Severe Obsessive-Compulsive Disorder With and Without Comorbid Hair Pulling: Comparisons and Clinical Implications
J Clin Psychiatry 2005;66(7):864-869
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Chronic hair pulling and
trichotillomania are putative obsessive-compulsive spectrum
disorders. This study determined the prevalence of hair pulling
in an inpatient obsessive-compulsive disorder (OCD) population
and compared clinical characteristics and treatment response
between subgroups with and without comorbid hair pulling.
Method: Patients with severe
DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to
an OCD residential treatment facility between August 2000 and
July 2003 were included. Clinician-rated (Yale-Brown Obsessive
Compulsive Scale) and patient-rated (Massachusetts General
Hospital Hairpulling Scale, Beck Depression Inventory, and
Posttraumatic Diagnostic Scale) measures were administered at
index evaluation. OCD patients with and without moderate to
severe hair pulling were statistically compared on clinical and
treatment characteristics and treatment response.
Results: Of the OCD subjects, 18.8%
(N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to
severe hair pulling, and 7.8% (N = 12) had severe hair pulling
comparable to that of a specialty trichotillomania clinic
population. OCD patients with moderate to severe hair pulling
were more likely to be women (p < .001), endorse > 1 comorbid
tic (p < .05), and have earlier-onset OCD (p = .001). This cohort
also had fewer contamination obsessions (p = .04) and checking
compulsions (p = .04) and was more likely to be receiving stimulant
(p = .006) or venlafaxine (p = .02) medication than those patients
without hair pulling. Posttraumatic Diagnostic Scale scores were
nearly significantly higher in the OCD + hair pulling group
(p = .08). OCD treatment response was unaffected by the presence of
comorbid hair pulling.
Conclusion: Hair pulling is a highly
common comorbidity in severe OCD. Women and early-onset OCD
patients appear to be more vulnerable to comorbid hair pulling.
OCD sufferers with comorbid hair pulling also exhibit an
increased risk for tics and may present with different OCD