The Trichotillomania Scale for Children: Development and Validation

The Institute of Living, Anxiety Disorders Center, 200 Retreat Avenue, Hartford, CT 06106, USA.
Child Psychiatry and Human Development (Impact Factor: 1.93). 10/2008; 39(3):331-49. DOI: 10.1007/s10578-007-0092-3
Source: PubMed


Trichotillomania (TTM) is a chronic impulse control disorder characterized by repetitive hair-pulling resulting in alopecia. Although this condition is frequently observed in children and adolescents, research on pediatric TTM has been hampered by the absence of validated measures. The aim of the present study was to develop and test a new self-report measure of pediatric TTM, the Trichotillomania Scale for Children (TSC), a measure that can be completed by children and/or their parents. One hundred thirteen children meeting self-report criteria for TTM, and 132 parents, provided data over the internet. An additional 41 child-parent dyads from an outpatient clinic also provided data. Replicated principal components analysis, with elimination of poorly-loading items, yielded two components, which we labeled Severity (five items) and Distress/Impairment (seven items). The TSC total score and subscales showed adequate internal consistency and test-retest reliability. Parent-child agreement was good in the internet sample, but more modest in the clinic sample. Children's TSC scores correlated significantly with other measures of TTM severity, although some exceptions were noted. Parents' TSC scores correlated significantly with other measures of parent-rated TTM severity in the internet sample, but showed more attenuated relationships with child- and interviewer-rated TTM severity in the clinic sample. The present results suggest that the TSC may be a useful measure of TTM for child and adolescent samples, although additional clarification of convergent validity is needed.

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Available from: David F Tolin, Jan 27, 2014
    • "Hair pulling seems to affect females with increased incidence compared to males in non-clinical adult samples (Woods et al., 2006). Those who pull their hair are at risk for heightened social impairment, increased comorbidities, and functional disability (Duke et al., 2009; Lochner, Seedat, & Stein, 2010; Tolin et al., 2008). Childhood trichotillomania is associated with the presence of clinically significant anxiety (Reeve, Bernstein, & Christenson, 1992; Santhanam, Fairley, & Rogers, 2008; Tolin, Franklin, Diefenbach, Anderson, & Meunier, 2007), disruptive behavior, attentional problems (King, Scahill, Vitulano, & Schwab-Stone, 1995; Tolin et al., 2007), and other body focused repetitive behaviors (e.g., thumb sucking, nail biting, lip biting, and cheek chewing; Flessner, Woods, Franklin, Keuthen, & Piacentini, 2009; Orange, Peereboom-Wynia, & DeRaeymaecker, 1986; Reeve et al., 1992; Santhanam et al., 2008; Simeon et al., 1997). "
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    ABSTRACT: Body-focused repetitive behaviors (BFRBs; e.g., hair pulling, skin picking, and nail biting) can cause significant physical and psychological distress. However, data examining BFRBs in non-clinical youth is limited. This study examined parent-reports of the incidence and clinical correlates of BFRBs in 315 Salvadorian children (4–17 years). Forty-six percent had at least one BFRB; nail biting was commonly reported (34.6%), followed by skin picking (24.8%), and hair pulling (10.5%). Of those endorsing BFRBs, 13.7% reported elevated distress and/or interference due to these behaviors, including approximately one third of skin pickers and hair pullers (8.3% and 2.9% of the total sample) and one fifth of nail biters (7.3% of the total sample). Skin pickers and hair pullers, but not nail biters, had higher levels of internalizing and externalizing behaviors, poorer adaptive functioning, and more difficulties with inattention, compared to those who reported no BFRBs. Skin picking symptom severity was positively correlated with externalizing and internalizing behaviors. Nail biting symptom severity was associated with increased internalizing symptoms, while severity of hair pulling was not significantly associated with behavioral and emotional functioning. These data suggest that BFRBs are commonplace and may be associated with behavioral and emotional functioning.
    No preview · Article · Feb 2015 · Journal of Obsessive-Compulsive and Related Disorders
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    • "In order of preference, preferred clinician-rating scales included the National Institute of Mental Health-Trichotillomania Severity Scale (NIMH-TSS; Swedo et al., 1989), Psychiatric Institute Trichotillomania Scale (PITS; Winchel et al., 1992), and the Yale-Brown Obsessive Compulsive Scale modified for Trichotillomania (Y-BOCS- TTM; Stanley et al., 1999). In the absence of clinician ratings, selfreport measures of hair pulling severity were preferred, which included the MGH-HPS (Keuthen et al., 1995; O'Sullivan et al., 1995) and the Trichotillomania Scale for Children and Parents (Tolin et al., 2008). When standardized ratings scales were unavailable, selfreported ratings of hair pulling severity were utilized that included weekly ratings of hair pulling severity (Christenson et al., 1991a; Streichenwein and Thornby, 1995), and the number of daily hair pulling episodes (Azrin et al., 1980). "
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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.
    Full-text · Article · Nov 2014 · Journal of Psychiatric Research
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    • "Trichotillomania Scale for Children-Child version (TSC-C). The TSC-C (Tolin et al., 2008) is a 12-item measure of HP. It consists of severity and distress/impairment subscales. "
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    ABSTRACT: Background and aims: Trichotillomania (TTM) often first presents in adolescence, a developmental period marked by vulnerability in body image. To date, no one has studied the relationship between this disorder and body esteem. Methods: 49 adolescents with DSM-IV TTM or chronic hair pulling (HP) and 23 control adolescents were administered diagnostic assessments and self-report measures of hair pulling and body esteem. Results: HP youth vs. controls reported lower levels of body esteem on all Body-Esteem Scale for Adolescents and Adults (BESAA) subscales (appearance, attribution and weight satisfaction). HP contributed to lowered body esteem, independent of comorbid anxiety or depression. As expected, HP youth with vs. without comorbid anxiety or depression reported lowered levels of body esteem. Further, greater HP severity and distress were significantly associated with lower levels of body esteem. HP severity alone but not distress/impairment predicted lower levels of body esteem, independent of comorbid anxiety and depression. Conclusions: Both hair pulling and comorbid anxiety and depression can independently impact body esteem in adolescent hair pullers.
    Full-text · Article · Jun 2014 · Journal of Behavioural Addictions
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