Longitudinal follow-up of naturalistic treatment outcome in patients with trichotillomania.
BACKGROUND
Little is known about the longitudinal course of treatment outcome in patients with trichotillomania. The authors conducted a second follow-up assessment on a cohort of hair pullers previously studied.


METHODS
Forty-four subjects completed a hair-pulling questionnaire and paper-and-pencil measures of hair-pulling severity and impact, psychosocial functioning, depression, anxiety, and self-esteem. Mean time elapsed between the first and second follow-up assessment was 2.5 years (index evaluation to first follow-up = 3.5 years).


RESULTS
Twenty-seven subjects (61.4%) had active treatment since the first follow-up. No significant changes in hair pulling, depression, anxiety, or psychosocial functioning were reported from first to second follow-up. Self-esteem scores significantly worsened during this period (p = .000). A trend toward worsening also existed for psychosocial impact scores. Comparison of scores at index evaluation with second follow-up still showed significant improvement over time for hair pulling (p = .001) but significant worsening in self-esteem (p = .000). Treatment and responder status were unrelated to clinical functioning, with the exception of depression and psychosocial impact.


CONCLUSIONS
Although hair pullers exhibit initial improvement with treatment, scale scores plateau or worsen by second follow-up. Significant worsening in self-esteem at second follow-up may be related to the absence of further improvements in hair-pulling severity. Future research should focus on the interrelationships among self-esteem, depression, and hair pulling during treatment for this disorder.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA. keuthen@psych.mgh.harvard.edu
N J
NJ
Keuthen
C
C
Fraim
T
T
Deckersbach
D D
DD
Dougherty
L
L
Baer
M A
MA
Jenike
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D001521:Behavior Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006990:Hypnosis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012649:Self Concept; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome; D014256:Trichotillomania / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
D011619:Psychotropic Drugs