Obsessive-compulsive disorder and trichotillomania: a phenomenological comparison

Christine Lochner¹ , Soraya Seedat¹ , Pieter L du Toit¹ , Daniel G Nel² , Dana JH Niehaus¹ , Robin Sandler¹ and Dan J Stein¹

¹MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa

²Center for Statistical Consultation, Department of Statistics & Actuarial science, University of Stellenbosch, Stellenbosch, South Africa

author email corresponding author email

BMC Psychiatry 2005, 5:2doi:10.1186/1471-244X-5-2


Published:	13 January 2005

Abstract

Background

Similarities between obsessive-compulsive disorder (OCD) and trichotillomania (TTM) have been widely recognized. Nevertheless, there is evidence of important differences between these two disorders. Some authors have conceptualized the disorders as lying on an OCD spectrum of conditions.

Methods

Two hundred and seventy eight OCD patients (n = 278: 148 male; 130 female) and 54 TTM patients (n = 54; 5 male; 49 female) of all ages were interviewed. Female patients were compared on select demographic and clinical variables, including comorbid axis I and II disorders, and temperament/character profiles.

Results

OCD patients reported significantly more lifetime disability, but fewer TTM patients reported response to treatment. OCD patients reported higher comorbidity, more harm avoidance and less novelty seeking, more maladaptive beliefs, and more sexual abuse. OCD and TTM symptoms were equally likely to worsen during menstruation, but OCD onset or worsening was more likely associated with pregnancy/puerperium.

Conclusions

These findings support previous work demonstrating significant differences between OCD and TTM. The classification of TTM as an impulse control disorder is also problematic, and TTM may have more in common with conditions characterized by stereotypical self-injurious symptoms, such as skin-picking. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.