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Statistical predictors of psychosocial impairment in body-focused repetitive behaviors

Published online by Cambridge University Press:  30 April 2021

Jon E. Grant Open the ORCID record for Jon E. Grant [Opens in a new window] ,
Ibrahim H. Aslan  and
Samuel R. Chamberlain
Jon E. Grant*
Affiliation:
Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
Ibrahim H. Aslan
Affiliation:
Department of Psychiatry, University of Southampton, Southampton, United Kingdom
Samuel R. Chamberlain
Affiliation:
Department of Psychiatry, University of Southampton, Southampton, United Kingdom Department of Psychiatry, University of Cambridge & Cambridgeshire/Peterborough NHS Foundation Trust, Cambridge, United Kingdom
*
*Author for correspondence: Jon E. Grant, JD, MD, MPH Email: jongrant@uchicago.edu
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Abstract

Background

Skin picking disorder and trichotillomania, also characterized as body-focused repetitive behaviors (BFRBs), often lead to functional impairment. Some people with BFRBs, however, report little if any psychosocial dysfunction. There has been limited research as to which clinical aspects of BFRBs are associated with varying degrees of functional impairment.

Methods

Adults (n = 98), ages 18 to 65 with a current diagnosis of trichotillomania (n = 37), skin picking disorder (n = 32), trichotillomania plus skin picking disorder (n = 10), and controls (n = 19) were enrolled. Partial least squares regression (PLS) was used to identify variables associated with impairment on the Sheehan Disability Scale.

Results

PLS identified an optimal model accounting for 45.8% of variation in disability. Disability was significantly related to (in order of descending coefficient size): severity of picking, perceived stress, comorbid disorders (specifically, anxiety disorders / obsessive–compulsive disorder), trait impulsivity, family history of alcohol use disorder, atypical pulling/picking sites, and older age.

Conclusions

At present mental disorders are viewed as unitary entities; however, the extent of impairment varies markedly across patients with BFRBs. These data suggest that whereas symptom nature/severity is important in determining impairment, so too are other variables commonly unmeasured in clinical practice. Outcomes for patients may thus be maximized by rigorously addressing comorbid disorders; as well as integrating components designed to enhance top-down control and stress management. Interestingly, focused picking and emotional pulling were linked to worse disability, hinting at some differences between the two types of BFRBs, in terms of determinants of impairment.

Keywords

Trichotillomaniaskin pickingdisabilitydysfunctionimpairmentpredictors
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 5 , October 2022 , pp. 621 - 625
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
Stein, DJ, Flessner, CA, Franklin, M, et al. Is trichotillomania a stereotypic movement disorder? An analysis of body-focused repetitive behaviors in people with hair-pulling. Ann Clin Psychiatry. 2008;20(4):194–198.CrossRefGoogle ScholarPubMed
Tucker, BT, Woods, DW, Flessner, CA, et al. The Skin Picking Impact Project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. J Anxiety Disord. 2011;25(1):88–95. doi:10.1016/j.janxdis.2010.08.007.CrossRefGoogle Scholar
Tung, ES, Tung, MG, Altenburger, EM, et al. The relationship between hair pulling style and quality of life. Ann Clin Psychiatry. 2014;26(3):193–198.Google ScholarPubMed
Cavic, ES, Valle, SR, Chamberlain, SR, et al. Sleep quality and its clinical associations in trichotillomania and skin picking disorder. Compr Psychiatry. 2021;105:152221. doi:10.1016/j.comppsych.2020.152221.CrossRefGoogle ScholarPubMed
Franklin, ME, Flessner, CA, Woods, DW, et al. The child and adolescent trichotillomania impact project: descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr. 2008;29(6):493–500. doi:10.1097/DBP.0b013e31818d4328.CrossRefGoogle ScholarPubMed
Woods, DW, Flessner, CA, Franklin, ME, et al. The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry. 2006;67(12):1877–1888.CrossRefGoogle ScholarPubMed
Lewin, AB, Piacentini, J, Flessner, CA, et al. Depression, anxiety, and functional impairment in children with trichotillomania. Depress Anxiety. 2009;26(6):521–527. doi:10.1002/da.20537.Google ScholarPubMed
Grant, JE, Redden, SA, Leppink, EW, et al. Psychosocial dysfunction associated with skin picking disorder and trichotillomania. Psychiatry Res. 2016;239:68–71. doi:10.1016/j.psychres.2016.03.004.CrossRefGoogle ScholarPubMed
Huppert, JD, Simpson, HB, Nissenson, KJ, et al. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety. 2009;26(1):39–45. doi:10.1002/da.20506.CrossRefGoogle Scholar
Jacoby, RJ, Leonard, RC, Riemann, BC, et al. Predictors of quality of life and functional impairment in obsessive–compulsive disorder. Compr Psychiatry. 2014;55(5):1195–1202. doi:10.1016/j.comppsych.2014.03.011.CrossRefGoogle ScholarPubMed
Mancebo, MC, Greenberg, B, Grant, JE, et al. Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Compr Psychiatry. 2008;49(1):43–50. doi:10.1016/j.comppsych.2007.05.016.CrossRefGoogle Scholar
Storch, EA, Larson, MJ, Muroff, J, et al. Predictors of functional impairment in pediatric obsessive-compulsive disorder. J Anxiety Disord. 2010;24(2):275–283. doi:10.1016/j.janxdis.2009.12.004.CrossRefGoogle ScholarPubMed
Bennett, F, Hodgetts, S, Close, A, et al. Predictors of psychosocial outcome of bipolar disorder: data from the Stanley Foundation Bipolar Network. Int J Bipolar Disord. 2019;7(1):28. doi:10.1186/s40345-019-0169-5.CrossRefGoogle ScholarPubMed
Marques, L, LeBlanc, N, Robinaugh, D, et al. Correlates of quality of life and functional disability in individuals with body dysmorphic disorder. Psychosomatics. 2011;52(3):245–254. doi:10.1016/j.psym.2010.12.015.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, et al., The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22–33.Google ScholarPubMed
Sheehan, DV, Harnett-Sheehan, K, Raj, BA. The measurement of disability. Int Clin Psychopharmacol 1996;11(Suppl 3):89–95.CrossRefGoogle ScholarPubMed
Keuthen, NJ, Tung, ES, Woods, DW, et al. Replication study of the Milwaukee inventory for subtypes of trichotillomania-adult version in a clinically characterized sample. Behav Modif. 2015;39(4):580–599. doi:10.1177/0145445515580533.CrossRefGoogle Scholar
Keuthen, NJ, O’Sullivan, RL, Ricciardi, JN, et al. The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and factor analyses. Psychother Psychosom. 1995;64(3–4):141–145.CrossRefGoogle ScholarPubMed
Walther, MR, Flessner, CA, Conelea, CA, et al. The Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS): initial development and psychometric properties. J Behav Ther Exp Psychiatry. 2009;40(1):127–135. doi:10.1016/j.jbtep.2008.07.002.CrossRefGoogle ScholarPubMed
Snorrason, I, Olafsson, RP, Flessner, CA, et al. The Skin Picking Impact Scale: factor structure, validity and development of a short version. Scand J Psychol. 2013;54(4):344–348. doi:10.1111/sjop.12057.CrossRefGoogle ScholarPubMed
Taylor, JM. Psychometric analysis of the Ten-Item Perceived Stress Scale. Psychol Assess. 2005;27(1):90–101. doi:10.1037/a0038100.CrossRefGoogle Scholar
Hook, RW, Grant, JE, Ioannidis, K, et al. Trans-diagnostic measurement of impulsivity and compulsivity: a review of self-report tools. Neurosci Biobehav Rev. 2021;120:455–469. doi:10.1016/j.neubiorev.2020.10.007.CrossRefGoogle ScholarPubMed
Patton, JH, Stanford, MS, Barratt, ES. Factor structure of the Barratt impulsiveness scale. J. Clin. Psychol. 1995;51(6):768–774.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Stanford, MS, Mathias, CW, Dougherty, DM, et al. Fifty years of the Barratt Impulsiveness Scale: an update and review. Personality Indiv Differ. 2016;47(5):385–395.CrossRefGoogle Scholar
Höskuldsson, A. PLS regression methods. J Chemometr. 1988;2(3):211–228. doi:10.1002/cem.1180020306.CrossRefGoogle Scholar
Wold, S. Personal memories of the early PLS development. Chemometr Intell Lab Syst. 2001;58:83–84.CrossRefGoogle Scholar
Wold, S, Sjöström, M, Erikkson, L. PLS-regression: a basic tool of chemometrics. Chemometr Intell Lab Syst. 2001;58(2, 28):109–130.CrossRefGoogle Scholar
Grant, JE, Peris, TS, Ricketts, EJ, et al. Subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder using mixture modeling in a multicenter sample. J Psychiatr Res. 2020;S0022–3956(20):31057–31058. doi:10.1016/j.jpsychires.2020.11.001.Google Scholar