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Introduction: Trichotillomania is a heterogeneous disorder with a wide range of presentations. Past studies have described the phenomenology of trichotillomania, but individual differences based on the body site from which hair is pulled have not been thoroughly explored. Contextual variables relevant to pulling (e.g., settings, tool use) may vary as a function of pulling site. We constructed a detailed profile of individual and clinical characteristics based on pulling site and describe contextual factors associated with different pulling sites. Methods: Data were drawn from two randomized control trials of psychotherapy for trichotillomania. Participants included treatment-seeking adults with trichotillomania (N = 153; 89% women; Mage=33.41) who took part in either a face-to-face (n = 92) or an online (n = 61) trial. Study 1 explored differences in age, gender, trichotillomania symptom severity, and levels of automatic and focused pulling as a function of pulling site. Study 2 included a subset of Study 1 participants (n = 65) and examined pulling site differences for relevant contextual variables. Results: Study 1 revealed differences in age, gender, and level of automatic vs. focused pulling based on pulling site. Study 2 showed that pulling from different bodily sites was more likely to occur in specific settings and with certain tools. Discussion: These results reflect considerable variability in the phenomenology of trichotillomania across pulling sites and contribute to the overall understanding of trichotillomania. A clearer picture of contextual cues and clinical characteristics for different hair pulling sites has treatment implications. Clinical applications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Background: Trichotillomania (TTM) is a psychiatric disorder that leads to significant hair loss, distress, and impairment. Few validated measures exist to assess TTM, and psychometric research examining these tools is sparse. This study evaluated the psychometric properties of commonly used TTM severity measures and extended prior research by including hair loss severity ratings in our analyses. Methods: Participants included 91 adults (92.3% Female; M age = 35.0) with TTM who completed baseline assessments as part of a randomized clinical trial of psychotherapy for TTM. TTM measures included the Massachusetts General Hospital Hairpulling Scale (MGH-HS) and National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). Independent evaluators rated photos of participants' most severely affected pulling sites using a one-item hair loss severity scale. Results: Results showed mixed psychometric properties for TTM measures. The MGH-HS showed acceptable internal consistency (alpha = 0.83; omega = 0.89), while the NIMH-TSS had lower internal consistency (alpha = 0.52; omega = 0.73). Both the MGH-HS and NIMH-TSS demonstrated low test-retest reliability. Total scores on the MGH-HS and NIMH-TSS were not associated with hair loss severity. Conclusions: Given these findings, it is imperative to develop new, psychometrically-sound TTM measures. These results also emphasize the importance of a multi-method approach to TTM assessment. In addition to self-report and clinician-administered measures, hair loss severity ratings may offer valuable information as part of a comprehensive assessment of TTM. [ABSTRACT FROM AUTHOR]

The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoarding disorder as a distinct diagnosis in youth, and review the relationship between pediatric hoarding and other psychiatric disorders. Finally, we describe preliminary models of treatment for pediatric hoarding. We conclude that there is support for hoarding disorder as a distinct diagnosis in youth. However, more precise and developmentally appropriate assessment tools are needed to provide stronger evidence for this claim and to further our knowledge of prevalence and associated clinical characteristics. Although there is no evidence-based treatment for pediatric hoarding, preliminary evidence from case studies suggests that cognitive and behavioral methods may have promise. [ABSTRACT FROM AUTHOR]

Efforts to understand the nature of "Not Just Right Experiences" (NJREs) have expanded the scientific understanding of obsessive-compulsive (OC) behavior. Approximately 80% of unselected adults report experiencing NJREs and these experiences have been found to highly correlate with OC behavior. The purpose of this study was to assess NJREs in an unselected sample of adolescents (ages 14-17; N = 152), to compare their experience with adults (N = 237), and to assess the relation between NJREs and OC symptoms. Findings from questionnaires completed on the Internet were consistent with previous findings in adults, 81% of adolescents endorsed recently having an NJRE. Some reactions differed according to age: adults reported NJREs as more frequent and adolescents endorsed feeling more compelled to respond. Surprisingly, OC symptoms were not significantly related to NJREs in the adolescents. Implications, limitations, and future directions for the study of NJREs in youth are discussed. [ABSTRACT FROM AUTHOR]

Growing research has examined parental accommodation among the families of children with obsessive-compulsive disorder (OCD). However, these studies have utilized a parent-report (PR) version of a measure, the Family Accommodation Scale (FAS) that has never received proper psychometric validation. In turn, previously derived subscales have been developed via clinical rather than empirical evidence. This study aims to conduct a comprehensive psychometric analysis of the FAS-PR utilizing data collected from 96 youths with OCD. Exploratory factors analysis was conducted and revealed a 12-item scale yielding two separate, yet related subscales, Avoidance of Triggers (AT) and Involvement in Compulsions (IC). Subsequent analyses revealed good internal consistency and convergent and discriminant validity. These findings suggest that future research should seek to examine factors that may impact various facets to accommodation as well as the role these facets plays in predicting treatment outcome. Limitations are discussed. [ABSTRACT FROM AUTHOR]

The current study utilized a cross-sectional design to examine pulling severity, phenomenology, functional impact, and “focused” and “automatic” pulling styles in women with TTM across a wide age spectrum. “Automatic” pulling refers to pulling occurring primarily out of one’s awareness, while “focused” pulling refers to pulling with a compulsive quality that may include pulling in response to a negative emotional state (e.g., anxiety, stress, anger, etc.), an intense thought or urge, or in an attempt to establish symmetry. In the present study, data were collected from 1,471 female participants (age 10–69) meeting modified diagnostic criteria for TTM via two separate online surveys (one for children/adolescents, one for adults). Pulling severity remained stable across the different developmental cohorts. However, fluctuations in functional impact (e.g., social and interpersonal impairment) were noted. “Automatic” pulling showed relatively little fluctuation from adolescence to adulthood, while “focused” pulling demonstrated considerable fluctuation coinciding with psychological distress and typical ages of important biological changes (e.g., pubertal onset) in children/adolescents and adults (e.g., perimenopause). Conclusions, treatment implications, limitations, and future areas of research are discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This article describes the development of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), which was designed to assess “automatic” and “focused” pulling subtypes of trichotillomania (TTM). Participants reporting symptoms of TTM ( n = 1,697) completed an internet survey; participants were later randomly assigned to either Exploratory ( n = 848) or Confirmatory ( n = 849) Analyses. Exploratory Analyses examined the development and psychometric properties of the MIST-A. Results of an exploratory factor analysis revealed a two-factor solution. Factor 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of ten and five items respectively, with both scales demonstrating adequate internal consistency and good construct and discriminant validity. Subsequent confirmatory factor analysis demonstrated support for the scale’s underlying factor structure. The MIST-A provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, although replication using a clinically ascertained sample is necessary. [ABSTRACT FROM AUTHOR]

The current study examined the frequency and associated distress of both hairpulling and skin picking behaviors in 1,324 college students using the Massachusetts General Hospital Hairpulling Scale (MGHHS) and Skin Picking Scale (SPS). In this sample, many participants reported significant distress secondary to both hairpulling and skin picking. Participants who endorsed relatively frequent hairpulling or skin picking ( N = 72) were scheduled for a follow-up testing session to further assess the relationship between these behaviors and measures of affective distress. Compared to a control sample, the follow-up sample endorsed significantly more symptoms of anxiety and stress reactivity, and had higher scores on a measure of obsessive-compulsive symptoms. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has been shown to be a highly effective treatment for children and adults. In the current review, we briefly describe the historical developments of the treatment, and recent findings related to five areas of inquiry: 1) Does intensity of CBT impact outcome? 2) Does CBT work better on some subtypes of OCD than others? 3) How do cognitive and behavioral strategies relate to outcome? 4) How well does CBT work for children and adolescents with OCD? and 5) Does the combination of CBT and medication work better than CBT alone? After a discussion of these questions, we mention some areas currently being examined. [ABSTRACT FROM AUTHOR]

Interpretation bias, defined as the tendency to interpret ambiguous stimuli as threatening, is thought to play a central role in the maintenance of social phobia. However, the effect of cognitive-behavioral therapy (CBT) on this bias has not been determined. The present study examined interpretation bias in individuals with generalized social phobia (GSP) who had been treated with CBT, untreated GSPs, and nonanxious controls (NACs). Results indicated that untreated GSPs had higher negative bias scores than treated GSPs and NACs on a forced-choice measure of interpretation bias, although the latter two groups did not differ. Following study hypotheses, the interpretation bias found in untreated GSPs was specific to social items, and was evident when raters coded participants’ initial written responses to the scenarios, when compared with control subjects. Treated patients had open-ended responses that did not differ from controls or untreated GSPs. Findings are discussed in the context of other GSP interpretation bias studies, and future research directions are recommended. [ABSTRACT FROM AUTHOR]

Interpretation bias, defined as the tendency to interpret ambiguous stimuli as threatening, is thought to play a central role in the maintenance of social phobia. However, the effect of cognitive-behavioral therapy (CBT) on this bias has not been determined. The present study examined interpretation bias in individuals with generalized social phobia (GSP) who had been treated with CBT, untreated GSPs, and nonanxious controls (NACs). Results indicated that untreated GSPs had higher negative bias scores than treated GSPs and NACs on a forced-choice measure of interpretation bias, although the latter two groups did not differ. Following study hypotheses, the interpretation bias found in untreated GSPs was specific to social items, and was evident when raters coded participants’ initial written responses to the scenarios, when compared with control subjects. Treated patients had open-ended responses that did not differ from controls or untreated GSPs. Findings are discussed in the context of other GSP interpretation bias studies, and future research directions are recommended. [ABSTRACT FROM AUTHOR]

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed. [ABSTRACT FROM AUTHOR]

Probability and emotional impact estimates of intense positive and negative social events were examined in individuals with generalized social phobia (GSPs), obsessive compulsive disorder (OCDs), and nonanxious controls (NACs). Participants completed a questionnaire containing 20 event descriptions. For each event, they indicated the probability that the event would happen to them and rated aspects of their reactions to the event: magnitude, duration, self-esteem change, and strength of bodily reaction. Compared to NACs, GSPs estimated positive events as less likely and negative events as more likely to happen to them. GSPs rated the impact of both negative and positive social events higher than did NACs. Moreover, GSPs anticipated experiencing more frequent and intense negative reactions to positive social events than did NACs. On most measures, GSPs also differed from OCDs. Although evaluation biases of social events may be more characteristic of anxious individuals than of nonanxious individuals, they appear to be particularly related to social phobia. [ABSTRACT FROM AUTHOR]

Trichotillomania is currently classified as an impulse control disorder not otherwise classified, whereas body-focused behaviors other than hair-pulling may be diagnosed as stereotypic movement disorder. A number of disorders characterized by repetitive, body-focused behaviors (eg, skin-picking) are prevalent and disabling and may have phenomenological and psychobiological overlap. Such disorders deserve greater recognition in the official nosology, and there would seem to be clinical utility in classifying them in the same diagnostic category. [ABSTRACT FROM AUTHOR]