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Multicenter Study
. 2023 Feb;28(1):98-103.
doi: 10.1017/S109285292100095X. Epub 2021 Nov 3.

Neurobiology of subtypes of trichotillomania and skin picking disorder

Jon E Grant  1 , Richard A I Bethlehem  2 , Samuel R Chamberlain  3   4 , Tara S Peris  5 , Emily J Ricketts  5 , Joseph O'Neill  5 , Darin D Dougherty  6 , Dan Stein  7 , Christine Lochner  8 , Douglas W Woods  9 , John Piacentini  5 , Nancy J Keuthen  6
Affiliations
Multicenter Study

Neurobiology of subtypes of trichotillomania and skin picking disorder

Jon E Grant et al. CNS Spectr. 2023 Feb.

Abstract

Background: Trichotillomania (TTM) and skin picking disorder (SPD) are common and often debilitating mental health conditions, grouped under the umbrella term of body-focused repetitive behaviors (BFRBs). Recent clinical subtyping found that there were three distinct subtypes of TTM and two of SPD. Whether these clinical subtypes map on to any unique neurobiological underpinnings, however, remains unknown.

Methods: Two hundred and fifty one adults [193 with a BFRB (85.5% [n = 165] female) and 58 healthy controls (77.6% [n = 45] female)] were recruited from the community for a multicenter between-group comparison using structural neuroimaging. Differences in whole brain structure were compared across the subtypes of BFRBs, controlling for age, sex, scanning site, and intracranial volume.

Results: When the subtypes of TTM were compared, low awareness hair pullers demonstrated increased cortical volume in the lateral occipital lobe relative to controls and sensory sensitive pullers. In addition, impulsive/perfectionist hair pullers showed relative decreased volume near the lingual gyrus of the inferior occipital-parietal lobe compared with controls.

Conclusions: These data indicate that the anatomical substrates of particular forms of BFRBs are dissociable, which may have implications for understanding clinical presentations and treatment response.

Keywords: Trichotillomania; imaging; neurobiology; skin picking disorder; subtypes.

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Figures

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Figure 3. Cortical volume differences across hair pulling subtypes
See this image and copyright information in PMC

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