(PS9-C65) Comorbidities Among Youth with Trichotillomania

Objective.  The heterogeneity of trichotillomania (TTM) presentations remains understudied, specifically in examing the role of psychiatric comorbidity in TTM. Previous studies have found that the presence of any comorbidity was associated with greater self-reported TTM severity  in adults (Lochner et al., 2019). To our knowledge, no studies have examined how youth with TTM who have co-occurring psychiatric disorders differ from those who do not. We investigated the frequency of different specific comorbid conditions among youth with TTM and the association between the total number of comorbidities and clinician-rated TTM severity. We also examined the differences in clinical presentation of youth with TTM who have a comorbidity, compared to those with TTM that do not have the respective co-occurring diagnoses. 

Method.  The present study used baseline data from the Behavior Therapy for Pediatric TTM study, an efficacy study conducted at the University of Pennsylvania. 44 youth ages 10-17 (M = 13.32, SD = 2.4) with a primary DSM-5 diagnosis of TTM with complete baseline data on comorbidity as rated by the clinician-administered ADIS-IV were included in the current study. The relationship between total number of comorbidities and clinician-rated TTM severity was examined using a bivariate correlation. Differences in clinical characteristics (age, pulling style, premonitory urge, family functioning, and total number of pulling sites) between youth with TTM and a specific co-occurring psychiatric disorder and youth with TTM without that respective diagnosis were examined using independent samples t-tests.

Results.  On average, 31.8% participants had at least one psychiatric comorbidity. 25% of participants had any anxiety comorbidity, 11.3% of participants had a comorbid ADHD diagnosis, and 6% of participants had any mood disorder. Results of Pearson correlation analyses indicated a statistically significant positive relationship between the total number of comorbidities and clinician-rated TTM severity (r(42) = .32, p < .05).There was a statistical trend suggesting that youth with TTM that met criteria for any anxiety disorder were more likely to have higher automatic pulling style scores (t(42) = -2.23 p = .04), higher focused pulling style scores (t(42) = -1.84, p = .07), and higher premonitory urge scores (t(42) = -1.91, p = .06), compared to youth with TTM that did not meet criteria for any anxiety disorder.

Conclusions.  Results suggest that comorbidities, particularly anxiety disorders, are common among youth with TTM. Preliminary results also suggest that having any psychiatric comorbidity in addition to TTM is associated with greater clinical TTM severity, while having a comorbid anxiety disorder is associated with greater intensity of premonitory urges scores and higher rates of both focused and automatic pulling. Continuing to explore potential reasons for this link may further our understanding of TTM. For example, it may be that pulling behaviors serve to regulate emotions in youth with comorbid diagnoses, particularly for youth with co-occurring anxiety. Findings also suggest that assessing for comorbidities may be important in gauging TTM severity and treatment trajectory for youth.