Category: Tic and Impulse Control Disorders
Trichotillomania (TTM) is the recurrent pulling out of one’s hair from any region of the body. TTM sufferers are unable to decrease their pulling, leading to significant distress and impairment due to concerns about noticeable hair loss. TTM is found in children and adults and has a female to male ratio of 10:1 (American Psychiatric Association, 2013). In assessing the severity of TTM a common measure is the clinician administered NIMH Trichotillomania Scales, consisting of the Trichotillomania Symptom Severity Scale (NIMH-TSS), and the Trichotillomania Impairment/”Global” Scale. The NIMH-TSS is made up of seven questions which provide a total score, while the Impairment/Global scale score contains a single 1 to 10 (higher more severe) report of impairment. Most research has utilized the NIMH-TSS, but little is known about the relationship of the Impairment/Global scale with other relevant measures of TTM. The current analysis aimed to assess the association of the NIMH Impairment/Global scale with common measures of TTM symptoms and severity in children.
In the current study children (age 8 to 17) diagnosed with TTM (N=54) based on the Trichotillomania Diagnostic Interview (TDI) were administered the NIMH TTM interview, NIMH Impairment/Global Scale, Trichotillomania Scale for Children (TSC-C) and parents (TSC-P), Milwaukee Inventory for Styles of Trichotillomania-Children (MIST-C) and parents (MIST-P), Children’s Depression Inventory 2nd Edition (CDI-2), and Clinical Global Impression – Severity of Illness Scale (CGI-S). The demographic breakdown of the sample was 81% female (n = 44), mean age of 13.3 (range = 9, SD = 2.79), 13% ethnically Hispanic (n = 7), 85% Caucasian (n = 46), 9% Asian (n = 5), 2% African American (n = 1), and 4% Multiracial (n = 2). We collected measurements for all participants on the NIMH Impairment/Global (M = 5.75, SD = 1.37), NIMH Total (M = 11.71, SD = 4.36), TDI Total (M = 16.71, SD = 3.43), TSC-C Impairment (M = .95, SD = .29), TSC-C Severity (M = 1.11, SD = .24), TSC-P Impairment (M = .95, SD = .24), TSC-P Severity (M = 1.14, SD = .27), MIST-A (M = 17.58, SD = 9.16), MIST-F (M = 90.51, SD = 36.83), CDI-2 Emotional Problems (M = 4.90, SD = 4.17), CDI-2 Negative Mood (M = 3.04, SD = 2.67), CDI-2 Negative Self-Esteem (M = 1.86, SD = 1.97), CDI-2 Functional Problems (M = 5.54, SD = 3.85), CDI-2 Ineffectiveness (M = 4.02, SD = 3.17), CDI-2 Interpersonal Problems (M = 1.22, SD = 1.10), and CGI-S (M = 3.98, SD = .73).
In the current sample the correlations between the NIMH Impairment/Global Scale and other measures of TTM symptom severity were significant for the NIMH Total (r = .46, p = .001), CDI-2 Emotional Problems (r = .35, p = .015), CDI-2 Negative Mood (r = .42, p = .003), CDI-2 Interpersonal Problems (r = .33, p = .021), and CGI-S (r = .39, p = .004). The TSC-C Impairment approached significance (r = .26, p = .074), while all other correlations were insignificant. These findings indicate that NIMH Impairment/Global Scale is a valuable outcome measure, as it relates to aspects of clinician rated symptom severity, mood, emotion, behavioral problems, and child self-report of impairment. Theoretical and clinical implications will be discussed.
Stephan Siwiec– Doctoral Candidate, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
Michelle Rohde– University of Wisconsin-Milwaukee
Rachel Kresser– University of Wisconsin-Milwaukee
Kyra Dietzen– University of Wisconsin-Milwaukee
Taylor Davine– Graduate student, University of Wisconsin-Milwaukee
Hanjoo Lee– University of Wisconsin-Milwaukee