Predictors of Impairment and Self-Concept in Children and Adolescents with Persistent Tic Disorder

This study examined predictors of, and associations between, self-concept, demographic variables, and clinical measures in fifty-eight children and adolescents with Persistent Tic Disorder (PTD; 44 males, Mage = 11.9 years, SD = 2.74). Participants completed measures that assessed self-concept, tic severity, tic-related impairment, and comorbid psychological symptoms. Results showed that generalized anxiety disorder, major depressive disorder, persistent depressive disorder, total tic severity, number and complexity of tics, and total and social tic-related impairment were associated with self-concept. Tic-related social impairment mediated the relationship between tic severity and self-concept. Exploratory analyses found that total tic severity, motor tic severity, and vocal tic severity, as well as the number, intensity, and interference of tics predicted social tic-related impairment. Results suggest that treatments to reduce the number and complexity of tics, with additional focus on navigating social interactions, may serve to decrease tic severity and impairment, and in turn, improve self-concept.

Latent class analysis of emotions experienced during compulsive hair-pulling episodes

BACKGROUND AND OBJECTIVES

Reasons for compulsive hair pulling are heterogeneous and not fully understood. Given that many people who experience compulsive hair pulling do not respond to treatment, identifying subgroups can inform potential mechanisms and treatment design.

METHODS

We sought to identify empirical subgroups among participants in an online treatment program for trichotillomania (N = 1728). A latent class analysis was used to identify patterns of emotions associated with compulsive hair-pulling episodes.

RESULTS

Six classes of participants were found which reflected three predominant themes. One theme reflected expected patterns, where emotional changes were seen following pulling. Two other themes were more surprising, where one reflected high overall emotional activation that did not show consistent change in response to pulling, and another showed low emotional activation overall. These results suggest that there are multiple types of hair-pulling and a sizeable group of people may benefit from treatment adjustments.

LIMITATIONS

Participants did not receive semi-structured diagnostic assessment. A majority of participants were Caucasian, and future research would benefit from increased participant diversity. Emotions associated with compulsive hair-pulling were measured across an entire treatment program, but the relationship between specific intervention components and change in specific emotions was not systematically collected.

CONCLUSIONS

While previous research has addressed overall phenomenology and comorbidity, the present study is the first to identify empirical subgroups of people who experience compulsive hair-pulling at the level of individual pulling episodes. Identified participant classes had distinguishing features that can aid in personalizing treatment to individual symptom presentations.

Pilot data supporting an attachment-based theory of adolescent social media use

BACKGROUND

Adolescents have virtually universal access to social media. Despite ample research linking attachment to social functioning in youth, neither this empirical research nor related theory has been extended to the virtual social context. The broad aim of this study was to test an attachment-based model of social media use in adolescents in order to address a gap in the literature during this developmental stage and examine attachment and the related process of mentalizing as correlates of online behavior.

METHOD

Online social comparison/feedback-seeking was selected as an outcome variable due to its known negative effects on adolescents. Analyses were conducted in a sample of 68 adolescents ranging in age from 15 to 18.

RESULTS

No evidence of a main effect of parent-child attachment on social comparison/feedback-seeking was found, but a significant mediational effect indicated that more insecure parent-child attachment is linked with hypermentalizing errors (i.e., overinterpretation of others' mental states) and that such errors explain increased social comparison/feedback-seeking.

CONCLUSIONS

The current study confirmed previously documented relations between parent-child attachment and hypermentalization as well as research demonstrating that parent-child attachment acts on an adolescent's social world - in this case their virtual social world - through anomalous mentalization.

Comprehensive behavioral treatment for an adult with sensory-based trichotillomania: An illustrative case study

Trichotillomania (TTM) is a poorly understood condition that causes significant impairment, but effective behavioral management strategies exist. The phenomenology of TTM is complex and requires an individualized treatment approach, and there are some important facets of TTM that have only recently been recognized. Specifically, contemporary research indicates that hair pulling is often performed to regulate aversive sensations and provide somatosensory reward. In this article, we describe the complex phenomenology of TTM, evidence-based treatment options, and illustrate a case of sensory-based TTM treated effectively with a comprehensive behavioral intervention.

Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders

Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impairment Scale - Parent Report (CTIM-P) to examine parents' attributions of their child's impairment in home, school, and social domains in a sample of 58 children with PTD. Each domain was rated on the extent to which the parents perceived that impairment was related to tics versus non-tic-related concerns. In addition, the Yale Global Tic Severity Scale (YGTSS) was used to explore the relationship between tic-related impairment and tic severity. Results showed impairment in school and social activities was not differentially attributed to tics versus non-tic-related impairment, but impairment in home activities was attributed more to non-tic-related concerns than tics themselves. Moreover, tic severity was significantly correlated with tic-related impairment in home, school, and social activities, and when the dimensions of tic severity were explored, impairment correlated most strongly with motor tic complexity. Results suggest that differentiating tic-related from non-tic-related impairment may be clinically beneficial and could lead to treatments that more effectively target problems experienced by children with PTDs.

Comprehensive Behavioral Treatment of Trichotillomania

This study aimed to concretize and pilot test comprehensive behavioral (ComB) treatment of trichotillomania (TTM), to facilitate rigorous testing of its efficacy. ComB provides a conceptualization to develop individualized treatment and choose interventions for managing distinct factors that maintain the individual’s hair pulling. It has been used by clinicians for almost three decades, yet was not previously manualized or studied empirically. A manual was drafted and revised based on patient ( N = 16) and therapist feedback, an intervention choice study demonstrated therapists reliably selected model-consistent interventions, and a therapist adherence measure was developed and tested. Uncontrolled preliminary data showed ComB to be highly acceptable, and it led to reduced TTM symptom severity and impairment, with large effects. Quality of life and disability also improved, with effects maintained at follow-up. This study resulted in the development of a manual and measures to be used in a randomized controlled trial (RCT) of ComB for TTM.

StopPicking.com: Internet-based treatment for self-injurious skin picking

StopPicking.com is an interactive self-help approach derived from an evidence-based cognitive behavioral model of treatment for skin picking (SP). We examined the development and two phases of program evaluation for an Internet-based self-help treatment for self-injurious SP. Participants included 372 individuals consecutively enrolling in StopPicking.com during a 5-month period. Results revealed significant reductions in frequency of picking episodes and symptom severity ratings from baseline to post-intervention. Treatment response rates were comparable or superior to previous research utilizing pharmacotherapy for the treatment of SP suggesting that StopPicking.com may provide an alternative or adjunctive treatment for SP. The current study is limited by lack of a control condition and use of a non-referred sample of skin pickers.

Affective correlates of trichotillomania

Affective correlates of hair pulling were investigated in a sample of 44 participants diagnosed with trichotillomania (TM). Participants completed the Hair Pulling Survey on which they rated the intensity of ten different affective states across three different phases of hair pulling (before, during and after). Repeated measures analysis of variance was used to examine the change of emotional experience across the hair pulling cycle. Results indicated significant decreases in boredom, anxiety and tension, and significant increases in guilt relief, sadness and anger across time (p<0.005). The role of co-existent anxiety and mood disorders also was examined using repeated measures analysis of variance. Results of these analyses indicated that patients with and without co-existent disorders differed only on patterns of anger across time, and therefore do not support affective subtypes of TM patients based on co-existent diagnosis. Implications of these findings for conceptualization and treatment of TM are discussed.