The Trichotillomania Impact Project (TIP): Exploring Phenomenology, Functional Impairment, and Treatment Utilization.

Douglas W. Woods, PhD; Christopher A. Flessner, MS; Martin E. Franklin, PhD; Nancy J. Keuthen, PhD; Renee D. Goodwin, PhD; Dan J. Stein, MD, PhD; Michael R. Walther, BA; the Trichotillomania Learning Center-Scientific Advisory Board

J Clin Psychiatry 2006;67(12):1877-1888

Article Abstract

Background: Trichotillomania (TTM) occurs in 0.6% to 3.4% of adults. Questions remain about phenomenological features of the disorder, its impact on functioning, and treatment utilization. The current study (i.e., The Trichotillomania Impact Project) was designed to provide initial information regarding these issues.

Method: An Internet-based survey was completed by 1697 individuals who self-reported symptoms consistent with a diagnosis of TTM (DSM-IV-TR). The survey assessed phenomenological experiences; social, occupational, academic, and psychological impact; as well as treatment-seeking experiences. The survey link operated from April 2005 through May 2005.

Results: Survey results suggest considerable variability in TTM phenomenology. Individuals with more severe TTM symptoms endorsed more frequent phenomenological experiences of physical or mental anxiety prior to pulling and relief, pleasure, or gratification after pulling. Mild to moderate life impairment in social, occupational, academic, and psychological functioning was reported for the entire study sample. These impairments were more pronounced as TTM symptoms became more severe. A summary of treatment seeking in the sample suggests that pharmacotherapy was the most commonly received treatment, followed by behavior therapy. Unfortunately, treatment in general was perceived as relatively ineffective.

Conclusion: This study underscores the clinical significance of severe hair pulling and highlights the need for research on its pathogenesis and treatment.