Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder

Ted Avi Gerstenblith, Ashley Jaramillo-Huff, Tuua Ruutiainen, Paul S. Nestadt, Jack F. Samuels, Marco A. Grados, Bernadette A. Cullen, Mark A. Riddle, Kung Yee Liang, Benjamin D. Greenberg, Steven A. Rasmussen, Scott L. Rauch, James T. McCracken, John Piacentini, James A. Knowles, Gerald Nestadt, O. Joseph Bienvenu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Article number152123
JournalComprehensive Psychiatry
StatePublished - Oct 2019


  • Comorbidity
  • Impulse-control disorder
  • Obsessive-compulsive disorder
  • Trichotillomania
  • classification

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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