(PS3-D80) SCAMP: Development of a Test of Hair Pulling

Trichotillomania (TTM) is a chronic hair pulling disorder (1.7% prevalence rate; Grant et al., 2020). The three main criteria for a TTM diagnosis are recurrent self-hair pulling, repeated attempts to limit or decrease hair pulling and clinically significant functional distress/impairment due to hair pulling (DSM 5). While previously used interventions such as Habit Reversal Therapy (HRT), Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have shown some success in symptom improvement and distress relief, issues of increased rates of relapse, lack of formalized follow-ups and inability to comprehensively capture TTM presentation remain. The Comprehensive Behavioral (ComB) model of TTM is proposed as an alternative intervention to take into account the heterogeneity of TTM development and presentation and address the antecedents and consequences of hair pulling behavior (Mansueto et al., 1999). The ComB model involves identification of 5 antecedent domains of hair pulling namely Sensory, Cognitive, Affective, Motoric, and Place domains (i.e., SCAMP model). The current study aimed to develop a standardized cue-based assessment “Hair Pulling Questionnaire” (HPQ) for TTM antecedents to allow for a more rigorous testing of the ComB model and to generate a cue-based measure for use across various interventions.

The project included 2 studies using measures of demographics, provisional HPQ measures (27-item Study 1, 60-item Study 2), , Milwaukee Inventory for Styles of Trichotillomania-Adult-Revised (MIST-A-Revised; Keuthen et al., 2015) for hair pulling styles, The Massachusetts General Hospital – Hair Pulling Scale (MGH-HPS, Keuthen et al., 1995) for symptom severity, and the 10-item Big Five Inventory (Rammstedt & John, 2007) for assessing personality dimensions.

 Study 1 (n = 277, 97.1% female, 90% White, Median_age 32 years) focused on test development and analysis of a provisional 30-item measure with apriori work on test content and empirical testing of a final 27-item measure. Study 2 (n=184, 90.5% female, 90% white, M_age = 35.53) focused on evaluating a revised and expanded 60-item HPQ measure developed after analysis from Study 1.

 Study 2 resulted in a final 49-item hair pulling measure (HPQ) with the small to medium intercorrelations among the SCAMP domains suggesting a level of empirical independence. Endorsement of Sensory, Affective and Place domains was negatively associated with age. All SCAMP domains, except Cognitive, were positively associated with symptom severity. Those high on Intentional hair pulling reflected lower scores in Motoric and Place domains, and higher scores on the Cognitive domain. Those high in Emotional hair pulling were highly likely to endorse the Affective cue domain. The Sensory, Affective and Motoric domains were positively associated with Neuroticism. The Sensory domain was also negatively associated with Conscientiousness. Lastly, the Affective and Place domains were negatively and positively associated with Extraversion respectively. The HPQ could be used to understand TTM heterogeneity and develop a cue-based profile for individuals (e.g. high sensory and low affective) allowing for easier selection and implementation of cue-matched interventions.