Where on the obsessive impulsive-compulsive spectrum does hair-pulling disorder belong?

OBJECTIVE: Hair-pulling disorder (HPD) is a putative obsessive-compulsive spectrum disorder, but proper categorization is challenging. Distinct subgroups of HPD may exist, depending on the primary motivation in the act of pulling. Two notable proposed subgroups are "relief pullers" (pulling primarily to reduce anxiety- a "compulsive" subgroup) and "pleasure/gratification pullers" (pulling primarily for reward- an "impulsive" subgroup) which we sought to examine in order to contribute to conversations on the categorization of HPD. METHODS: A total of 111 HPD subjects (mean age 33.7 ± 10.7 [range 18-61] years; 87.4% female) were included. Demographic and clinical characteristics were compared between subgroups (pleasure: n = 51; relief: n = 60); and cognitive performance where data were available (n = 29 per group) and 32 matched healthy controls. RESULTS: No significant demographic differences were noted between groups. Pleasure pullers were significantly more conscious of their pulling. Response inhibition and set shifting deficits were noted in HPD versus controls; however, pleasure and relief pullers did not differ significantly from each other on neurocognitive measures. CONCLUSIONS: The results suggest common clinical features and associated neural dysfunction between relief and pleasure/gratification pullers, rather than supporting their existence as discrete clinical entities. Selection of appropriate treatment may focus on other aspects of hair pulling, including family history and comorbidity.

Recreational gamblers with and without parental addiction.

Research has found that children who have parents with an addiction may be more vulnerable to developing psychopathology compared to children without parental addiction. We compared young adult, recreational gamblers with and without parental addiction on measures of gambling behavior and impulsivity. A total of 286 recreational gamblers (defined as having gambled at least five times in the past 12 months) between the ages of 18 and 29 participated in an initial intake of a longitudinal study assessing susceptibility to pathological gambling. Trained staff members interviewed subjects, and subjects completed cognitive testing and self-report measures. Fifty-three subjects (18.53%) reported at least one parent with an addiction (including alcohol and substance dependence and pathological gambling). Subjects with at least one addicted parent were significantly more likely to report problems resulting from gambling, have significantly greater rates of psychiatric comorbidity, and report significantly more current marijuana and tobacco use. Subjects with an addicted parent were not significantly different on measures of impulsivity. These findings suggest that even at a stage of low-risk gambling, before what has been considered a psychopathology arises, those with a possible environmental and/or genetic risk of addiction exhibit a range of problematic behaviors.

Selective decision-making deficits in at-risk gamblers.

Despite reasonable knowledge of pathological gambling (PG), little is known of its cognitive antecedents. We evaluated decision-making and impulsivity characteristics in people at risk of developing PG using neuropsychological tests. Non-treatment seeking volunteers (18-29 years) who gamble ≥ 5 times/year were recruited from the general community, and split into two groups: those "at risk" of developing PG (n=74) and those social, non-problem gamblers (n=112). Participants undertook the Cambridge Gamble and Stop-signal tasks and were assessed with the Mini-International Neuropsychiatric Interview and the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling. On the Cambridge Gamble task, the at-risk subjects gambled more points overall, were more likely to go bankrupt, and made more irrational decisions under situations of relative risk ambiguity. On the Stop-signal task, at-risk gamblers did not differ from the social, non-problem gamblers in terms of motor impulse control (stop-signal reaction times). Findings suggest that selective cognitive dysfunction may already be present in terms of decision-making in at-risk gamblers, even before psychopathology arises. These findings implicate selective decision-making deficits and dysfunction of orbitofronto-limbic circuitry in the chain of pathogenesis between social, non-problematic and pathological gambling.