Ted Avi Gerstenblith1, Ashley Jaramillo-Huff2, Tuua Ruutiainen3, Paul S Nestadt1, Jack F Samuels1, Marco A Grados1, Bernadette A Cullen1, Mark A Riddle1, Kung-Yee Liang4, Benjamin D Greenberg5, Steven A Rasmussen5, Scott L Rauch6, James T McCracken7, John Piacentini7, James A Knowles8, Gerald Nestadt1, O Joseph Bienvenu9. 1. Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America. 2. University of New Mexico School of Medicine, Department of Obstetrics and Gynecology, United States of America. 3. University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, United States of America. 4. National Yang-Ming University, Taiwan. 5. Brown Medical School, Department of Psychiatry and Human Behavior, United States of America. 6. Harvard Medical School, Department of Psychiatry, United States of America. 7. University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America. 8. SUNY Downstate Medical Center College of Medicine, Department of Cell Biology, United States of America. 9. Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America. Electronic address: obienve1@jhmi.edu.
Abstract
BACKGROUND: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
BACKGROUND: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
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