Evidence map›Paper›PMID 31692297›Full record

ArticleBrain and behavior2019

Comorbidity in trichotillomania (hair-pulling disorder): A cluster analytical approach.

Christine Lochner, Nancy J Keuthen, Erin E Curley, Esther S Tung, Sarah A Redden, Emily J Ricketts, Christopher C Bauer, Douglas W Woods, Jon E Grant, Dan J Stein

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Brain and behavior, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.

  1. Pharmacotherapy for trichotillomania.The Cochrane database of systematic reviews · 2021
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  13. Natural recovery in trichotillomania.The Australian and New Zealand journal of psychiatry · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 2 countries.

Christine LochnerSA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.ORCID 0000-0002-4766-3704
Nancy J KeuthenDepartment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Erin E CurleyDepartment of Psychology, Temple University, Philadelphia, PA, USA.
Esther S TungDepartment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Sarah A ReddenDepartment of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
Emily J RickettsDepartment of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
Christopher C BauerDepartment of Psychology, Marquette University, Milwaukee, WI, USA.
Douglas W WoodsDepartment of Psychology, Marquette University, Milwaukee, WI, USA.
Jon E GrantDepartment of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
Dan J SteinSA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Marquette University · USSouth African Medical Research Council · ZABoston University · USFlorida State University · USHarvard University · USTemple University · USUniversity of California, Los Angeles · USUniversity of Chicago · US

Funding

Research Design, Data, and Analytics CoreP30DK092949 · NIDDK · UNIVERSITY OF CHICAGO · PI ELBERT S. HUANG · 2011 to 2026
$10.0M
NIDDK NIH HHS P30 DK092949
6 · The paper itself

Abstract

backgroundA promising approach to reducing the phenotypic heterogeneity of psychiatric disorders involves the identification of homogeneous subtypes. Careful study of comorbidity in obsessive-compulsive disorder (OCD) contributed to the identification of the DSM-5 subtype of OCD with tics. Here we investigated one of the largest available cohorts of clinically diagnosed trichotillomania (TTM) to determine whether subtyping TTM based on comorbidity would help delineate clinically meaningful subgroups.

methodsAs part of an ongoing international collaboration, lifetime comorbidity data were collated from 304 adults with pathological hair-pulling who fulfilled criteria for DSM-IV-TR or DSM-5 TTM. Cluster analysis (Ward's method) based on comorbidities was undertaken.

resultsThree clusters were identified, namely Cluster 1: cases without any comorbidities (n = 63, 20.7%) labeled "simple TTM," Cluster 2: cases with comorbid major depressive disorder only (N = 49, 16.12%) labeled "depressive TTM," and Cluster 3: cases presenting with combinations of the investigated comorbidities (N = 192, 63.16%) labeled "complex TTM." The clusters differed in terms of hair-pulling severity (F = 3.75, p = .02; Kruskal-Wallis [KW] p < .01) and depression symptom severity (F = 5.07, p = <.01; KW p < .01), with cases with any comorbidity presenting with increased severity. Analysis of the temporal nature of these conditions in a subset suggested that TTM onset generally preceded major depressive disorder in (subsets of) Clusters 2 and 3.

conclusionsThe findings here are useful in emphasizing that while many TTM patients present without comorbidity, depression is present in a substantial proportion of cases. In clinical practice, it is crucial to assess comorbidity, given the links demonstrated here between comorbidity and symptom severity. Additional research is needed to replicate these findings and to determine whether cluster membership based on comorbidity predicts response to treatment.

Indexed as

AdolescentAdultAgedComorbidityDiagnostic and Statistical Manual of Mental DisordersFemaleHumansMajor Depressive DisorderMaleMiddle AgedObsessive-Compulsive DisorderSeverity of Illness IndexTrichotillomaniaYoung Adultborderline personality disordercomorbiditydepressiontreatmenttrichotillomania

Identifiers

PMID31692297
PMCPMC6908854
OpenAlexW2983916955

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.