Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome

Eur Child Adolesc Psychiatry. 2018 May;27(5):569-579. doi: 10.1007/s00787-017-1074-z. Epub 2017 Nov 2.


Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive-compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.

Keywords: Body-focused repetitive behaviors; Excoriation disorder/skin picking disorder; Obsessive–compulsive disorder; Tourette syndrome; Trichotillomania/hair pulling disorder.

Publication types

  • Multicenter Study

MeSH terms

  • Child
  • Comorbidity
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / etiology*
  • Prevalence
  • Self-Injurious Behavior / etiology*
  • Surveys and Questionnaires
  • Tourette Syndrome / diagnosis*
  • Tourette Syndrome / pathology
  • Trichotillomania / etiology*