Acceptance-enhanced behavior therapy for trichotillomania: Randomized controlled trial rationale, method, and strategies for recruiting minority participants.

Trichotillomania (TTM) involves the chronic pulling out of hair to the point of hair loss or thinning, which continues despite repeated attempts to stop. Behavior therapy is a promising treatment for the condition, but studies have been limited by the lack of a credible control condition, small sample sizes, follow-up periods of short duration, and low participation by underrepresented populations. In the current article, the authors describe the theoretical rationale for an acceptance-enhanced form of behavior therapy for TTM in adults and describe the methodology used to test the efficacy of this intervention against a psychoeducation and supportive control condition. In addition, the authors discuss the importance of and difficulties encountered with enrolling minority participants into TTM research, as well as strategies used to enhance minority recruitment. Finally, the authors discuss the instruments, procedures, and related outcomes of the fidelity measures used in the randomized controlled trial.

A retrospective review of 12 patients with trichotillomania treated in a psychodermatology service.

Trichotillomania is a condition characterized by the pulling of hair from anywhere on the body and is classified as an obsessive-compulsive and related disorder. Patients with hair disorders are commonly referred to psychodermatology services, and can represent a management challenge. Few publications exist that report outcomes for patients with trichotillomania in real clinical practice. We report 12 such patients seen within our own psychodermatology service, who were managed using a variety of treatment strategies. The rate of defaulting of appointments was high, but improvements were seen in patients engaging with services.

Race/Ethnicity and Treatment Outcome in a Randomized Controlled Trial for Trichotillomania (Hair-Pulling Disorder).

OBJECTIVE: Treatment outcome was compared among non-Hispanic White and racial/ethnic minority participants with trichotillomania (TTM), or hair-pulling disorder. METHOD: Symptom severity, quality of life, and TTM-related disability were compared in a behavior therapy trial with a stepped care approach: web-based self-help and then individual behavior therapy. The sample comprised 72% (n = 38) non-Hispanic White participants and 28% (n = 15) minority participants. RESULTS: The ethnic groups responded differently to treatment, with fewer minority participants showing improvement during web-based self-help. Response rates were equivalent between ethnic groups during the in-person behavior therapy. These results should be interpreted with caution because of the small sample size of minorities in the study and consequent inability to analyze results for each racial/ethnic group individually. CONCLUSIONS: Future studies should focus on the investigation of factors that may enable or hinder racial and ethnic minority participants to benefit from online and/or self-help behavior therapy for TTM.

A systematic approach to Afro-textured hair disorders: dermatoscopy and when to biopsy.

Trichoscopy facilitates the diagnosis of various hair and scalp disorders and is often useful in predicting the disease course. However, to date, few studies describe the dermoscopic findings unique to Afro-textured hair. This article reviews what is currently known regarding trichoscopy and discusses its usefulness in this population.

Trichotillomania symptoms in African American women: are they related to anxiety and culture?

Trichotillomania (TTM) is a little understood disorder that has been underresearched in the African American community. Furthermore, the incorporation of cultural factors into TTM research has virtually been ignored. Existing data from an African American college student population suggest TTM is associated with high levels of anxiety. In this study, we explored anxiety symptoms and cultural hair messages in an African American female community sample with TTM symptoms. We predicted high levels of TTM severity and impairment would be associated with high level of anxiety symptoms. We also predicted that cultural messages about hair will influence both TTM and anxiety symptoms. In this telephone study, 41 African American females participated in interviews about their TTM. TTM impairment and severity was positively correlated with general anxiety symptoms as measured on the Symptom Checklist 90-Revised (SCL 90-R(®) ). Severity was also positively correlated with obsessive-compulsive symptoms. Given the significance of hair for African American women, we also explored the childhood cultural messages receive about hair. Over half the sample received at least one cultural message about hair. Although many women received the same message, the value they placed on the message differed. Messages received about hair were not associated with TTM severity or impairment. The association among obsessive-compulsive symptoms and hair messages approached significance. Results highlight the importance of assessing anxiety comorbidity and culture with African American TTM samples. Little is known about TTM in African American samples. Existing research indicates this population seeks TTM help from their hairdressers. Among college students, a significant correlation has been found for anxiety as measured on the Beck Anxiety Inventory and TTM. To the best of our knowledge, this is the first paper to examine cultural messages about hair in an African American sample. In addition, rather than looking at college students, this research is conducted with a community sample of mostly professional African American women. The use of the SCL-90-R(®) specific anxiety dimensions demonstrates the relationship with TTM severity and impairment.

Ethnic differences in trichotillomania: phenomenology, interference, impairment, and treatment efficacy.

In this Internet study, we explore differences among minority and Caucasian participants in the phenomenology of, interference and impairment related to, and perceived efficacy of treatments for trichotillomania (TTM) symptoms. A demographic difference was found for number of children only. Results indicate that the minority sample was less likely to report pulling from their eyebrows and eyelashes than the Caucasian sample. Minorities were less likely to report increased tension before a pulling episode. Minorities reported high levels of TTM interference with home management but Caucasians reported higher TTM interference with their academic life. Caucasians with TTM reported higher daily stress than their minority counterparts. Although minorities were less likely to utilize treatment, no significant differences were found for treatment improvement. This Internet study sheds important light on differences in TTM symptoms among minorities and Caucasians. The lack of economic and education differences between groups is a strength of this research.

Hair pulling and its affective correlates in an African-American university sample.

Like other clinical phenomena, repetitive hair pulling in African-Americans has attracted little systematic investigation. Slightly over 200 participants were recruited from a historically black university. Participants completed the Hair Pulling Scale [Stanley, M. A., Borden, J. W., Bell, G. E., & Wagner, A. L. (1994). Nonclinical hair pulling: phenomenology and related psychopathology. Journal of Anxiety Disorders, 8, 119-130], the Beck Depression Inventory, and the Beck Anxiety Inventory (BAI). Ten percent of the African-American sample thought about pulling out hair and 6.3% actually pulled out hair. A variety of types of affect was reported before, during, and after pulling or picking. Several statistically significant relationships were found: status as a person who thinks about pulling out hair is significantly correlated with anxiety as measured by the BAI (r=.265, p=.000), status as a person who pulls hair is significantly correlated with anxiety as measured by the BAI (p=.192, r=.007). Implications are discussed.

Affective states and racial identity among African-American women with trichotillomania.

Affective correlates of hair pulling were investigated in a sample of 43 African-American women with trichotillomania. The relationship among affective correlates and dimensions of racial identity was also examined. Via phone interview, participants completed the hair-pulling survey on which they rated the intensity of 10 different affective states across three different points in the hair-pulling episode (before, during and after). Participants also completed the Multidimensional Inventory of Racial Identity, which assesses racial identity across the dimensions of centrality, regard and ideology. Univariate analyses identified the feelings of being bored, happy, anxious, guilty and relieved as reflecting a time difference. Negative correlations were found among the racial identity dimension of private regard and the affective correlates of happy and relief that were experienced during and after pulling. Negative correlations were found between the racial identity dimension of humanist ideology and relieved affect as well as humanist ideology and relieved affect during a pulling episode. In light of the results, the importance of understanding and assessing cultural factors in the affective experience of African-American women with trichotillomania is discussed.

Trichotillomania. Two case reports from a similar cultural background.

Case reports of 2 female patients from the Makrani culture are presented. They were both around 30 years of age, clinically depressed and responded favorably to antidepressants. One of these patients was infertile, and the other one had started pulling her hair when deprived of her jewelry. Fertility and possession of jewelry represent femininity in the Makrani culture. A brief review of the literature on trichotillomania and its psychopathology is also included.