The Trichotillomania Impact Project (TIP): Exploring Phenomenology, Functional Impairment, and Treatment Utilization

Douglas W. Woods, Ph.D.; Christopher A. Flessner, M.S.; Martin E. Franklin, Ph.D.; Nancy J. Keuthen, Ph.D.; Renee D. Goodwin, Ph.D.; Dan J. Stein, M.D., Ph.D.; Michael R. Walther, B.A.; and the Trichotillomania Learning Center-Scientific Advisory Board

Background: Trichotillomania (TTM) occurs in 0.6% to 3.4% of adults. Questions remain about phenomenological features of the disorder, its impact on functioning, and treatment utilization. The current study (i.e., The Trichotillomania Impact Project) was designed to provide initial information regarding these issues.

Method: An Internet-based survey was completed by 1697 individuals who self-reported symptoms consistent with a diagnosis of TTM (DSM-IV-TR). The survey assessed phenomenological experiences; social, occupational, academic, and psychological impact; as well as treatment-seeking experiences. The survey link operated from April 2005 through May 2005.

Results: Survey results suggest considerable variability in TTM phenomenology. Individuals with more severe TTM symptoms endorsed more frequent phenomenological experiences of physical or mental anxiety prior to pulling and relief, pleasure, or gratification after pulling. Mild to moderate life impairment in social, occupational, academic, and psychological functioning was reported for the entire study sample. These impairments were more pronounced as TTM symptoms became more severe. A summary of treatment seeking in the sample suggests that pharmacotherapy was the most commonly received treatment, followed by behavior therapy. Unfortunately, treatment in general was perceived as relatively ineffective.

Conclusion: This study underscores the clinical significance of severe hair pulling and highlights the need for research on its pathogenesis and treatment.

(J Clin Psychiatry 2006;67:1877-1888)

Received Jan. 11, 2006; accepted April 10, 2006. From the Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee (Dr. Woods and Mr. Flessner); the Center for the Treatment and Study of Anxiety, University of Pennsylvania School of Medicine, Philadelphia (Dr. Franklin and Mr. Walther); the Department of Psychiatry, Harvard University/Massachusetts General Hospital, Charlestown, Mass. (Dr. Keuthen); the Department of Epidemiology, Columbia University, New York, N.Y. (Dr. Goodwin); the Department of Psychiatry, University of Cape Town, Cape Town, Western Cape, South Africa and the Department of Psychiatry, Mt. Sinai School of Medicine, New York, N.Y. (Dr. Stein); and the Trichotillomania Learning Center-Scientific Advisory Board (TLC-SAB), Santa Cruz, Calif.

This project was funded by the Trichotillomania Learning Center (TLC).

Financial disclosure appears at the end of this article.

A complete list of the Trichotillomania Learning Center-Scientific Advisory Board members appears at the end of the article.

Acknowledgments appear at the end of the article.

Corresponding author and reprints: Douglas W. Woods, Ph.D., 2441 E. Hartford Ave., 211 Garland Hall, University of Wisconsin-Milwaukee, Milwaukee, WI 53211 (e-mail: dwoods@uwm.edu).