Trichotillomania, skin picking disorder, and stereotypic movement disorder: toward DSM-V

Depression and Anxiety (Impact Factor: 4.41). 06/2010; 27(6):611 - 626. DOI: 10.1002/da.20700
Source: PubMed


In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Although TTM fits optimally into a category of body-focused repetitive behavioral disorders, in a nosology comprised of relatively few major categories it fits best within a category of motoric obsessive–compulsive spectrum disorders, (2) available evidence does not support continuing to include (current) diagnostic criteria B and C for TTM in DSM-V, (3) the text for TTM should be updated to describe subtypes and forms of hair pulling, (4) there are persuasive reasons for referring to TTM as “hair pulling disorder (trichotillomania),” (5) diagnostic criteria for skin picking disorder should be included in DSM-V or in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and (6) the diagnostic criteria for stereotypic movement disorder should be clarified and simplified, bringing them in line with those for hair pulling and skin picking disorder. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.

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    • "In this model, the behavioral components (avoidance, obsessive and safety behaviors)—the cognitive components (core beliefs, intermediate beliefs, automatic thoughts)—the metacognitive components (positive and negative metacognitive beliefs and metacognitive strategies) have been considered in explaining SPD. The findings of the study are consistent with (Stein et al., 2010) in terms of the relationship between cognitive components and SPD. Among the reasons for this relationship, it can be noted that in these patients the underlying beliefs are more general, inflexible, rigid, negative and irrational that cause mind's natural processes associate with cognitive distortions, leading to an increase in negative automatic thoughts in these patients. "
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    ABSTRACT: The purpose of the present study is to provide an overview of the disorder and develop a new be-havioral-cognitive-metacognitive model to explain it. The present study is a descriptive-correla-tional research which uses the structural equation model. In this study, at first, a comprehensive and detailed explanation of skin picking disorder is presented. Then the conceptual model is presented and finally, the model which is developed by using structural equation model is tested by Amos Graphics. The results of the structural equation model showed that the developed model in this study is able to explain skin picking disorder. Also the results of the overall fit indices for structural equation modeling show that the developed model has good fit to the sample data and is closely associated with the theoretical assumptions. Since the model presented in this study is multi-dimensional and takes into consideration all of the three behavioral, cognitive, metacogni-tive dimensions and these three dimensions are considered interdependent and not dependent and contradictory, it is considered as a new explanatory model. The model may prompt future researches into skin picking disorder and facilitate clinical treatments and case formulations associated with this disorder.
    Psychology 08/2015; 6(10):1223-1231. DOI:10.4236/psych.2015.610120
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    • "Hair pulling behaviors are common in the general population (Duke et al., 2009), with between 1% and 3% of adults reporting clinically significant hair pulling (Christenson et al., 1991b). Hair pulling disorder, commonly referred to as trichotillomania (TTM), is characterized by excessive hair pulling that can be automatic (e.g., outside of awareness) or focused (e.g., consciously pulled) in nature (American Psychiatric Association, 2013; Stein et al., 2010). Individuals with TTM frequently experience co-occurring anxiety disorders, depressive disorders, and other body-focused repetitive behaviors (Duke et al., 2010; Panza et al., 2013). "
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    ABSTRACT: Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES= 1.41, p< 0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p= 0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p= 0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES= 0.41, p= 0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.
    Journal of Psychiatric Research 11/2014; 58. DOI:10.1016/j.jpsychires.2014.07.015 · 3.96 Impact Factor
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    • "Excoriation disorder includes chronic skin picking not attributable to substance use or a medical condition despite attempts to stop and results in tissue damage and clinically significant impairment in social, school, or occupational functioning. The prevalence of chronic skin picking in adults is between 1.4% and 13% (American Psychiatric Association, 2013; McGuire et al., 2012; Stein et al., 2010); however, less is known regarding prevalence in children, but females are clearly more likely to engage in skin picking than males (McGuire et al., 2012). "
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    ABSTRACT: This case study included functional assessment and treatment of trichotillomania and skin picking by a 6-year old female kindergarten student of typical development. The school's behavior specialist provided assessment and treatment services in the school setting. Functional assessment included indirect assessment (i.e., teacher completed functional assessment rating scale and follow-up interview) followed by a brief functional analysis. The behavior specialist used functional assessment data to individually tailor a simplified habit reversal intervention, which effectively treated trichotillomania and skin picking. Treatment gains maintained at 3-month follow-up. Results from this case study may be used to inform assessment and treatment of trichotillomania and skin picking across school and clinical settings.
    Journal of Obsessive-Compulsive and Related Disorders 07/2014; 3(3). DOI:10.1016/j.jocrd.2014.06.006 · 1.18 Impact Factor
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