DSM-5 field survey: hair-pulling disorder (trichotillomania)

The aim of this multisite field survey was to examine the DSM-IV-TR criteria, proposed DSM-5 diagnostic criteria, as well as a number of possible additional diagnostic criteria, in patients with hair-pulling disorder (HPD, or trichotillomania).

Four sites were involved. Participants older than 10 years of age, male or female, with hair-pulling symptoms in the last 4 weeks were included. Participants were assessed with two modules based on the Structured Clinical Interview for DSM (SCID-I/P), which addressed the DSM-IV-TR criteria set as well as proposed DSM-5 diagnostic criteria for HPD, respectively. Additional questions were established to test other possible diagnostic criteria.

Eighty-four (79 female, 5 male, 83 adult) participants with current hair-pulling symptoms were included. All of these participants had recurrent hair-pulling and most (n = 82 [98%]) reported repeated attempts to decrease or stop hair-pulling, and 70 (n = 70 [83%]) met the clinical significance criterion. Diagnostic criteria focused on "urge," "tension," "need," "drive," or "impulse" to pull, or pleasure, gratification or relief during or after pulling, were endorsed by many, but not all. Individuals who did endorse such criteria had significantly more severe hair-pulling symptoms.

These data support the proposed diagnostic criteria for HPD in adults. Although most adult patients have urges to pull or experience a sense of relief on pulling, as in the case of skin-picking disorder, such phenomena are not universal and so should not be included in the diagnostic criteria. An additional criterion focused on repeated attempts to decrease or stop hair-pulling seems warranted.