title: Predictors of life disability in trichotillomania.
abstract: BACKGROUND
  Limited research has investigated disability and functional impairment in trichotillomania (TTM) subjects. This study examined the relationships between hair pulling (HP) style and severity and disability while controlling for mood severity. Disability was measured in individual life areas (work, social, and family/home life) instead of as a total disability score as in previous studies.
  
  
  METHODS
  One hundred fifty three adult hair pullers completed several structured interviews and self-report instruments. HP style and severity, as well as depression, anxiety, and stress were correlated with work, social, and family/home life impairment on the Sheehan Disability Scale (SDS). Multiple regression analyses were performed to determine significant predictors of life impairment.
  
  
  RESULTS
  Depressive severity was a significant predictor for all SDS life areas. In addition, interference/avoidance associated with HP was a predictor for work and social life disability. Distress from HP was a significant predictor of social and family/home life disability. Focused HP score and anxiety were significant predictors of family/home life disability.
  
  
  CONCLUSIONS
  As expected, depression in hair pullers predicted disability across life domains. Avoiding work and social situations can seriously impair functioning in those life domains. Severity of distress and worry about HP may be most elevated in social situations with friends and family and thus predict impairment in those areas. Finally, since HP often occurs at home, time spent in focused hair pulling would have a greater negative impact on family and home responsibilities than social and work life.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge St., Suite 2200, Boston, MA, 02114, USA. Electronic address: etung2@partners.org.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Tung
authors.affiliation: Department of Psychology, Kent State University, 600 Hilltop Drive, Kent, OH, 44242, USA. Electronic address: cflessne@kent.edu.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Flessner
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, USA. Electronic address: jgrant4@bsd.uchicago.edu.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Grant
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge St., Suite 2200, Boston, MA, 02114, USA. Electronic address: nkeuthen@partners.org.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Keuthen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology*; D003863:Depression / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014256:Trichotillomania / Q000503:physiopathology*