Clinical characteristics of natural recovery in trichotillomania and skin picking disorder.

Background: Approximately 25% of people with trichotillomania recover without receiving formal treatment. Rates of natural recovery in skin picking disorder are unknown. More importantly, variables that predict natural recovery in trichotillomania and skin picking disorder have been understudied. This study aims to examine these variables in a sample of individuals with trichotillomania and/or skin picking disorder. Methods: 21 adults (76.2% trichotillomania only, 14.3% skin picking disorder only, 9.5% both; 85.7% female; mean age=32.19, SD = 10.21) who reported naturally recovering (i.e., not meeting full DSM-5 diagnostic criteria in the previous 12 months) from trichotillomania or skin picking disorder completed a virtual interview and self-report forms. The mean number of years since criteria was unmet was 5.95 (SD = 6.27). 41 participants with current trichotillomania or skin picking disorder were matched to naturally recovered participants on sex, diagnosis, and age (mean age=31.02, SD = 7.95; 2 matches for each participant except for one participant who has 1 match). They were compared on demographics, clinical characteristics, and treatment history. Results: When asked about their pulling or picking at its worst, there were no significant differences in self-reported days per week or time per day spent pulling or picking, or functional interference from pulling or picking. Participants with current trichotillomania or skin picking disorder reported greater distress from their pulling or picking, but this did not remain significant after controlling for current comorbidities. Naturally recovered participants were significantly less likely to have a current comorbid psychiatric disorder, specifically depression and ADHD. However, they were significantly more likely to have a lifetime substance use disorder and current alcohol use disorder. In total, 77.8% of participants either still pulled or picked occasionally and/or replaced it with another behavior. Conclusion: Although it may seem intuitive that those who naturally recover can do so because their disorder is less severe, these results indicate that severity was not associated with natural recovery. Given the persistence of subclinical symptoms after natural recovery, the effectiveness of natural recovery over recovery via treatment is questionable. A major limitation of this study is its small sample size and limited power. Future research should use larger sample sizes and further explore potential differences in comorbidities.