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Reid M, Lin A, Farhat LC, Fernandez TV, Olfson E. The genetics of trichotillomania and excoriation disorder: A systematic review. Compr Psychiatry 2024; 133:152506. [PMID: 38833896 DOI: 10.1016/j.comppsych.2024.152506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Trichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. AIM In this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. METHOD We systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. RESULTS Of the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. CONCLUSIONS Our review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.
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Affiliation(s)
- Madison Reid
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; The University of the South, USA
| | - Ashley Lin
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Olfson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Csigó K, Münnich Á, Molnár J. The importance of examining early maladaptive schemas in the diagnosis and treatment of obsessive-compulsive disorder. Front Psychiatry 2024; 15:1360127. [PMID: 38800063 PMCID: PMC11116796 DOI: 10.3389/fpsyt.2024.1360127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas. Methods 112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ). Results We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the numberof the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas. Discussion The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.
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Affiliation(s)
- Katalin Csigó
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary
- Psychotherapy Center, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Ákos Münnich
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Molnár
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Alonazi SD, AlHnake AW, Alahmari FS, Abahussain E, Alkahtani AH, Alharbi KA, Alasiri A. Prevalence and Factors Influencing Trichotillomania Among Healthcare Workers and Students in Saudi Arabia: A Cross-Sectional Analytical Study. Cureus 2023; 15:e51128. [PMID: 38149061 PMCID: PMC10750989 DOI: 10.7759/cureus.51128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Trichotillomania (TTM) is a psychiatric disorder characterized by repetitive pulling out of one's own hair, in which the scalp, brows, and eyelids are the most common sites. This study aimed to measure the prevalence of TTM among healthcare workers and students and to determine its association with psychiatric disorders. METHODOLOGY This cross-sectional study was conducted among healthcare workers and students in Saudi Arabia. Data were collected through an online self-administered questionnaire. The questionnaire consisted of sociodemographic characteristics, the Massachusetts General Hospital (MGH) Hairpulling Scale to measure TTM, and the Depression and Anxiety Stress Scale (DASS-21) to measure the psychiatric disorders of the participants. A convenience sampling technique was implemented. The sample size was calculated to be 385. RESULTS Of the total 460 participants, 62% (n = 285) were students, 55% were females and 61.7% (n = 284) were aged between 18 and 24 years. The most commonly associated chronic disease was diabetes (n = 34, 7.4%), followed by asthma (n = 30, 6.5%). The prevalence of TTM was 4.8% (n = 22), which was higher among medical students (n = 15, 5.3%) as compared to medical workers (n = 7, 4%). While taking psychiatric medication (AOR = 0.197; 95% CI = 0.076-0.508 p = 0.001) was identified as the protective factor for TTM, previous diagnoses of psychiatric illness (AOR = 4.298; 95% CI = 1.759-10.499; p = 0.001), stress (AOR = 4.759; 95% CI = 1.541-14.695; p = 0.007), and depression (AOR = 3.149; 95% CI = 1.190-8.334; p = 0.021) were recognized as independent risk factors of TTM. CONCLUSION Trichotillomania was less common among health workers and students in Saudi Arabia. However, if trichotillomania is present, the disorder was found to be more common among those with associated psychiatric illnesses, including those who were anxious and depressed. Hence, further research is required to validate the impact of psychiatric conditions on the prevalence of TTM in the study region.
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Affiliation(s)
- Sadeem D Alonazi
- Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Alanoud W AlHnake
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Faisal S Alahmari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Eman Abahussain
- Neuroscience, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Khalid A Alharbi
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Ahmed Alasiri
- Psychiatry, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Snorrason I, Kuckertz JM, Swisher VS, Pendo K, Rissman AJ, Ricketts EJ. Hair pulling disorder and skin picking disorder have relatively limited associations with negative emotionality: A meta-analytic comparison across obsessive-compulsive and related disorders. J Anxiety Disord 2023; 98:102743. [PMID: 37499420 DOI: 10.1016/j.janxdis.2023.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
The obsessive-compulsive and related disorders (OCRD) chapter in DSM-5 includes two relatively distinct groups of disorders: (1) Compulsive disorders [i.e., obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD)] and (2) grooming disorders [i.e., skin picking disorder (SPD) and hair pulling disorder (HPD)]. The two groups may relate differently with negative emotionality; however, the literature has produced mixed findings. The current study sought to quantify the concurrent association between negative emotionality and each of the five OCRDs. We conducted systematic reviews of research reporting correlations between (1) negative emotionality (i.e., depression, anxiety, stress, negative affect, and neuroticism) and (2) severity of OCRD symptoms in both clinical and non-clinical adult samples. We used three-level meta-analytic models to estimate the size of the correlations. Negative emotionality had robust positive correlation with symptoms of OCD [k = 156, r = 0.44, 95% CI= 0.43-0.46], BDD [k = 58, r = 0.45, 95% CI= 0.43-48], and HD [k = 67, r = 0.39, 95% CI= 0.36-0.42] but significantly smaller correlation with SPD [k = 31, r = 0.31, 95% CI= 0.27-0.34] and HPD [k = 24, r = 0.28, 95% CI= 0.25-0.32]. Overall, the results indicate that grooming disorders have relatively limited associations with negative emotionality. Implications for classification of OCRDs within the broader taxonomy of psychopathology are discussed.
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Affiliation(s)
- Ivar Snorrason
- Center for OCD & Related Disorders (CORD), Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
| | - Jennie M Kuckertz
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; OCD Institute, McLean Hospital, Belmont, MA, United States
| | - Valerie S Swisher
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Kevin Pendo
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Ariel J Rissman
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Emily J Ricketts
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States
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Dostal AL, Pilkington PD. Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2023; 336:42-51. [PMID: 37217101 DOI: 10.1016/j.jad.2023.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a condition with poor treatment outcomes. Improved understanding of the aetiology can inform prevention and treatment approaches; hence several studies have assessed early maladaptive schemas (EMSs) in OCD. This systematic review and meta-analysis aimed to synthesise the evidence on relationships between the 18 EMSs and OCD. METHODS The study was conducted according to PRISMA guidelines and registered on PROSPERO (CRD42022329337). A systematic search of PubMed, PsycINFO, and CINAHL Complete was conducted on 4 June 2022. Studies in peer-reviewed journal articles were included if they assessed EMSs and OCD (diagnosis or symptom severity) in adults with a mean age of 18 years or older. Studies were excluded if they were not in English, did not include original quantitative data, or reported on case studies. Study details were tabulated and the meta-analysis findings were presented using forest plots. Methodological quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). RESULTS Based on 22 studies (pooled N = 3699), all 18 EMSs were positively correlated with OCD. The largest associations were with the dependence/incompetence (r = 0.40 95 % CI [0.32, 0.47]), vulnerability to harm or illness (r = 0.40 95 % CI [0.32, 0.48]), and negativity/pessimism schemas (r = 0.42 95 % CI [0.22, 0.58]). LIMITATIONS Several meta-analyses showed considerable heterogeneity and publication bias. CONCLUSIONS The findings suggest all EMSs, particularly those relating to disproportionate negative expectations and a perceived inability to cope, are implicated in OCD. Psychological prevention and treatment for OCD may benefit from targeting these schemas.
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Affiliation(s)
- Amy L Dostal
- School of Behavioural and Health Sciences, Australian Catholic University, Australia.
| | - Pamela D Pilkington
- School of Behavioural and Health Sciences, Australian Catholic University, Australia
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Farhat LC, Reid M, Bloch MH, Olfson E. Prevalence and gender distribution of excoriation (skin-picking) disorder: A systematic review and meta-analysis. J Psychiatr Res 2023; 161:412-418. [PMID: 37023597 PMCID: PMC11137851 DOI: 10.1016/j.jpsychires.2023.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
Epidemiological studies of excoriation disorder have reported different prevalence estimates for this condition, limiting our understanding of its public health impact. We performed a systematic review and meta-analysis to collate epidemiological studies of excoriation disorder. We aimed to estimate the pooled prevalence and the female-to-male ratio of excoriation disorder in the general population. We searched Embase, PsycInfo, and PubMed up to May 2020 and updated the PubMed search in October 2021. Studies which reported the frequency of excoriation disorder in a sample from the general population were included in our meta-analyses. We made no restrictions regarding the definition or assessment of excoriation disorder. Data were pooled through random-effects meta-analyses. Of the 677 records identified through database searches, 19 studies involving 38,038 participants met our inclusion criteria. Meta-analyses demonstrated that excoriation disorder has an overall prevalence of 3.45% (95% CI 2.55, 4.65%) and impacts women more than men (female-to-male OR = 1.45; 95% CI 1.15, 1.81, p = 0.001). These findings underscore the public health impact of excoriation disorder, which will hopefully motivate future research focused on advancing our understanding and management of this condition.
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Affiliation(s)
- Luis C Farhat
- Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Madison Reid
- Child Study Center, Yale University, New Haven, CT, USA
| | - Michael H Bloch
- Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Emily Olfson
- Child Study Center, Yale University, New Haven, CT, USA.
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Grant JE, Valle S, Aslan I, Chesivoir EK, Chamberlain SR. Temperament in trichotillomania and skin picking disorder. Ann Clin Psychiatry 2023; 35:87-92. [PMID: 37074974 PMCID: PMC7614459 DOI: 10.12788/acp.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Trichotillomania (TTM) and skin picking disorder (SPD) result in significant psychosocial burden. Despite this burden, however, risk factors related to the development of these disorders remain unclear. The present study assessed temperament in a well-characterized sample of adults with TTM or SPD. METHODS A total of 202 adults age 18 to 65 were enrolled; 44 had TTM, 30 had SPD, and 128 served as controls. Participants completed the self-report Tridimensional Personality Questionnaire (TPQ) to examine the severity of TTM and SPD symptoms, quality of life, and temperament. Group differences were characterized and correlations with other measures were examined. RESULTS Compared to controls, those with TTM or SPD scored significantly higher on harm avoidance and its subscales, with TTM associated with higher scores than SPD. Those with TTM or SPD scored significantly higher on only 1 measure of novelty seeking (extravagance). Higher TPQ harm avoidance correlated with worse hair pulling severity and worse quality of life. CONCLUSIONS The temperament traits of participants with TTM or SPD differed in significant ways from controls; those with TTM or SPD generally demonstrated similar trait profiles. A dimensional approach to the personalities of those with TTM or SPD may offer insight and provide clues to treatment strategies.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Stephanie Valle
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ibrahim Aslan
- Department of Psychiatry, Southampton University, Southampton, UK
| | - Eve K Chesivoir
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Turk T, Liu C, Fujiwara E, Straube S, Hagtvedt R, Dennett L, Abba-Aji A, Dytoc M. Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials. J Cutan Med Surg 2023; 27:140-149. [PMID: 36802832 PMCID: PMC10068402 DOI: 10.1177/12034754231155888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). METHODS The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. RESULTS Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. CONCLUSION Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future.
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Affiliation(s)
- Tarek Turk
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - Chaocheng Liu
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Esther Fujiwara
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- 12357 Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- 12357 ABA, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- 67111 Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Adam Abba-Aji
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Marlene Dytoc
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada
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Öğüt Ç, Öğüt ND. Trichotillomania, Skin Picking Disorder, and Different Aspects of Impulsivity: A Systematic Review. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20221220-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Thomson HA, Farhat LC, Olfson E, Levine JLS, Bloch MH. Prevalence and gender distribution of trichotillomania: A systematic review and meta-analysis. J Psychiatr Res 2022; 153:73-81. [PMID: 35802953 DOI: 10.1016/j.jpsychires.2022.06.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
Epidemiological studies have provided varying prevalence estimates of trichotillomania (TTM) and other hair-pulling behaviors. We performed a systematic review and meta-analysis to provide data-driven prevalence estimates of TTM and hair-pulling. PubMed, PsycInfo and Embase were searched on June 2020 (updated in November 2021). Studies reporting the frequency of TTM defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria or hair-pulling behaviors were included. Prevalence data was extracted for both genders, and female-to-male odds ratios (OR) were computed for TTM and any hair-pulling behaviors. Data were pooled through random-effects meta-analyses. Of the 713 records identified through database searches, 30 studies involving 38,526 participants were included. Meta-analyses indicated TTM had a prevalence of 1.14% (95% CI 0.66%, 1.96%), while any hair-pulling behavior had a prevalence of 8.84% (95% CI 6.33%, 12.20%). Meta-analyses demonstrated females were at an increased risk of any hair-pulling when noticeable hair loss was required (OR = 2.23, 95% CI 1.60, 3.10, p < 0.0001), but not of any hair-pulling when noticeable hair loss was not required (OR = 0.90, 95% CI 0.72, 1.64, p = 0.33). Meta-analyses did not indicate female preponderance in TTM (k = 10; N = 22,775; OR = 1.29; 95% CI 0.91, 1.83; I2 = 28%, p = 0.15), although there was considerable heterogeneity across studies. This study demonstrates that TTM impacts ∼1% of the population, while general hair-pulling behaviors affects ∼8%, highlighting the significant public health impact of this understudied condition. Additional research should clarify the gender distribution of TTM in epidemiological samples.
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Affiliation(s)
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Emily Olfson
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | | | - Michael H Bloch
- Yale Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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11
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Miller ML, Roche AI, Lemon E, O'Hara MW. Obsessive-compulsive and related disorder symptoms in the perinatal period: prevalence and associations with postpartum functioning. Arch Womens Ment Health 2022; 25:771-780. [PMID: 35614279 PMCID: PMC11131363 DOI: 10.1007/s00737-022-01239-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) symptoms are more likely to develop or be exacerbated during pregnancy and the postpartum period, which can cause significant distress and impairment. However, the disorders grouped with OCD in the DSM-5, obsessive-compulsive and related disorders (OCRD; e.g., hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (TTM), excoriation disorder (ED)), have rarely been examined in the perinatal period. This study aimed to explore (1) the prevalence of all clinically significant OCRD symptoms in pregnancy and the postpartum period and (2) the correlations between OCRD psychopathology and postpartum functioning. Participants were recruited during their second trimester of pregnancy from a Midwestern medical center. Participants completed an online questionnaire and a semi-structured clinical interview during pregnancy (28-32 weeks' gestation, N = 276) and the postpartum period (6-8 weeks, N = 221). BDD and OCD symptoms were the most prevalent. In pregnancy, 14.9% (N = 41) of participants endorsed clinically significant BDD symptoms and 6.2% (N = 17) endorsed clinically significant OCD symptoms. In the postpartum period, 11.8% (N = 26) endorsed clinically significant BDD symptoms and 14% (N = 31) endorsed clinically significant OCD symptoms. Poorer postpartum functioning was associated with elevated OCRD symptoms in pregnancy and postpartum. OCRD symptoms occur during pregnancy and the postpartum period at rates similar or higher than other life periods. Elevated OCRD symptoms are associated with poorer postpartum functioning across domains. Future research should explore how all OCRD symptoms may affect functioning in the perinatal period, not only OCD symptoms.
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Affiliation(s)
- Michelle L Miller
- University of Iowa, Iowa City, USA.
- Indiana University School of Medicine/IU Health Physicians, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St, Indianapolis, IN, 46202, USA.
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Li M, Ahmed MZ, Hiramoni FA, Zhou A, Ahmed O, Griffiths MD. Mental Health and Personality Traits during COVID-19 in China: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8693. [PMID: 34444441 PMCID: PMC8391495 DOI: 10.3390/ijerph18168693] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
During the COVID-19 pandemic, mental health problems have increased and are likely to be influenced by personality traits. The present study investigated the association between personality traits and mental health problems (anxiety, depression, post-traumatic stress syndrome (PTSD) symptoms, and obsessive-compulsive disorder (OCD) symptoms) through the person-centered approach because this has some advantages over the variable-centered approach. The data were collected from a sample of 765 Chinese citizens who participated in an online survey in October 2020. Latent profile analysis identified three latent personality profiles-highly adaptive, adaptive, and maladaptive. Highly adaptive individuals had higher extroversion, agreeableness, conscientiousness, openness, and lower neuroticism, while maladaptive individuals had lower extroversion, agreeableness, conscientiousness, openness, and higher neuroticism. Multivariate analysis of variance results showed that individuals with highly adaptive profiles had lower anxiety, depression, and PTSD symptoms compared to individuals with adaptive and maladaptive profiles. The findings of the present study indicate mental health professionals would benefit from formulated intervention plans given the association between latent personality profiles and mental health problems.
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Affiliation(s)
- Mei Li
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; (M.L.); (M.Z.A.)
- School of Education, Lanzhou City University, Lanzhou 730070, China
| | - Md Zahir Ahmed
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; (M.L.); (M.Z.A.)
| | | | - Aibao Zhou
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; (M.L.); (M.Z.A.)
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram 4331, Bangladesh;
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham NG1 4FQ, UK;
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13
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Kinderlehrer DA. Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study. Int Med Case Rep J 2021; 14:279-287. [PMID: 34007219 PMCID: PMC8121620 DOI: 10.2147/imcrj.s311516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022] Open
Abstract
The etiology of anorexia nervosa (AN) is multifactorial, and infections may play a contributory and possibly a prominent role. A case is presented which is indicative of a causal association between tick-borne infections and AN. This adolescent female was diagnosed with AN at an eating disorder clinic after excessive food restriction and an irrational fear of weight gain necessitating nasogastric tube feeding. Her history was consistent with systemic infections and she tested serologically positive to Borrelia burgdorferi, Babesia microti, and Mycoplasma pneumoniae; in addition, her clinical presentation was consistent with a Bartonella infection. After treatment with oral and intravenous antimicrobials, she stopped food restriction and no longer had body image concerns. Physicians should be aware of the possibility that tick-borne infections could underly a diagnosis of AN. The role of tick-borne infections in the etiology of AN warrants further study.
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14
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Grant JE, Chamberlain SR. Personality traits and their clinical associations in trichotillomania and skin picking disorder. BMC Psychiatry 2021; 21:203. [PMID: 33882867 PMCID: PMC8059235 DOI: 10.1186/s12888-021-03209-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations. AIM The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both. METHODS Adults (n = 98, aged 18-65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined. RESULTS In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress. DISCUSSION Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.
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Affiliation(s)
- Jon E. Grant
- grid.170205.10000 0004 1936 7822Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637 USA
| | - Samuel R. Chamberlain
- grid.5491.90000 0004 1936 9297Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.467048.90000 0004 0465 4159Southern Health NHS Foundation Trust, Southampton, UK
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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16
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Oh Y, Choi J, Song YM, Jhung K, Lee YR, Yoo NH, Kim Y. Defining Subtypes in Children with Nail Biting: A Latent Profile Analysis of Personality. Psychiatry Investig 2020; 17:517-525. [PMID: 32450625 PMCID: PMC7324728 DOI: 10.30773/pi.2019.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/07/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB. METHODS 681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children's personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245). RESULTS For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule-breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes ('adaptiveness,' 'high reward dependence,' 'low self-directedness,' and 'maldaptiveness'). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated highest tendency for problematic behavior irrespective of the frequency of NB. CONCLUSION Children with NB reported significantly more problematic behaviors compared to children without NB. Children with specific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accompanying personality profiles should be considered when assessing behavioral problems in children with NB.
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Affiliation(s)
- Yunhye Oh
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea.,Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungwon Choi
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Nursing, Honam University, Gwangju, Republic of Korea
| | - Kyungun Jhung
- Department of Psychiatry, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Young-Ryeol Lee
- Incorporated Korea Family Association for the Mentally Disabled, Sejong, Republic of Korea
| | - Nam-Hee Yoo
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Yeni Kim
- Department of Psychiatry, Dongguk University International Hospital, Institute of Clinical Psychopharmacology, Dongguk University School of Medicine, Goyang, Republic of Korea
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17
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Abstract
PURPOSE OF REVIEW Studies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work. RECENT FINDINGS Medium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional. The consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.
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Affiliation(s)
- Aurora Szentágotai-Tătar
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania. .,The Institute for Research, Development and Innovation in Applied Natural Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Andrei C Miu
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.,Cognitive Neuroscience Laboratory, Babeș-Bolyai University, Cluj-Napoca, Romania
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18
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Mattina GF, Slyepchenko A, Steiner M. Obsessive–compulsive and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:369-386. [DOI: 10.1016/b978-0-444-64123-6.00025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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19
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Lamothe H, Baleyte JM, Mallet L, Pelissolo A. Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:87-104. [PMID: 31576938 PMCID: PMC6986481 DOI: 10.1590/1516-4446-2019-0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Université de Caen Normandie (UNICAEN), INSERM, U1077, Caen, France
| | - Luc Mallet
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
- Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Antoine Pelissolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
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20
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Peris TS, Rozenman M, Gonzalez A, Vreeland A, Piacentini J, Tan PZ, Ricketts EJ. Family functioning in pediatric trichotillomania, obsessive compulsive disorder, and healthy comparison youth. Psychiatry Res 2019; 281:112578. [PMID: 31586836 DOI: 10.1016/j.psychres.2019.112578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.
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Affiliation(s)
- Tara S Peris
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States.
| | | | - Araceli Gonzalez
- California State University Long Beach, Long Beach, CA 90840, United States
| | | | - John Piacentini
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
| | - Patricia Z Tan
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
| | - Emily J Ricketts
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
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21
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Sunde T, Hummelen B, Himle JA, Walseth LT, Vogel PA, Launes G, Haaland VØ, Haaland ÅT. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2019; 19:318. [PMID: 31655556 PMCID: PMC6815412 DOI: 10.1186/s12888-019-2285-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. METHODS Young Schema Questionnaire -Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) were measured in 40 OCD patients in a general outpatient clinic before and after group ERP, after 12-months and at extended follow-up. To analyze the predictors, a multiple regression analyses was conducted. Changes in overall EMS was analyzed by mixed models procedures. RESULTS The major finding is that patients with high pre-treatment YSQ-SF total scores were less likely to respond to initial treatment or were more likely to relapse between post-treatment and the extended follow-up. The YSQ-SF total score at pre-treatment explained 10.5% of the variance of extended long-term follow-up outcome. The entire sample experienced a significant reduction in overall EMS over time with largest reduction from pre- to post-test. There were no statistically significant differences in total EMS change trajectories between the patients who were recovered at the extended follow-up compared to those who were not. CONCLUSION The results from the present study suggest that patients with higher pre-treatment EMSs score are less likely to recover in the long-term after receiving group ERP for OCD. A combined treatment that also targets early maladaptive schemas may be a more effective approach for OCD patients with elevated EMS who don't respond to standard ERP.
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Affiliation(s)
- Tor Sunde
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Benjamin Hummelen
- Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Joseph A. Himle
- School of Social Work and School of Medicine-Psychiatry, University of Michigan, Ann Arbor, USA
| | - Liv Tveit Walseth
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Patrick A. Vogel
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Launes
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Vegard Øksendal Haaland
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
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Gerstenblith TA, Jaramillo-Huff A, Ruutiainen T, Nestadt PS, Samuels JF, Grados MA, Cullen BA, Riddle MA, Liang KY, Greenberg BD, Rasmussen SA, Rauch SL, McCracken JT, Piacentini J, Knowles JA, Nestadt G, Bienvenu OJ. Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder. Compr Psychiatry 2019; 94:152123. [PMID: 31518848 PMCID: PMC6980465 DOI: 10.1016/j.comppsych.2019.152123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/24/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
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Affiliation(s)
- Ted Avi Gerstenblith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Ashley Jaramillo-Huff
- University of New Mexico School of Medicine, Department of Obstetrics and Gynecology, United States of America
| | - Tuua Ruutiainen
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, United States of America
| | - Paul S Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Jack F Samuels
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Marco A Grados
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | | | - Benjamin D Greenberg
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Steven A Rasmussen
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Scott L Rauch
- Harvard Medical School, Department of Psychiatry, United States of America
| | - James T McCracken
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - John Piacentini
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - James A Knowles
- SUNY Downstate Medical Center College of Medicine, Department of Cell Biology, United States of America
| | - Gerald Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - O Joseph Bienvenu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America.
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23
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Early maladaptive schemas in patients with obsessive-compulsive disorder, bipolar disorder, and schizophrenia: A comparative study. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00195-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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24
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Abstract
OBJECTIVE Evidence suggests that skin picking disorder (SPD) could be a prevalent condition associated with comorbidity and psychosocial dysfunction. However, just a few studies have assessed the prevalence and correlates of SPD in samples from low- and middle-income countries. In addition, the impact of SPD on quality of life (QoL) dimension after multivariable adjustment to potential confounders remains unclear. METHODS Data were obtained from a Brazilian anonymous Web-based research platform. Participants provided sociodemographic data and completed the modified Skin Picking-Stanford questionnaire, the Hypomania Checklist (HCL-32), the Patient Health Questionnaire-9 (PHQ-9), the Fagerström Test for Nicotine Dependence, Alcohol Use Disorder Identification Test (AUDIT), Symptom Checklist-90-Revised inventory (SCL-90R), early trauma inventory self report-short form, and the World Health Organization quality of life abbreviated scale (WHOQOL-Bref). Associations were adjusted to potential confounders through multivariable models. RESULTS For our survey, 7639 participants took part (71.3% females; age: 27.2±7.9 years). The prevalence of SPD was 3.4% (95% CI: 3.0-3.8%), with a female preponderance (P<0.001). In addition, SPD was associated with a positive screen for a major depressive episode, nicotine dependence, and alcohol dependence, as well as suicidal ideation. Physical and psychological QoL was significantly more impaired in participants with SPD compared to those without SPD, even after adjustment for comorbidity. CONCLUSIONS In this large sample, SPD was a prevalent condition associated with co-occurring depression, nicotine, and alcohol dependence. In addition, SPD was independently associated with impaired physical and psychological QoL. Public health efforts toward the early recognition and treatment of SPD are warranted.
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Slikboer R, Castle DJ, Nedeljkovic M, Rossell SL. Types of avoidance in hair-pulling disorder (trichotillomania): An exploratory and confirmatory analysis. Psychiatry Res 2018; 261:154-160. [PMID: 29306818 DOI: 10.1016/j.psychres.2017.12.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/27/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
Abstract
Hair-pulling disorder (HPD) or Trichotillomania is a complex disorder with frequent relapses. Avoidance has been highlighted as an important behavioural feature in HPD. To improve our understanding of avoidance, two studies were conducted to identify the types of avoidance that may be experienced by those who pull hair. Internet questionnaires were used to collect data. Data from study one was split into two subsets. An exploratory factor analysis was conducted to identify the different types of avoidance experienced by those reporting symptoms of hair pulling (subset one, n = 278), followed by a confirmatory factor analysis (subset two, n = 295). In study two a MANOVA was conducted (n = 300) to examine whether levels of avoidance differed between controls and those with hair pulling symptoms. Participants with hair pulling symptoms had greater levels of avoidance on each of the five types: 'Avoidance of non-social goals', 'Self-concealment', 'Behavioural social avoidance', 'Avoidance of relationship problem solving' and 'Avoidance of thinking about the future'. These data expand on the current literature, which has predominantly focused on experiential avoidance. Future research will need to validate these findings in a clinical group.
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Affiliation(s)
- Reneta Slikboer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - David J Castle
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Central Clinical School, Melbourne, VIC, Australia
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Daudin M, Calteau M. La trichotillomanie. À propos d’un cas de trichobézoard. ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khosravani V, Sharifi Bastan F, Samimi Ardestani M, Jamaati Ardakani R. Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder. Psychiatry Res 2017; 255:441-448. [PMID: 28686949 DOI: 10.1016/j.psychres.2017.06.080] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Abstract
There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.
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Affiliation(s)
- Vahid Khosravani
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Mehdi Samimi Ardestani
- Departments of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Medeiros GC, Torres AR, Boisseau CL, Leppink EW, Eisen JL, Fontenelle LF, do Rosário MC, Mancebo MC, Rasmussen SA, Ferrão YA, Grant JE. A cross-cultural clinical comparison between subjects with obsessive-compulsive disorder from the United States and Brazil. Psychiatry Res 2017; 254:104-111. [PMID: 28457988 PMCID: PMC5517316 DOI: 10.1016/j.psychres.2017.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD patients recruited in the United States (U.S.) and Brazil. Our sample consisted of 1187 adult, treatment-seeking OCD outpatients from the U.S. (n=236) and Brazil (n=951). With regards to the demographics, U.S. participants with OCD were older, more likely to identify as Caucasian, had achieved a higher educational level, and were less likely to be partnered when compared to Brazilians. Concerning the clinical variables, after controlling for demographics the two samples presented largely similar profiles. Brazilian participants with OCD, however, endorsed significantly greater rates of generalized anxiety disorder and post-traumatic stress disorder, whereas U.S. subjects were significantly more likely to endorse a lifetime history of addiction (alcohol-use and substance-use disorders). This is the largest direct cross-cultural comparison to date in the OCD field. Our results provide much needed insight regarding the development of culture-sensitive treatments.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America.
| | - Albina R Torres
- Botucatu Medical School-São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Christina L Boisseau
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Eric W Leppink
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| | - Jane L Eisen
- Department of Psychiatry, Mount Sinai St. Lukes/Mount Sinai West, New York, NY, United States of America
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil
| | - Maria C do Rosário
- Department of Psychiatry and Psychology, Federal University of São Paulo, São Paulo (SP), Brazil
| | - Maria C Mancebo
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Steven A Rasmussen
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ygor A Ferrão
- Porto Alegre Health Sciences Federal University, Rio Grande do Sul, Porte Alegre/RS, Brazil
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
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Schema therapy augmented exposure and response prevention in patients with obsessive-compulsive disorder: Feasibility and efficacy of a pilot study. J Behav Ther Exp Psychiatry 2016; 52:59-67. [PMID: 27016846 DOI: 10.1016/j.jbtep.2016.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In spite of the availability of effective treatments for obsessive-compulsive disorder (OCD), many patients do not respond sufficiently or relapse. Treatments using other potentially effective methods such as experiential techniques need to be investigated. We developed a 12-week inpatient treatment augmenting exposure and response prevention (ERP) with schema therapy (ST) called STERP. The feasibility and effectiveness of STERP was tested.. METHODS In a pilot study, 10 inpatients with OCD who failed to respond to Cognitive Behavioral Therapy (CBT) with ERP received STERP. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) served as primary outcome. Secondary outcome measures were the Obsessive Compulsive Inventory-revised (OCI-R) and the Beck Depression Inventory (BDI-II). Treatment effects were assessed with t-tests for paired samples. RESULTS Significant reductions of the Y-BOCS, OCI-R and the BDI-II were found, with very large effect sizes (Cohen's d = 1.48-2.25). Results remained stable at 6 months follow-up. Five prior non-responders responded according to the 35% Y-BOCS symptom reduction criterion.. LIMITATIONS Lack of control group, small sample size and lack of repeated outcome measures during baseline. CONCLUSIONS STERP may be a feasible and potentially effective treatment for prior non-responders among OCD patients and thus worth further investigation in randomized controlled trials..
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Houghton DC, Maas J, Twohig MP, Saunders S, Compton SN, Neal-Barnett A, Franklin ME, Woods DW. Comorbidity and quality of life in adults with hair pulling disorder. Psychiatry Res 2016; 239:12-9. [PMID: 27137957 PMCID: PMC4855296 DOI: 10.1016/j.psychres.2016.02.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/09/2015] [Accepted: 02/27/2016] [Indexed: 01/12/2023]
Abstract
Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and psychosocial functioning in a well-characterized sample of adults with HPD (N=85) who met DSM-IV criteria, had at least moderate hair pulling severity, and participated in a clinical trial. Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis. Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders. The relationships between certain comorbidity patterns, hair pulling severity, current mood and anxiety symptoms, and quality of life were also examined. Results showed that current depressive symptoms were the only predictor of quality of life deficits. Implications of these findings for the conceptualization and treatment of HPD are discussed.
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Affiliation(s)
- David C. Houghton
- Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843-4235
| | - Joyce Maas
- Radboud University-Nijmegen, Department of Clinical Psychology, P.O. Box 9104, NL-6500 HE Nijmegen, The Netherlands.
| | - Michael P. Twohig
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT 84322-2810
| | - Stephen Saunders
- Marquette University, Department of Psychology, 328E Cramer Hall, Milwaukee, WI 53233
| | - Scott N. Compton
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC 3527, Durham, NC 27710
| | - Angela Neal-Barnett
- Kent State University, Department of Psychology, 203 Kent Hall Addition, Kent, OH 44242
| | - Martin E. Franklin
- University of Pennsylvania School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104
| | - Douglas W. Woods
- Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843-4235,Corresponding author. Tel.: (979)845 2540
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Brennan E, Francazio S, Gunstad J, Flessner C. Inhibitory Control in Pediatric Trichotillomania (Hair Pulling Disorder): The Importance of Controlling for Age and Symptoms of Inattention and Hyperactivity. Child Psychiatry Hum Dev 2016; 47:173-82. [PMID: 26001984 DOI: 10.1007/s10578-015-0554-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trichotillomania (hair pulling disorder, HPD) is characterized by significant psychological distress, childhood-onset, and, in adults, certain cognitive deficits such as inhibitory control. A total absence of such literature exists within pediatric HPD samples, including research investigating neurocognitive aspects of disparate pulling-styles. The present study aims to address these gaps in the literature. Youth with HPD and healthy controls (N = 45) were compared on an automated neurocognitive task--stop-signal task (SST)--assessing inhibitory control. Youth with HPD (n = 17), controlling for age and attention issues, were found to perform better on the stop-signal reaction time compared to controls (n = 28). No significant relationships between performance on the SST and HPD severity, distress/impairment, or pulling-styles were noted. Findings from the current study suggest that children with HPD may not exhibit deficits in motor inhibition as compared to controls when the effects of age and attentional problems are controlled.
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Affiliation(s)
- Elle Brennan
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, USA
| | - Sarah Francazio
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, USA
| | - Christopher Flessner
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, USA.
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Flessner CA, Brennan E, Murphy YE, Francazio S. IMPAIRED EXECUTIVE FUNCTIONING IN PEDIATRIC TRICHOTILLOMANIA (HAIR PULLING DISORDER). Depress Anxiety 2016; 33:219-28. [PMID: 26580849 DOI: 10.1002/da.22450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/27/2015] [Accepted: 10/09/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, science's understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant-free sample of children with HPD. METHODS Sixteen and 23 children between 9 and 17 years of age meeting DSM-5 diagnostic criteria for HPD or classified as a healthy control, respectively, were recruited (N = 39) to complete structured interviews, self-reports, and a subset of tests from the Cambridge Automatic Neurocognitive Test Assessment Battery (CANTAB) assessing cognitive flexibility/reversal learning (intradimensional/extradimensional; IED), working memory (spatial span; SSP), and planning and organization (Stocking of Cambridge; SOC). RESULTS Hierarchical regression analyses indicated that, after controlling for appropriate covariates, diagnostic status predicted impaired performance on both the IED (reversal learning only) and SOC (planning and organization) but failed to predict cognitive flexibility or working memory capacity. Correlational analyses revealed that pulling severity was strongly related to working memory capacity, while disparate relationships between pulling styles (automatic, focused pulling) were evident with respect to working memory and planning and organization. CONCLUSIONS Children with HPD performed more poorly on tasks of executive functioning as compared to controls. Correlational analyses suggest potentially distinct pathophysiology underlying automatic and focused pulling warranting further research. Limitations and future areas of inquiry are discussed.
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Affiliation(s)
| | - Elle Brennan
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Yolanda E Murphy
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Sarah Francazio
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Johnson J, El-Alfy AT. Review of available studies of the neurobiology and pharmacotherapeutic management of trichotillomania. J Adv Res 2016; 7:169-84. [PMID: 26966559 PMCID: PMC4767796 DOI: 10.1016/j.jare.2015.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/05/2015] [Accepted: 05/20/2015] [Indexed: 12/16/2022] Open
Abstract
Trichotillomania (TTM) is a psychiatric disorder characterized by an irresistible urge to pull out one's hair. Currently there are no FDA approved treatments for TTM, which makes it difficult for clinicians to select an appropriate therapeutic plan. The clinical studies that have been performed do not provide sufficient or consistent evidence regarding which drug classes should be administered. Unfortunately, most of the available data consist of case reports and clinical trials with limited sample size. This review provides an overview of currently available clinical literature that targets TTM. A summary of clinical trials as well as case reports is provided. The most common rating scales used for clinical assessment are also reviewed. The etiology of TTM remains unclear. Studies that examine various neuroanatomical, neurobiologic, as well as genetic factors associated with TTM are thoroughly discussed in this review. It is evident that clear understanding of TTM is crucial to provide better recognition, assessment, and treatment to patients of this disorder. Finally, despite research efforts for establishing pharmacological options for treatment, it is clear that new targets are warranted in order to ensure a clinically supported effective pharmacological approach to treat TTM.
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Affiliation(s)
| | - Abir T. El-Alfy
- Department of Pharmaceutical Sciences, Chicago State University, Chicago, IL 60628, USA
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Rozenman M, Peris TS, Gonzalez A, Piacentini J. Clinical Characteristics of Pediatric Trichotillomania: Comparisons with Obsessive-Compulsive and Tic Disorders. Child Psychiatry Hum Dev 2016; 47:124-32. [PMID: 25894516 DOI: 10.1007/s10578-015-0550-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study compared youth ages 5-17 years with a primary diagnosis of trichotillomania (TTM, n = 30) to those with primary OCD (n = 30) and tic disorder (n = 29) on demographic characteristics, internalizing, and externalizing symptoms. Findings suggest that youth with primary TTM score more comparably to youth with tics than those with OCD on internalizing and externalizing symptom measures. Compared to the OCD group, youth in the TTM group reported lower levels of anxiety and depression. Parents of youth in the TTM group also reported fewer internalizing, externalizing, attention, and thought problems than those in the OCD group. Youth with TTM did not significantly differ from those with primary Tic disorders on any measure. Findings suggest that pediatric TTM may be more similar to pediatric tic disorders than pediatric OCD on anxiety, depression, and global internalizing and externalizing problems.
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Affiliation(s)
- Michelle Rozenman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA.
| | - Tara S Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Araceli Gonzalez
- Department of Psychology, California State University Long Beach, Long Beach, CA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
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Kwak KH, Lee SJ. A comparative study of early maladaptive schemas in obsessive-compulsive disorder and panic disorder. Psychiatry Res 2015; 230:757-62. [PMID: 26599390 DOI: 10.1016/j.psychres.2015.11.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/06/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
Schema theory and therapy may be an additional therapeutic approach to identify and treat chronic psychological problems, namely early maladaptive schemas (EMSs), in patients with obsessive-compulsive disorder (OCD) and panic disorder (PAD). In the current study, we investigated the characteristics in EMSs between patients with OCD and PAD. Fifty-one patients with OCD, 46 patients with PAD, and 70 normal controls participated in this study. EMSs and depressive symptoms were measured using the Young Schema Questionnaire and the Beck Depression Inventory (BDI), respectively. Analysis of covariance was conducted with age, sex, BDI score, and education level as covariates to assess group differences. Direct comparisons among the three groups revealed that the defectiveness/shame and social isolation/alienation schemas were prominently activated in patients with OCD, whereas the vulnerability to harm or illness and self-sacrifice were activated in patients with PAD. In subgroup analysis, these differences were observed between subgroups with lower BDI scores, but not between the patient subgroups with higher BDI scores. However, the differences between the patient groups in the defectiveness/shame and vulnerability to harm or illness schemas almost reached significance. Patients with OCD and PAD differed in particular EMS characteristics, which could have potential therapeutic implications.
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Affiliation(s)
- Kyung-Hwa Kwak
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, South Korea
| | - Seung Jae Lee
- Department of Psychiatry, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, South Korea.
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Keuthen NJ, Tung ES, Altenburger EM, Blais MA, Pauls DL, Flessner CA. Trichotillomania and personality traits from the five-factor model. ACTA ACUST UNITED AC 2015; 37:317-24. [PMID: 26375807 DOI: 10.1590/1516-4446-2015-1657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/01/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether personality traits have predictive validity for trichotillomania (TTM) diagnosis, pulling severity and control, and hair pulling style. METHODS In study 1, logistic regression was used with TTM cases (n=54) and controls (n=25) to determine if NEO Five-Factor Inventory (NEO-FFI) personality domains predicted TTM case vs. control classification. In study 2, hierarchical multiple regression was used with TTM cases (n=164) to determine whether NEO-FFI personality domains predicted hair pulling severity and control as well as focused and automatic pulling styles. RESULTS TTM case vs. control status was predicted by NEO-FFI neuroticism. Every 1-point increase in neuroticism scores resulted in a 10% greater chance of TTM diagnosis. Higher neuroticism, higher openness, and lower agreeableness were associated with greater pulling severity. Higher neuroticism was also associated with less control over hair pulling. Higher neuroticism and lower openness were associated with greater focused pulling. None of the personality domains predicted automatic hair pulling. CONCLUSIONS Personality traits, especially neuroticism, can predict TTM diagnosis, hair pulling severity and control, and the focused style of pulling. None of the personality traits predicted automatic pulling. Longitudinal studies are needed to determine whether personality variables predispose to TTM onset, impact disorder course, and/or result from hair pulling behavior.
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Affiliation(s)
- Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Esther S Tung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - David L Pauls
- Psychiatric Neurogenetics Unit, Massachusetts General Hospital, Boston, MA, USA
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Brennan E, Flessner C. An interrogation of cognitive findings in pediatric obsessive-compulsive and related disorders. Psychiatry Res 2015; 227:135-43. [PMID: 25912428 DOI: 10.1016/j.psychres.2015.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 02/23/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
Current findings in the field of psychology have led to increased interest and a new conceptualization of disorders characterized by repetitive behaviors, namely the obsessive compulsive and related disorders (OCRDs). Scant research, however, has sought to collect and categorize the extant research on pediatric OCRDs. Particularly, no adequate review of the pediatric cognitive literature existed until now, despite the clear implication of abnormalities in neuroanatomical structures and cognitive functioning in adult samples. While evidence for cognitive dysfunction in pediatric samples is presented, this paper also suggests that differences in cognitive dysfunction may indeed exist between adults and youth with OCRDs. Specifically, those irregularities present in said youth at varying developmental stages may impact the origination and maintenance of OCRDs across time. Finally, this paper seeks to formulate potential future goals for the research field, particularly through transdiagnostic approaches to processes linked with symptom presentations. This is of particular importance as an improved understanding of the interaction of cognitive function and growth is key to further comprehension of the OCRDs.
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Affiliation(s)
- Elle Brennan
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA.
| | - Christopher Flessner
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA
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Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord 2015; 171:74-84. [PMID: 25299438 PMCID: PMC4252512 DOI: 10.1016/j.jad.2014.09.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/05/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame׳s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work. METHODS We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs. RESULTS General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors. LIMITATIONS Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct. CONCLUSIONS Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.
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Thiel N, Tuschen-Caffier B, Herbst N, Külz AK, Nissen C, Hertenstein E, Gross E, Voderholzer U. The prediction of treatment outcomes by early maladaptive schemas and schema modes in obsessive-compulsive disorder. BMC Psychiatry 2014; 14:362. [PMID: 25540106 PMCID: PMC4324412 DOI: 10.1186/s12888-014-0362-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Higher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls. This study examines the relationship of EMS and schema modes to OC symptom severity and the predictive value of EMS and schema modes on treatment outcome in inpatients receiving Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). The main assumption was a negative association between the EMS of the domain 'disconnection' and dysfunctional coping and parent schema modes and the treatment outcome. METHODS EMS, schema modes, depression and traumatic childhood experiences were measured in 70 patients with OCD. To analyze the predictors, two regression analyses were conducted considering multiple variables, such as depression, as covariates. RESULTS Regression analyses demonstrated that higher scores on the EMS named failure and emotional inhibition and depressive symptom severity at pretreatment were significantly related to poor outcome and explained a high percentage of the variance in OC symptoms at posttreatment. No influence on the treatment outcome was observed for schema modes, other EMS or other covariates. CONCLUSIONS The results support the approach to extend the CBT with ERP treatment with therapeutic elements focusing on maladaptive schemas, particularly in non-responders.
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Affiliation(s)
- Nicola Thiel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany.
| | - Nirmal Herbst
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Anne Katrin Külz
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Elisabeth Hertenstein
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Ellen Gross
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany.
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Wilhelm S, Berman NC, Keshaviah A, Schwartz RA, Steketee G. Mechanisms of change in cognitive therapy for obsessive compulsive disorder: role of maladaptive beliefs and schemas. Behav Res Ther 2014; 65:5-10. [PMID: 25544403 DOI: 10.1016/j.brat.2014.12.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/12/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.
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Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States.
| | - Noah C Berman
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Aparna Keshaviah
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Rachel A Schwartz
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Gail Steketee
- Boston University School of Social Work, 264Bay State Rd., Boston, MA 02215, United States
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Kim JE, Lee SW, Lee SJ. Relationship between early maladaptive schemas and symptom dimensions in patients with obsessive-compulsive disorder. Psychiatry Res 2014; 215:134-40. [PMID: 23962740 DOI: 10.1016/j.psychres.2013.07.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/23/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
The aims of this study were to evaluate early maladaptive schemas (EMSs) of patients with obsessive-compulsive disorder (OCD) and to clarify relationships between particular EMSs and the five factor-analyzed symptom dimensions and other clinical variables. Fifty-seven patients with OCD and 70 normal controls completed the Young Schema Questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Y-BOCS symptom checklist, and the Beck Depression Inventory. Patients with OCD had significantly higher scores for schema related to defectiveness/shame, social isolation/alienation, and failure than did normal controls. Among the five OCD symptom dimensions, the sexual/religious dimension was only significantly correlated with two schemas of vulnerability to harm or illness and enmeshment/undeveloped self. These two schemas were significant predictors of the sexual/religious dimension, accounting for 33% of the total variance in this dimension. Any EMSs in patients with OCD were not related to clinical variables such as severity of OCD and duration of illness. These findings may constitute evidence to improve our understandings of OCD from a perspective of schema theory.
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Affiliation(s)
- Ji Eun Kim
- Department of Psychiatry, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, South Korea
| | - Sang Won Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daegeon 305-701, South Korea
| | - Seung Jae Lee
- Department of Psychiatry, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, South Korea.
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Abstract
PURPOSE OF REVIEW Evidence-based pharmacological interventions for obsessive compulsive disorder (OCD) are targeted mainly at the serotonergic and dopaminergic pathways, and are not always effective. It is timely to review the growing evidence from animal models and clinical research (e.g., brain imaging, genetics) on the role of the glutamatergic system in OCD. RECENT FINDINGS Emerging evidence from both animal models and clinical research (including brain imaging, neurogenetics) supports the glutamatergic system as a potential target for pharmacotherapy in OCD. Although there have been relatively few randomized controlled trials of glutamatergic agents in pediatric or adult OCD to date, there is some work on riluzole, memantine, ketamine, topiramate, lamotrigine, N-acetylcysteine, and D-cycloserine. SUMMARY Given the need for more efficacious treatments in OCD, and given emergent findings on the role of the glutamatergic system in this disorder, there is a need for additional pharmacotherapy trials on glutamatergic agents in OCD. Possible research designs for such trials might include stand-alone approaches, pharmacotherapy augmentation, or psychotherapy augmentation.
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Torres AR, Shavitt RG, Torresan RC, Ferrão YA, Miguel EC, Fontenelle LF. Clinical features of pure obsessive-compulsive disorder. Compr Psychiatry 2013; 54:1042-52. [PMID: 23746710 DOI: 10.1016/j.comppsych.2013.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/07/2013] [Accepted: 04/17/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Psychiatric comorbidity is the rule in obsessive-compulsive disorder (OCD); however, very few studies have evaluated the clinical characteristics of patients with no co-occurring disorders (non-comorbid or "pure" OCD). The aim of this study was to estimate the prevalence of pure cases in a large multicenter sample of OCD patients and compare the sociodemographic and clinical characteristics of individuals with and without any lifetime axis I comorbidity. METHOD A cross-sectional study with 955 adult patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Assessment instruments included the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, The USP-Sensory Phenomena Scale and the Brown Assessment of Beliefs Scale. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses were followed by logistic regression. RESULTS Only 74 patients (7.7%) presented pure OCD. Compared with those presenting at least one lifetime comorbidity (881, 92.3%), non-comorbid patients were more likely to be female and to be working, reported less traumatic experiences and presented lower scores in the Y-BOCS obsession subscale and in total DY-BOCS scores. All symptom dimensions except contamination-cleaning and hoarding were less severe in non-comorbid patients. They also presented less severe depression and anxiety, lower suicidality and less previous treatments. In the logistic regression, the following variables predicted pure OCD: sex, severity of depressive and anxious symptoms, previous suicidal thoughts and psychotherapy. CONCLUSIONS Pure OCD patients were the minority in this large sample and were characterized by female sex, less severe depressive and anxious symptoms, less suicidal thoughts and less use of psychotherapy as a treatment modality. The implications of these findings for clinical practice are discussed.
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Affiliation(s)
- Albina R Torres
- Department of Neurology, Psychology and Psychiatry - Botucatu Medical School, Univ Estadual Paulista (Unesp), Botucatu (SP), Brazil.
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Recurrent trichobezoar due to trichophagia: a case report. Gen Hosp Psychiatry 2013; 35:439-41. [PMID: 23541805 DOI: 10.1016/j.genhosppsych.2013.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 01/24/2013] [Accepted: 01/26/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Trichobezoar, a hair ball in the gastrointestinal tract, is usually the result of the urge to pull out one's own hair (trichotillomania) and swallow it (trichophagia). It is almost exclusively seen in young females and may cause serious medical complications. This case report will describe an adult female patient with recurrent trichobezoars. METHOD Data for this case report was collected from peer-reviewed literature and treatment encounters by the consultation-liaison psychiatry unit; subsequent to obtaining informed consent. RESULTS The personality characteristics, familial structure and domestic stress found in this case mirror the literature. We initiated behavioral interventions including habit reversal training and patient education in combination with pharmacologic therapy with clomipramine. CONCLUSION Left untreated, trichophagia can cause a life-threatening emergency, requiring surgery. Recurrence of tichobezoars can be anticipated when the underlying emotional disorder is not addressed using multimodal management including psychiatric evaluation and treatment combined with surgical procedures.
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Alireza GN, Estilaee F, Sadeghi MM. Familial trichotillomania: role of genetic factors in the determination of subtypes. Acta Neuropsychiatr 2013; 25:187-90. [PMID: 25287474 DOI: 10.1111/acn.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Trichotillomania (TTM) is a psychiatric syndrome characterised by the inability to control repetitive hair pulling. Psychiatric data reveal that TTM is not usually prevalent among all family members of patients, and so far only one case of familial TTM has been reported. METHODS In this study, we report a case of familial TTM that afflicted four sisters and discuss the importance of genetic factors in this disorder. RESULTS This report suggests that, similar to many other psychiatric disorders, TTM can be detected in other family members and that genetic factors not only have a significant role in the development of such disorders but also in determination of the disorder subtype. This report also shows that the comorbidities in one member of the family might predict the existence of comorbidities in other members. On the basis of response to medication. CONCLUSION the authors suggest that a genetic disorder like polymorphism in serotonin receptors or dopamine can cause such a disorder.
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Affiliation(s)
- Ghaffari Nejad Alireza
- Psychiatry Department, Beheshti Hospital, Kerman University of Medical Sciences and Health Services, Kerman, Iran
| | - Fariborz Estilaee
- Psychiatry Department, Beheshti Hospital, Kerman University of Medical Sciences and Health Services, Kerman, Iran
| | - Mohammad M Sadeghi
- Psychiatry Department, Beheshti Hospital, Kerman University of Medical Sciences and Health Services, Kerman, Iran
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Galeano MG, Ruiz RD, Cuneo MFD, Ponzio MF. Effectiveness of fluoxetine to control fur-chewing behaviour in the chinchilla (Chinchilla lanigera). Appl Anim Behav Sci 2013. [DOI: 10.1016/j.applanim.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flessner CA, Knopik VS, McGeary J. Hair pulling disorder (trichotillomania): genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Res 2012; 199:151-8. [PMID: 22537722 DOI: 10.1016/j.psychres.2012.03.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/06/2011] [Accepted: 03/13/2012] [Indexed: 01/23/2023]
Abstract
Hair pulling disorder (trichotillomania) affects at least 3.7 million people in the United States and results in marked functional impairment. This article reviews empirical research investigating the genetics and neurobiology of hair pulling disorder (HPD). We also discuss recent advances in the characterization of this phenotype which have led to evidence supporting the existence of at least two disparate pulling styles-automatic and focused pulling. These pulling styles exhibit facets of behavioral processes, impulsivity and compulsivity, characteristic of several classes of disorders (e.g., obsessive-compulsive spectrum disorders, impulse control disorders). Available genetic, neurobiological, and clinical data support the importance of impulsivity for conceptualizing HPD. Impulsivity alone is insufficient to fully understand this complex phenotype. Characterizations of both automatic and focused pulling as well as preliminary findings from affective neuroscience across species highlight the importance of compulsivity for understanding HPD. Opposing and complementary aspects to impulsivity-compulsivity provide a more comprehensive conceptualization of HPD and supports HPD's potential importance for advancing scientific inquiry in relation to the pathogenesis and treatment of related phenotypes. This review concludes with a description of areas-phenotype, neurobiology, and genes-in need of further study.
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Javidi Z, Battersby M, Forbes A. A Case Study of Trichotillomania With Social Phobia: Treatment and 4-Year Follow-up Using Cognitive–Behaviour Therapy. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.24.4.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article describes a case study that demonstrates an innovative combination of predominantly behavioural techniques in the treatment of trichotillomania (TTM) preceded by social phobia. Outcomes are reported to 4-year follow-up. A master's qualified cognitive–behavioural nurse therapist administered the course of treatment over 1 year and followed the client for 4 years. A combination of exposure and response prevention, habit reversal and serial photography for TTM urges, exposure for social phobia, cognitive restructuring and problem solving were utilised. These treatments were provided sequentially and concurrently. Pre and posttreatment and repeated outcome measures were applied in three domains. The client received a total of 23 treatment sessions over 1 year and follow-up over 4 years. During treatment, discharge and follow-up improved outcomes in TTM and social phobia were achieved and maintained at 4 years. Benefits accrued beyond the presenting conditions to have a major positive impact on the client's life. Theoretical implications for the classification of TTM are discussed.
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Bipeta R, Yerramilli SS. Bupropion for the treatment of fluoxetine non-responsive trichotillomania: a case report. J Med Case Rep 2011; 5:557. [PMID: 22129450 PMCID: PMC3253696 DOI: 10.1186/1752-1947-5-557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 11/30/2011] [Indexed: 11/12/2022] Open
Abstract
Introduction Trichotillomania, classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, is characterized by the recurrent pulling out of one's hair, resulting in noticeable hair loss. The condition has a varied etiology. Specific serotonin reuptake inhibitors are considered the treatment of choice; however some patients fail to respond to this class of drugs. A few older reports suggest possible benefit from treatment with bupropion. Case presentation A 23-year-old Asian woman with fluoxetine non- responsive trichotillomania was treated with sustained release bupropion (up to 450 mg/day) and cognitive behavior therapy. She demonstrated clinically significant improvement on the Clinical Global Impression - Improvement scale by week 13. The improvement persisted throughout the 12-month follow-up period. Conclusions The present case report may be of interest to psychiatrists and dermatologists. Apart from the serotonergic pathway, others, such as the mesolimbic pathway, also appear to be involved in the causation of trichotillomania. Bupropion may be considered as an alternative pharmacological treatment for patients who do not respond to specific serotonin reuptake inhibitors. However, this initial finding needs to be confirmed by well designed double-blind placebo controlled trials.
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Affiliation(s)
- Rajshekhar Bipeta
- Rajasri Clinic, Anandbagh Crossroads, Malkajgiri, Hyderabad, Andhra Pradesh, India.
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