determine adults with whether or not there is a relationship between stress, childhood trauma, and matched control emotion regulation difficulties in TTM, while controlling for coexisting mood and trichotillomania participants anxiety disorders. completed questionnaires assessing perceived The participants were 56 adults with TTM and 31 sex- and age-matched controls, stress, childhood trauma, and difficulties in all of whom were recruited from a previous ongoing study. All participants emotion regulation. completed several questionnaires that assessed levels of perceived stress, childhood trauma, and difficulties in emotion regulation. TTM participants They found that all three factors completed a questionnaire assessing severity of hair pulling disorder. were significantly increased in The study showed that stress, childhood trauma, and difficulties in emotion trichotillomania patients regulation were all significantly increased in TTM patients compared to the controls, but there was no statistically significant relationship between hair but there was no statistically significant pulling severity and difficulties in emotion regulation, which does not support the predictions of the emotion regulation model. This study showed that rather than relationship between trichotillomania and increased pulling, stress in individuals with TTM significantly explained difficulties difficulties in emotion regulation, which does in emotion regulation. not support the emotion regulation model. The study overall suggests that the emotion regulation model may not be best in explaining the phenomenon of trichotillomania, although more studies need to The study concludes that this model may not be be conducted. Some limitations to this study included difficulty in controlling for the presence of coexisting disorders, which is needed to address the third aim. sufficient in describing pathological hair pulling, Another limiting factor was the collection of data across different time points, which although more studies need to be conducted. could have caused decreased validity. Lastly, the use of self-report measures may have increased response bias in participants. Demetriou, S. (2019). Emotion regulation in Trichotillomania (hair-pulling disorder): The role of stress and trauma. Master’s 13 thesis, Stellenbosch University Identifying Standardized Definitions of Treatment Response in Trichotillomania: Identifying Standard Definitions of Treatment Response in Trichotillomania : A Meta-analysis A meta-analysis L.C. Farhat, E. Olfson, F. Li, S. Telang, & M.H. Bloch
The two most common hair-pulling surveys, the Two of the most frequently-used surveys in trichotillomania research are the MGHHPS* and NIMHTSS**, don’t currently have a Massachusetts General Hospital Hair Pulling Scale (MGHHPS) and the National standard score separating patients who benefited from Institute of Mental Health Trichotillomania Severity Scale (NIMHTSS). However, a treatment from those who didn’t. there is no standard cutoff score that separates patients who benefited from a treatment from those who didn’t with either of these scales, and most research uses being “pull-free” as the only indicator of recovery, an idea which is becoming This study analyzed 7 trichotillomania studies 270 less popular. The aim of this study was to look at the combined effect of several to find these standard cutoff scores. trichotillomania trials to define the best standard numbers for treatment response Total (aka ‘treatment response cutoff scores’) using the MGHHPS and NIMHTSS. The best MGHHPS treatment response cutoff Patients Only clinical trials of trichotillomania with at least 20 participants using either or score was 7 points lower (35%). both surveys were included - this totaled seven studies with 270 total participants. Four of the studies were psychotherapy trials and three were drug trials; four studies were done in adults, and three in children or adolescents. In these seven The best NIMHTSS treatment response cutoff studies, the analysis looked at both percentage changes and raw score (i.e., number of points) changes of trichotillomania severity as reflected in the surveys. score was 6 points lower (50%). For the MGHHPS, if someone scored 7 points lower at the end of a treatment than they did at the beginning (or scored 35% lower), that signifies that the treatment 4 3 4 3 worked. For the NIMHTSS, if someone scored 6 points lower at the end of a studies in studies used studies used studies in treatment than they did at the beginning (or scored 50% lower), that also means adults medications therapy children & the person responded to treatment. The NIMHTSS had slightly better accuracy at predicting treatment response than the MGHHPS, likely because the NIMHTSS is adolescents a clinician interview as opposed to a self-report survey.
Having standard numbers for treatment responders The main limitations are that they did not also study skin picking (because there will make it easier to consistently judge whether were not enough studies to analyze), and that the studies they did evaluate for accuracy used different criteria for the same two surveys, but the second limitation treatments work for trichotillomania patients. was taken care of by asking for individual data from the authors of the original studies. The results of this study were consistent with treatment response cutoffs *MGHHPS : Massachusetts General Hospital Hair-Pulling Scale identified in other studies, and they can be used moving forward as standardized **NIMHTSS : National Institute of Mental Health Trichotillomania Severity Scale benchmarks against which to judge how effective a treatment is for hair pulling. Farhat, L. C., Olfson, E., Li, F., Telang, S., & Bloch, M. H. (2019). Identifying standardized definitions of treatment response in trichotillomania: A meta-analysis. Progress in Neuro- Psychopharmacology and Biological Psychiatry, 89, 446-455. 16 By the Numbers : 3 Years of BFRB Research At-A-Glance Most-Frequently Published BFRB Authors By Geography
Emily Ricketts, John Piacentini 241 246 University of California, Los Angeles Mike Levin, Mike Twohig Utah State University 157 102 165 David Houghton University of Texas Medical Branch Galveston 59 Sarah Redden Florida State University 88 76 43 Jon Grant University of Chicago
Doug Woods, Jennifer Alexander 2017 2018 2019 Marquette University # Total Publications Mohammad Jafferany, Arsh Patel Central Michigan University experimental; non-experimental (case reports, reviews, etc.) Kieron O’Connor, Marc Lavoie University of Montreal
Aditya Gupta Uiversity of Toronto
Madhulika Gupta University of Western Ontario
Nancy Keuthen 12 18 20 Massachusetts General Hospital Ivar Snorrason McLean Hospital
Emily Olfson, Michael Bloch 2017 2018 2019 Yale School of Medicine
Eric Lee # Publications with TLC SAB Member as Author Hartford Hospital
Spencer Chamberlain University of Cambridge (UK) Children Joyce Maas (age 0-10) Tilburg University (Netherlands) 6.9% Brian Odlaug Adolescents University of Copenhagen (Denmark) (age 11-17) Christina Gallinat, Markus Moessner, Holger Haenssle, Julia Winkler, Matthias Backens, Stephanie Bauer University Hospital Heidelberg (Germany) College-age Anne Schienle (age 18-22) University of Graz (Austria)
Tayfun Kara, Ismail Akaltun Adults Sadi Konuk Hospital (Turkey) (age 23-50) Deniz Cildir Tepecik Hospital (Turkey) Older adults Cicek Hocaoglu Recep Tayyip Erdogan Hospital (Turkey) (age 51-99) Christine Lochner Stellenbosch University (South Africa)
Renata Slikboer, Maja Nedeljkovic, Imogen Rehm Participant Age Groups in Experimental Studies Swinburne University of Technology (Australia) 17 18 Prevalence and Clinical Characteristics Prevalence and Clinical Characteristics of Skin Picking of Skin Picking Among Adults with among Adults with Skin Disease Symptoms L.J. Dixon & I. Snorrason Skin Disease Symptoms. Researchers collected information from 237 Many studies have been done on Skin Picking Disorder (SPD) & dermatology participants between the age of 20-67 years old to patients, respectively, but few studies have examined the direct correlation learn more about the association between skin picking between SPD and dermatological conditions. The three main goals of this study disorder (SPD), dermatological conditions (eczema, were to: estimate the prevalence of skin picking urges and behaviors among hives, psoriasis, etc.) and psychosocial characteristics. those with self-reported skin diseases, examine the relationship between SPD and dermatological conditions, and examine the correlation between SPD severity and psychosocial characteristics. Based on previous studies, researchers The study found that although hypothesized that SPD would be more common in women, and that those in the SPD group would report other psychiatric symptoms at a higher rate. there was an association between SPD and other depression / For this study, data was collected from participants via online survey. After a psychosocial characteristics... SPD preliminary filtering of participants, researchers were left with a test group of 237 anxiety people, separated into two groups. The first group consisted of 107 participants who were identified as having some form of SPD. The second group consisted of 130 participants who did not have SPD. The final sample consisted of people ...there was a lack of difference between the ages of 20 and 67 years old. Of the 237 participants, 67.9% identified between participants of as female. 1-12 different dermatological conditions were acknowledged per differing sexes. participant, and acne was the most commonly reported condition.
The data collected appear to show that people with SPD report skin conditions 1-12 different skin conditions at an elevated frequency, in comparison to those without SPD. Within the SPD were acknowledged per person group of 107, 52 of these participants displayed symptoms that met the criteria for pathological skin picking. Results show that although more women reported (acne was the most common) having SPD, there was not a significant sex difference in SPD prevalence. Those with SPD also reported a larger number of dermatological conditions Validating the association between SPD (eczema, hives, psoriasis, etc.), and increased symptom severity. Skin picking severity was also positively associated with depression, anxiety, stress and social and dermatological conditions highlights anxiety symptoms, confirming the association between SPD and psychosocial the necessity to make SPD resources characteristics. In conclusion, this study reveals a relationship between SPD and readily available to those seeking treatment dermatological symptoms, as well as psychosocial conditions such as depression for other dermatological conditions. and anxiety. This study is the first to specifically examine these associations. Test results may have been affected by a lack of a sizably diverse pool of participants, and follow-up studies are necessary to determine if the identified trends stand true Dixon, L. J., & Snorrason, Í. (2019). Prevalence and clinical among all social groups. characteristics of skin picking among adults with skin disease symptoms. Journal of Obsessive-Compulsive and Related 19 Disorders, 100454. A brief, residential peer‐support retreat for trichotillomania: A A Brief, Residential Peer-Support Retreat for Trichotillomania: A mixed methods evaluation mixed methods evaluation. R. Slikboer, I.C. Rehn, S.Lam, A. Maloney, & M. Nedeljkovic
Cognitive-Behavioral Cognitive-behavioral therapy (CBT) can be effective for treating trichotillomania, but it fails up to 50% of the time. Group-oriented therapy has similar relapse rates Therapy (CBT) leads to as CBT, but offers some therapeutic benefits that CBT doesn’t have, and many relapse up to 50% of the 8 women trichotillomania patients consider it effective. The purpose of this study was to participated in a 3 observe a brief residential peer support retreat for trichotillomania, and identify time, so researchers are day intensive retreat which factors the patients considered most important for recovery. looking into less-traditional in rural Australia. The retreat was three days long, low-cost, and took place in rural Australia. treatments to complement Activities during the retreat included group workshops discussing trichotillomania it, like group peer support management, self-care activities (e.g., pampering, yoga), and free leisure time. Eight women with trichotillomania took part in the retreat, and were interviewed retreats. before the retreat, as well as 1 week, 6 months, and 12 months after the retreat. Although the analysis was mainly qualitative, patients also filled out questionnaires There were no long-term improvements in hair-pulling, but for hair pulling severity, depression, anxiety, stress, and quality of life. improvements in depression, anxiety, and stress lasted a full year. Hair pulling was reduced immediately after the retreat, but worsened to pre- retreat levels by 6 months. Quality of life also did not seem to improve long- Most effective group term. However, lower levels of anxiety, depression, and stress persisted to one Most effective factors: sharing lived year post-retreat. Factors from the retreat that patients considered important individual factors: to recovery on an individual level included : readiness to change (e.g., taking experiences, connecting responsibility for their own recovery and feeling hope that recovery was possible) readiness to change with others in the and self-regulation (e.g., developing emotional awareness and practicing self- + self-regulation community, care). Important factors to recovery on a group level included : sharing lived normalizing hair-pulling, experiences, connecting with others in the community, normalizing hair pulling, and promoting feelings of safety and motivation. These feelings of social promoting feelings of acceptance and belonging persisted even 1 year after the retreat. safety + motivation Limitations of the study include the bias in memory that could occur from surveying The main benefits of group peer support retreats are increased patients long after the end of the retreat, and the fact that the sample was small psychosocial recovery and increased acceptance/belonging. and only made up of highly-motivated patients who voluntary signed up for the which can enhance traditional forms of therapy like CBT. retreat. In spite of these limitations, this study provided evidence of the therapeutic benefit of intensive small-group retreats. The benefit is not in hair pulling reduction, but rather in increasing hope, acceptance, and quality of life. As such, these Slikboer, R., Rehm, I. C., Lam, S., Maloney, A., & Nedeljkovic, M. retreats are not meant to take the place of traditional therapy like CBT, but can A brief, residential peer‐support retreat for trichotillomania: A enhance it. mixed methods evaluation. Australian Psychologist. 22 White matter volume alterations White Matter Volume Alterations in Hair Pulling Disorder in hair pulling disorder (Trichotillomania) A. Uhlmann, A. Dias, L. Taljaard, D.J. Stein, S.J. Brooks, & C. Lochner (trichotillomania)
Researchers in South Africa performed whole Neuroimaging studies of individuals with trichotillomania (TTM) are scarce, but evidence from such studies so far suggests that dysfunction in circuits known brain scans to assess grey vs. white matter volume to mediate cognitive, behavioral, and motor functions (circuits from the frontal in 29 people with TTM and 28 healthy controls lobe to the striatum, limbic system, and cerebellum) may be partly responsible. Imaging studies investigating the volume of grey matter (neuronal cell bodies) They found that TTM individuals had larger white matter have produced conflicting evidence, and those looking at white matter (tissue that volumes in the parahippocampal gyrus (important for memory) sends information back and forth between areas of grey matter) are generally and cerebellum (important for motor function) and less volume understudied. To contribute to the growing body of neuroimaging studies on TTM in the postcentral gyrus (helps process sensory info), compared patients, these researchers investigated differences in grey and white matter to controls. volumes between individuals with TTM and healthy controls. neuron postcentral gyrus The study consisted of 29 adults with a primary diagnosis of TTM and 28 healthy control adults. All the participants underwent a whole-brain scan at imaging centers in Cape Town, South Africa. The researchers then measured and analyzed grey and white matter volumes. white matter Only one individual in the study was male, while the rest of the participants were female. TTM participants exhibited larger white matter volumes in the parahippocampal gyrus (important for memory encoding and retrieval) and the cerebellum (important for motor function), and less volume in the postcentral temporal gyrus (helps process sensory information), relative to the control participants. lobe No statistically significant differences were found between the two groups in terms of grey matter volumes. Significant associations between larger white parahippocampal matter volumes in the temporal lobe and cerebellum were found, as well as fewer gyrus cerebellum attempts to resist hair pulling.
Although illuminating, the design of this study allowed researchers to draw No significant differences were found between the associations between white/grey matter and hair pulling behaviors, but no causal two groups for grey matter volume, but they saw an conclusions. The authors also note that some abnormalities in brain structure association between larger white matter volumes in may be related to other comorbid disorders in the TTM participants. Overall, the temporal lobe and cerebellum and fewer attempts the aberrations found in the brain regions in this study suggest abnormalities in to resist hair pulling. higher-order association and cognitive function in individuals with TTM. More brain imaging studies in TTM will help shed light on the mechanisms underlying the disorder, which may eventually lead to better treatments. Uhlmann A, Dias A, Taljaard L, Stein DJ, Brooks SJ, Lochner C. White matter volume alterations in hair-pulling 23 disorder (trichotillomania). Brain Imaging Behav. 2019. SciLit Wants YOU !!!
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25 26 Trichotillomania is more related to Tourette disorder than to Obsessive-Compulsive Disorder Trichotillomania is More Related to Tourette’s Disorder Than to Obsessive-Compulsive Disorder H. Lamothe, J-M Baleyte, L. Mallet, & A. Pelissolo
Classification of trichotillomania (TTM) has changed over time as our Trichotillomania understanding of the condition increases, thanks to ongoing scientific research in this area. In this review, the authors question the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). The authors aimed to answer this specific research question: “Could TTM be considered a tic disorder rather than an OCD related disorder?” Phenomenology Often Pharmacological co-existing Researchers established five axes of relevance to give their review of currently- treatments published data specific parameters: phenomenological investigation of urges (what the disorders look like), comorbidities (other symptoms that are also present), neuropsychology (cognition & behavior), imaging (structure of the brain), and pharmacology (medicinal treatments). Once the axes of relevance were established and the search was completed, it yielded 143 studies, relatively evenly split among the 5 axes. Tic-Related Genetics Obsessive- Neurobiology Compulsive In regards to phenomenological investigation of urges, the relevant papers Disorders seem to suggest that there is a significant difference between TTM and OCD, but not between TTM and tic disorders. When a closer look was taken at Disorder comorbidities, it appears that OCD and TTM are frequently comorbid. A deep dive on neuropsychology papers related to TTM, OCD and tic disorders came up with no significant findings relating these three disorders together. Upon reviewing the studies related to neurobiology, there is a significant genetic correlation between Maybe! OCD and Tourette’s Syndrome (TS). For the treatment axis, antipsychotics seem effective for both TS and TTM, while some studies found questionable results Given some shared phenomenology and pharmacological using serotonin reuptake inhibitors (SSRIs). However, the reviewed studies treatment traits, it's possible that TTM may have a greater indicate that SSRIs are seemingly effective for treating OCD, so the overall results are mixed. relationship with tic disorders than is currently understood. When evaluating treatment, clinicians may want to evaluate Upon completion of their review, the authors concluded that significant data exists treatments for tic related disorders as well as OCD-related suggesting not only a relationship between TTM and OCD, but also a strong traits. More research is needed! relationship between TTM and tic-related disorders. This suggests that it may be of value to those seeking treatment for TTM to not only try treatments developed Lamothe H, Baleyte J-M, Mallet L, Pelissolo A. Trichotillomania is for OCD, but also those for tic-related disorders. More research is needed on the more related to Tourette disorder than to obsessive-compulsive application of tic-related disorder treatment methods to treat TTM. disorder. Brazilian Journal of Psychiatry. 2019. 28 Comorbidity in Trichotillomania: Comorbidity in Trichotillomania (Hair Pulling Disorder) : A cluster analytical approach A cluster analytical approach. C. Lochner, N.J. Keuthen, E.E. Curley, E.S. Tung, S.A. Redden, E.J. Ricketts, & D.J. Stein Comorbidity Subtypes One of the ways to promote a precision medicine approach is to identify subtypes of patients with key features in common. For trichotillomania (TTM), some of the subtypes proposed to date have been age of onset, oral behaviors, self-injury, personality traits, or the well-known focused/automatic subtypes. It is difficult to say which of these are meaningful to treatment, but another way to subtype TTM is comorbidity, meaning other disorders someone may have besides TTM. The aim of this study was to explore possible TTM subtypes based on comorbidity profiles. SIMPLE DEPRESSIVE COMPLEX
The study tested 304 adults in the USA and South Africa who were enrolled in a separate study on genetics. A cluster analysis was done on lifetime comorbidity data for fourteen disorders, including different anxiety disorders, depressive trich disorders, and OCD Spectrum disorders. just trich! trich + + There were three distinct clusters. The first was “simple TTM,” which consisted depression other: of the patients without any comorbidities. The second cluster was “depressive depression TTM,” which consisted of the patients that also had depression (but nothing 16% OCD else). The third cluster was “complex TTM,” which consisted of the patients with skin picking other combinations of comorbidities. This also included depression, since 62% of 20% people in the complex TTM group had depression, among other things. The other etc most common disorders in the complex TTM cluster were OCD (36%) and skin- picking (24%). There was a relationship between symptom severity and number of comorbidities; patients with more comorbidities tended to have more severe Comorbidity = other disorders 63% hair-pulling symptoms, as well as more severe depression. someone might have besides TTM
This study demonstrates that TTM is not always a sign of another, more severe Trich is not always caused by something else! disorder, since one-fifth of TTM patients don’t suffer from other disorders. It also shows how large the overlap is between depression and TTM (over half of the TTM patients were also depressed) – there is no conclusive research about if Trich and depression influence each other one causes the other, but they can certainly influence each other. Finally, it raises questions about how treatment can change by taking comorbidities into account. Treatment can be more effective when The study is limited by not having treatment data for all the subjects and not considering comorbidities having enough participants to test more disorders, but by successfully breaking Lochner, C., Keuthen, N. J., Curley, E. E., Tung, E., S., Redden, S. TTM down into subtypes, this study has laid important groundwork for more A., Ricketts, E. J., ... & Stein, D. J. (2019). Comorbidity in tailored TTM treatment. trichotillomania (hair‐pulling disorder): A cluster analytical 29 approach. Brain and behavior, 9(12). Family Functioning in Pediatric Trichotillomania, Obsessive Compulsive Family Functioning in Pediatric Trichotillomania, Obsessive- Compulsive Disorder, & Healthy Comparison Youth Disorder, and T.S. Peris, M. Rozenman, A. Gonzalez, A. Vreeland, J. Piacentini, P. Tan, & E.J. Ricketts Healthy Comparison Youth Although several studies document impaired family functioning in pediatric OCD, DOMAINS OF FAMILY FUNCTION few have investigated this aspect in pediatric trichotillomania (TTM). Such studies might be useful for improving TTM treatment, as the OCD research has produced interventions that directly target familial dysfunction to improve patient outcomes. This study sought to improve upon past research, to understand how family functioning in TTM and OCD might have implications for treatment development.
In the study, 30 children and adolescents with TTM, 30 with OCD, and 30 healthy controls completed several interview-based questionnaires and self-assessments COHESION CONFLICT related to anxiety, OCD, and TTM severity, as well as assessment of family environment and parenting behavior. Notably, 44% of the full sample self-identified as racial/ethnic minorities. The researchers compared TTM with OCD and healthy control youth on the measures of family environment and perceptions of parenting behavior.
Parents of OCD and control groups reported more cohesion amongst family members than did TTM youths, and OCD parents reported that their families expressed emotions better than parents of the children with TTM did. The healthy EXPRESSIVENESS ORGANIZATION control individuals self-reported significantly higher cohesion and organization within their families, and lower conflict than the TTM and OCD groups. The KEY FINDINGS: controls reported higher expressiveness of family members than the TTM youth, as well. There were no significant differences in youth- or parent-reported perceptions of parenting behavior.
Overall, the study supports the hypothesis that family functioning is more impaired in TTM and OCD youth compared to healthy controls, particularly in the domains of conflict, cohesion, expressiveness and organization. Family functioning may be somewhat worse in the TTM versus OCD group in terms of cohesion, but not GREATER TTM FAMILIES NO LINK TO conflict. However, there was little evidence for links between severity of TTM IMPAIRMENT IN LESS SYMPTOM and degree of family impairment, nor between TTM and parenting behavior. The TTM FAMILIES EXPRESSIVE SEVERITY study highlights the importance of family expressiveness and cohesion in youth TTM, and further investigation into family functioning in pediatric TTM groups may ultimately help differentiate treatment options for families. Some limitations Peris, T. S., Rozenman, M., Gonzalez, A., Vreeland, A., Piacentini, of the study include a small sample size, recruitment only from a university-based J., Tan, P., & Ricketts, E. (2019). Family Functioning in Pediatric specialty treatment program, and the inability to determine direction of effects Trichotillomania, Obsessive Compulsive Disorder, and Young Adult Action Council between TTM and family functioning based on study design. 32 Healthy Comparison Youth. Psychiatry Research, 112578.