Search

Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive-compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.

The factor structure, reliability, and concurrent validity of the Distress Tolerance Scale were evaluated in a large outpatient sample (N = 775). Prior research demonstrates mixed findings regarding the most appropriate factor structure, finding evidence for the presence of four subfactors as well as a potential second-order (hierarchical) General Distress Tolerance factor. Competing factor structures were compared using confirmatory factor analyses. A second-order hierarchical model with correlated residuals fit the data well, though results suggested poor factor discrimination. A bifactor hierarchical model also demonstrated acceptable fit. However, all subfactors except for Regulation demonstrated small or nonsignificant loadings and/or variances. The model was respecified with all items loading onto a General Distress Tolerance factor and three items loading onto the Regulation factor, which also demonstrated acceptable fit. In support of its concurrent validity, General Distress Tolerance was more strongly associated with neuroticism and a measure of difficulties with emotion regulation than with symptoms of anxiety and depression. The present study extends the literature by demonstrating support for a hierarchical bifactor structure and the favorable psychometric properties of the Distress Tolerance Scale in a large clinical sample. Public Significance Statement: The Distress Tolerance Scale (DTS) was originally theorized to consist of four underlying dimensions. However, in the present sample of outpatients with emotional disorders, the DTS instead seems to capture one general, higher order distress tolerance construct with just one distinct subfacet (Regulation, or efforts to avoid or rapidly alleviate distress). These findings should inform continued use of the DTS in clinical and research settings. [ABSTRACT FROM AUTHOR]

Religion and spirituality have frequently been associated with mental health and well-being. However, inconsistent results suggest that there may be mediating factors. God representations highlight individual differences in relating to the sacred, which may have implications for mental health. Attachment theory has also been related to God representations and mental health. This study examined the relationships between benevolent and authoritarian God representations, attachment to God, and mental health in a sample of graduate students. Benevolent God representations were negatively associated with mental health problems, and this effect was mediated by attachment to God. Future research directions and implications are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Skin-picking disorder (SPD) was recognized as its own entity for the first time in DSM-5. The existing SPD literature is limited and, to date, no study has examined the differences between clinical and sub-clinical SPD. Identifying differences between these 2 groups may improve diagnostic accuracy, treatment, and prevention efforts. METHODS: Israeli adults (N = 4,325) from 2 previous studies were examined for the presence of clinical and subclinical SPD. Individuals with clinical SPD (n = 150) vs subclinical SPD (n = 219) were compared on skin-picking characteristics, psychological phenomena, and clinical correlates. RESULTS: There were many similarities between clinical and subclinical skin pickers. Individuals with clinical SPD, however, had more severe skin picking, greater associated functional impairment, greater perceived stress, and greater depressive and obsessive-compulsive symptoms, and were also more likely to have a first-degree relative with SPD. CONCLUSIONS: This study suggests that although there are some similarities between clinical and subclinical SPD, there also are distinct differences in the clinical presentation. Understanding these differences may be an important factor in treatment and prevention planning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trichotillomania (TTM), obsessive-compulsive disorder (OCD), and skin-picking disorder (SPD) frequently occur together and share overlapping phenomenology, pathophysiology, and possible genetic underpinnings. This study sought to identify factors that predict OCD and SPD in hair pullers. METHODS: Five hundred fifty-five adult female hair pullers were recruited from specialty clinics and assessed using standardized, semi-structured interviews and self-reports. Clinical predictors and multivariate models were evaluated using logistic regression modeling. RESULTS: Hair pullers met criteria for OCD (18.9%), SPD (19.5%), or chronic skin picking (CSP) (5%), or both comorbid diagnoses, respectively. In the final multivariate model for OCD, family history of OCD and an eating disorder diagnosis were associated with an increased risk of OCD in TTM. A nail-biting diagnosis was associated with a decreased risk of OCD in TTM. In the final multivariate model for SPD/CSP, only family history of OCD was associated with an increased risk of SPD/CSP in TTM. CONCLUSIONS: Identification of factors predicting OCD and SPD in TTM provides evidence for the relatedness of these disorders and supports their collective classification as obsessive-compulsive and related disorders (OCRDs) in DSM-5. The findings of this study further underscore the importance of assessing for comorbid OCRDs and family histories of OCRDs in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trichotillomania (TTM) appears to be a fairly common disorder, yet little is known about sex differences in its clinical presentation. Long thought to be a primarily female disorder, males with TTM may have unique clinical presentations. METHODS: Participants with TTM (N = 462) were examined on a variety of clinical measures including symptom severity, functioning, and psychiatric comorbidity. Clinical features were compared between males (n = 27) and females (n = 435). RESULTS: There were many similarities in the clinical presentations of males and females with TTM. Males with TTM, however, were more likely to pull from their face, arms, and torso, and were more likely to suffer from a co-occurring substance use disorder. Females were more likely to be younger and less likely to be married. CONCLUSIONS: This study suggests that, although few males seek treatment for TTM, sex differences may be an important clinical factor when assessing and treating this disorder. Further research is needed to validate these findings and identify whether treatments should be tailored differently for males and females with TTM. [ABSTRACT FROM AUTHOR]

Background: Trichotillomania (TTM), obsessive-compulsive disorder (OCD), and skin-picking disorder (SPD) frequently occur together and share overlapping phenomenology, pathophysiology, and possible genetic underpinnings. This study sought to identify factors that predict OCD and SPD in hair pullers., Methods: Five hundred fifty-five adult female hair pullers were recruited from specialty clinics and assessed using standardized, semi-structured interviews and self-reports. Clinical predictors and multivariate models were evaluated using logistic regression modeling., Results: Hair pullers met criteria for OCD (18.9%), SPD (19.5%), or chronic skin picking (CSP) (5%), or both comorbid diagnoses, respectively. In the final multivariate model for OCD, family history of OCD and an eating disorder diagnosis were associated with an increased risk of OCD in TTM. A nail-biting diagnosis was associated with a decreased risk of OCD in TTM. In the final multivariate model for SPD/CSP, only family history of OCD was associated with an increased risk of SPD/CSP in TTM., Conclusions: Identification of factors predicting OCD and SPD in TTM provides evidence for the relatedness of these disorders and supports their collective classification as obsessive-compulsive and related disorders (OCRDs) in DSM-5. The findings of this study further underscore the importance of assessing for comorbid OCRDs and family histories of OCRDs in clinical practice.

Background: Trichotillomania (TTM) appears to be a fairly common disorder, yet little is known about sex differences in its clinical presentation. Long thought to be a primarily female disorder, males with TTM may have unique clinical presentations., Methods: Participants with TTM (N = 462) were examined on a variety of clinical measures including symptom severity, functioning, and psychiatric comorbidity. Clinical features were compared between males (n = 27) and females (n = 435)., Results: There were many similarities in the clinical presentations of males and females with TTM. Males with TTM, however, were more likely to pull from their face, arms, and torso, and were more likely to suffer from a co-occurring substance use disorder. Females were more likely to be younger and less likely to be married., Conclusions: This study suggests that, although few males seek treatment for TTM, sex differences may be an important clinical factor when assessing and treating this disorder. Further research is needed to validate these findings and identify whether treatments should be tailored differently for males and females with TTM.

Background: Skin-picking disorder (SPD) was recognized as its own entity for the first time in DSM-5. The existing SPD literature is limited and, to date, no study has examined the differences between clinical and sub- clinical SPD. Identifying differences between these 2 groups may improve diagnostic accuracy, treatment, and prevention efforts., Methods: Israeli adults (N = 4,325) from 2 previous studies were examined for the presence of clinical and subclinical SPD. Individuals with clinical SPD (n = 150) vs subclinical SPD (n = 219) were compared on skin-picking characteristics, psychological phenomena, and clinical correlates., Results: There were many similarities between clinical and subclinical skin pickers. Individuals with clinical SPD, however, had more severe skin picking, greater associated functional impairment, greater perceived stress, and greater depressive and obsessive-compulsive symptoms, and were also more likely to have a first-degree relative with SPD., Conclusions: This study suggests that although there are some similarities between clinical and subclinical SPD, there also are distinct differences in the clinical presentation. Understanding these differences may be an important factor in treatment and prevention planning.