Clinical features and comorbid psychiatric disorders in children and adolescents with trichotillomania: a clinical sample

Objective: Trichotillomania (TTM) is characterized by the repetitive pulling out of one's own hair from the scalp, eyebrows, eyelashes, or other areas of the body and is often associated with other psychiatric disorders. In this study we aimed to investigate the clinical and sociodemographic characteristics and comorbid psychiatric disorders in children with TTM. Methods: Twenty-three children and adolescents (15 females and 8 males, median age: 12, range: 6-18 years), who were followed at our outpatient clinic with the diagnosis of TTM, were included in the study. The Turkish version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime version was used to detect the comorbid psychiatric disorders. Depression and anxiety levels were measured by Childhood Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children, respectively. Results: The most commonly affected areas were; the scalp (n=13). Nine cases have been affected more than two areas. Median duration of the symptoms were 7±20.01 months (range: 7 days-72 months) at admission. 65.2% of the cases reported precipitating stress factors before the beginning of TTM symptoms. Nineteen (82.6%) subjects suffered from at least one psychiatric disorder and 14 (60.8%) from at least two psychiatric disorders. The most common comorbid disorders were anxiety disorders (n=15), disruptive behavioral disorders (n=6), tic disorder (n=3) and enuresis nocturna (n=3). The mean score in the CDI was 13.25±8.45. Mean state and trait anxiety scores were 37.19±8.01 and 37.62±7.61, respectively. There was a significant relationship between the time passed until admission to a psychiatry clinic and having multiple comorbid psychiatric disorders. Conclusion: High rates of comorbid psychiatric disorders were found in children and adolescents with TTM. Delay in psychiatric help-seeking seems to be associated with other psychiatric disorders. Early intervention may decrease comorbid psychiatric disorders, which may affect treatment options and prognosis.