Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive–compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive–compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McGuire JF, Kugler BB, Park JM, Horng B, Lewin AB, Murphy TK, Storch EA (2012) Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children. Child Psychiatry Hum Dev 43(6):855–883. https://doi.org/10.1007/s10578-012-0300-7

    Article  PubMed  Google Scholar 

  2. Ferrao YA, Miguel E, Stein DJ (2009) Tourette’s syndrome, trichotillomania, and obsessive–compulsive disorder: how closely are they related? Psychiatry Res 170(1):32–42. https://doi.org/10.1016/j.psychres.2008.06.008

    Article  PubMed  Google Scholar 

  3. Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42(7):436–447

    Article  CAS  PubMed  Google Scholar 

  4. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. 5th edn., Washington, DC

  5. Duke DC, Keeley ML, Geffken GR, Storch EA (2010) Trichotillomania: a current review. Clin Psychol Rev 30(2):181–193. https://doi.org/10.1016/j.cpr.2009.10.008

    Article  PubMed  Google Scholar 

  6. Christenson GA, Pyle RL, Mitchell JE (1991) Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry 52(10):415–417

    CAS  PubMed  Google Scholar 

  7. Snorrason I, Belleau EL, Woods DW (2012) How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clin Psychol Rev 32(7):618–629. https://doi.org/10.1016/j.cpr.2012.05.008

    Article  PubMed  Google Scholar 

  8. Grant JE, Odlaug BL, Chamberlain SR, Keuthen NJ, Lochner C, Stein DJ (2012) Skin picking disorder. Am J Psychiatry 169(11):1143–1149. https://doi.org/10.1176/appi.ajp.2012.12040508

    Article  PubMed  Google Scholar 

  9. Hayes SL, Storch EA, Berlanga L (2009) Skin picking behaviors: an examination of the prevalence and severity in a community sample. J Anxiety Disord 23(3):314–319. https://doi.org/10.1016/j.janxdis.2009.01.008

    Article  PubMed  Google Scholar 

  10. Keuthen NJ, Koran LM, Aboujaoude E, Large MD, Serpe RT (2010) The prevalence of pathologic skin picking in US adults. Compr Psychiatry 51(2):183–186. https://doi.org/10.1016/j.comppsych.2009.04.003

    Article  PubMed  Google Scholar 

  11. Prochwicz K, Kaluzna-Wielobob A, Klosowska J (2016) Skin picking in a non-clinical sample of young Polish adults. Prevalence and characteristics. Compr Psychiatry 71:77–85. https://doi.org/10.1016/j.comppsych.2016.08.013

    Article  PubMed  Google Scholar 

  12. Wilhelm S, Keuthen NJ, Deckersbach T, Engelhard IM, Forker AE, Baer L, O’Sullivan RL, Jenike MA (1999) Self-injurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 60(7):454–459

    Article  CAS  PubMed  Google Scholar 

  13. Keuthen NJ, Altenburger EM, Pauls D (2014) A family study of trichotillomania and chronic hair pulling. Am J Med Genet B Neuropsychiatr Genet 165B(2):167–174. https://doi.org/10.1002/ajmg.b.32218

    Article  PubMed  Google Scholar 

  14. Monzani B, Rijsdijk F, Harris J, Mataix-Cols D (2014) The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive–compulsive spectrum disorders. JAMA Psychiatry 71(2):182–189. https://doi.org/10.1001/jamapsychiatry.2013.3524

    Article  PubMed  Google Scholar 

  15. Lochner C, Stein DJ (2010) Obsessive-compulsive spectrum disorders in obsessive–compulsive disorder and other anxiety disorders. Psychopathology 43(6):389–396. https://doi.org/10.1159/000321070

    Article  PubMed  Google Scholar 

  16. Lovato L, Ferrao YA, Stein DJ, Shavitt RG, Fontenelle LF, Vivan A, Miguel EC, Cordioli AV (2012) Skin picking and trichotillomania in adults with obsessive–compulsive disorder. Compr Psychiatry 53(5):562–568. https://doi.org/10.1016/j.comppsych.2011.06.008

    Article  PubMed  Google Scholar 

  17. Stein DJ, Grant JE, Franklin ME, Keuthen N, Lochner C, Singer HS, Woods DW (2010) Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V. Depression Anxiety 27(6):611–626. https://doi.org/10.1002/da.20700

    Article  PubMed  Google Scholar 

  18. Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, Grados MA, Nestadt G (2000) The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 48(4):287–293

    Article  CAS  PubMed  Google Scholar 

  19. Bienvenu OJ, Samuels JF, Wuyek LA, Liang KY, Wang Y, Grados MA, Cullen BA, Riddle MA, Greenberg BD, Rasmussen SA, Fyer AJ, Pinto A, Rauch SL, Pauls DL, McCracken JT, Piacentini J, Murphy DL, Knowles JA, Nestadt G (2012) Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med 42(1):1–13. https://doi.org/10.1017/S0033291711000742

    Article  CAS  PubMed  Google Scholar 

  20. Cullen BA, Samuels JF, Bienvenu OJ, Grados M, Hoehn-Saric R, Hahn J, Liang KY, Wellen D, Dees M, Riddle MA, Nestadt G (2001) The relationship of pathologic skin picking to obsessive–compulsive disorder. J Nerv Ment Dis 189(3):193–195

    Article  CAS  PubMed  Google Scholar 

  21. Lenane MC, Swedo SE, Rapoport JL, Leonard H, Sceery W, Guroff JJ (1992) Rates of obsessive compulsive disorder in first degree relatives of patients with trichotillomania: a research note. J Child Psychol Psychiatry 33(5):925–933

    Article  CAS  PubMed  Google Scholar 

  22. Flessner CA, Knopik VS, McGeary J (2012) Hair pulling disorder (trichotillomania): genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Res 199(3):151–158. https://doi.org/10.1016/j.psychres.2012.03.039

    Article  PubMed  Google Scholar 

  23. Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, King RA, Sandor P, McMahon WM, Lyon GJ, Cath DC, Kurlan R, Robertson MM, Osiecki L, Scharf JM, Mathews CA (2015) Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry 72(4):325–333. https://doi.org/10.1001/jamapsychiatry.2014.2650

    Article  PubMed  PubMed Central  Google Scholar 

  24. Frank MC, Piedad J, Rickards H, Cavanna AE (2011) The role of impulse control disorders in Tourette syndrome: an exploratory study. J Neurol Sci 310(1–2):276–278. https://doi.org/10.1016/j.jns.2011.06.032

    Article  PubMed  Google Scholar 

  25. Janik P, Kalbarczyk A, Sitek M (2007) Clinical analysis of Gilles de la Tourette syndrome based on 126 cases. Neurol Neurochir Pol 41(5):381–387

    PubMed  Google Scholar 

  26. Coffey BJ, Miguel EC, Biederman J, Baer L, Rauch SL, O’Sullivan RL, Savage CR, Phillips K, Borgman A, Green-Leibovitz MI, Moore E, Park KS, Jenike MA (1998) Tourette’s disorder with and without obsessive–compulsive disorder in adults: are they different? J Nerv Ment Dis 186(4):201–206

    Article  CAS  PubMed  Google Scholar 

  27. Diniz JB, Rosario-Campos MC, Hounie AG, Curi M, Shavitt RG, Lopes AC, Miguel EC (2006) Chronic tics and Tourette syndrome in patients with obsessive–compulsive disorder. J Psychiatr Res 40(6):487–493. https://doi.org/10.1016/j.jpsychires.2005.09.002

    Article  PubMed  Google Scholar 

  28. Petter T, Richter MA, Sandor P (1998) Clinical features distinguishing patients with Tourette’s syndrome and obsessive–compulsive disorder from patients with obsessive–compulsive disorder without tics. J Clin Psychiatry 59(9):456–459

    Article  CAS  PubMed  Google Scholar 

  29. Gomes de Alvarenga P, de Mathis MA, Dominguez Alves AC, do Rosario MC, Fossaluza V, Hounie AG, Miguel EC, Rodrigues Torres A (2012) Clinical features of tic-related obsessive–compulsive disorder: results from a large multicenter study. CNS Spectr 17(2):87–93. https://doi.org/10.1017/S1092852912000491

    Article  PubMed  Google Scholar 

  30. Rozenman M, Peris TS, Gonzalez A, Piacentini J (2016) Clinical characteristics of pediatric trichotillomania: comparisons with obsessive–compulsive and tic disorders. Child Psychiatry Hum Dev 47(1):124–132. https://doi.org/10.1007/s10578-015-0550-2

    Article  PubMed  Google Scholar 

  31. Scharf JM, Yu D, Mathews CA, Neale BM, Stewart SE, Fagerness JA, Evans P, Gamazon E, Edlund CK, Service SK, Tikhomirov A, Osiecki L, Illmann C, Pluzhnikov A, Konkashbaev A, Davis LK, Han B, Crane J, Moorjani P, Crenshaw AT, Parkin MA, Reus VI, Lowe TL, Rangel-Lugo M, Chouinard S, Dion Y, Girard S, Cath DC, Smit JH, King RA, Fernandez TV, Fernandez TV, Leckman JF, Kidd KK, Kidd JR, Pakstis AJ, State MW, Herrera LD, Romero R, Fournier E, Sandor P, Barr CL, Phan N, Gross-Tsur V, Benarroch F, Pollak Y, Budman CL, Bruun RD, Erenberg G, Naarden AL, Lee PC, Weiss N, Kremeyer B, Berrio GB, Campbell DD, Cardona Silgado JC, Ochoa WC, Mesa Restrepo SC, Muller H, Valencia Duarte AV, Lyon GJ, Leppert M, Morgan J, Weiss R, Grados MA, Anderson K, Davarya S, Singer H, Walkup J, Jankovic J, Tischfield JA, Heiman GA, Gilbert DL, Hoekstra PJ, Robertson MM, Kurlan R, Liu C, Gibbs JR, Singleton A, Hardy J, Strengman E, Ophoff RA, Wagner M, Moessner R, Mirel DB, Posthuma D, Sabatti C, Eskin E, Conti DV, Knowles JA, Ruiz-Linares A, Rouleau GA, Purcell S, Heutink P, Oostra BA, McMahon WM, Freimer NB, Cox NJ, Pauls DL (2013) Genome-wide association study of Tourette’s syndrome. Mol Psychiatry 18(6):721–728. https://doi.org/10.1038/mp.2012.69

    Article  CAS  PubMed  Google Scholar 

  32. TSAICG (2007) Genome scan for Tourette disorder in affected-sibling-pair and multigenerational families. Am J Hum Genet 80(2):265–272

    Article  Google Scholar 

  33. Darrow SM, Illmann C, Gauvin C, Osiecki L, Egan CA, Greenberg E, Eckfield M, Hirschtritt ME, Pauls DL, Batterson JR, Berlin CM, Malaty IA, Woods DW, Scharf JM, Mathews CA (2015) Web-based phenotyping for Tourette syndrome: reliability of common co-morbid diagnoses. Psychiatry Res 228(3):816–825

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bussing R, Fernandez M, Harwood M, Wei H, Garvan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15(3):317–328. https://doi.org/10.1177/1073191107313888

    Article  PubMed  PubMed Central  Google Scholar 

  35. Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, Charney DS (1989) The Yale-Brown obsessive compulsive scale. II. Validity. Arch Gen Psychiatry 46(11):1012–1016

    Article  CAS  PubMed  Google Scholar 

  36. Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28(4):566–573

    Article  CAS  PubMed  Google Scholar 

  37. Arnold LM, Auchenbach MB, McElroy SL (2001) Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 15(5):351–359

    Article  CAS  PubMed  Google Scholar 

  38. Pauls DL, Raymond CL, Stevenson JM, Leckman JF (1991) A family study of Gilles de la Tourette syndrome. Am J Hum Genet 48(1):154–163

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Bienvenu OJ, Wang Y, Shugart YY, Welch JM, Grados MA, Fyer AJ, Rauch SL, McCracken JT, Rasmussen SA, Murphy DL, Cullen B, Valle D, Hoehn-Saric R, Greenberg BD, Pinto A, Knowles JA, Piacentini J, Pauls DL, Liang KY, Willour VL, Riddle M, Samuels JF, Feng G, Nestadt G (2009) Sapap3 and pathological grooming in humans: results from the OCD collaborative genetics study. Am J Med Genet B Neuropsychiatr Genet 150B(5):710–720. https://doi.org/10.1002/ajmg.b.30897

    Article  CAS  PubMed  Google Scholar 

  40. Hemmings SM, Kinnear CJ, Lochner C, Niehaus DJ, Knowles JA, Moolman-Smook JC, Corfield VA, Stein DJ (2004) Early- versus late-onset obsessive–compulsive disorder: investigating genetic and clinical correlates. Psychiatry Res 128(2):175–182. https://doi.org/10.1016/j.psychres.2004.05.007

    Article  PubMed  Google Scholar 

  41. Grados MA, Riddle MA, Samuels JF, Liang KY, Hoehn-Saric R, Bienvenu OJ, Walkup JT, Song D, Nestadt G (2001) The familial phenotype of obsessive–compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry 50(8):559–565

    Article  CAS  PubMed  Google Scholar 

  42. Mathews CA, Grados MA (2011) Familiality of Tourette syndrome, obsessive–compulsive disorder, and attention-deficit/hyperactivity disorder: heritability analysis in a large sib-pair sample. J Am Acad Child Adolesc Psychiatry 50(1):46–54

    Article  PubMed  Google Scholar 

  43. Lochner C, Seedat S, Stein DJ (2010) Chronic hair-pulling: phenomenology-based subtypes. J Anxiety Disord 24(2):196–202. https://doi.org/10.1016/j.janxdis.2009.10.008

    Article  PubMed  Google Scholar 

  44. Swedo SE, Lenane MC, Leonard HL (1993) Long-term treatment of trichotillomania (hair pulling). N Engl J Med 329(2):141–142. https://doi.org/10.1056/NEJM199307083290220

    Article  CAS  PubMed  Google Scholar 

  45. Coffey BJ, Biederman J, Smoller JW, Geller DA, Sarin P, Schwartz S, Kim GS (2000) Anxiety disorders and tic severity in juveniles with Tourette’s disorder. J Am Acad Child Adolesc Psychiatry 39(5):562–568

    Article  CAS  PubMed  Google Scholar 

  46. Morand-Beaulieu S, Grot S, Lavoie J, Leclerc JB, Luck D, Lavoie ME (2017) The puzzling question of inhibitory control in Tourette syndrome: a meta-analysis. Neurosci Biobehav Rev 80:240–262. https://doi.org/10.1016/j.neubiorev.2017.05.006

    Article  PubMed  Google Scholar 

  47. Jahanshahi M, Obeso I, Rothwell JC, Obeso JA (2015) A fronto-striato-subthalamic-pallidal network for goal-directed and habitual inhibition. Nat Rev Neurosci 16(12):719–732. https://doi.org/10.1038/nrn4038

    Article  CAS  PubMed  Google Scholar 

  48. Lochner C, Roos A, Stein DJ (2017) Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 13:1867–1872. https://doi.org/10.2147/NDT.S121138

    Article  PubMed  PubMed Central  Google Scholar 

  49. Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, Pittenger C, Leckman JF, Coric V (2007) Systematic review: pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry 62(8):839–846. https://doi.org/10.1016/j.biopsych.2007.05.019

    Article  CAS  PubMed  Google Scholar 

  50. Scharf JM, Miller LL, Mathews CA, Ben-Shlomo Y (2012) Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort. J Am Acad Child Adolesc Psychiatry 51(2):192–201. https://doi.org/10.1016/j.jaac.2011.11.004

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank the families, patients, and control volunteers who participated in this research, and the members of the Tourette Association for America International Genetics Consortium. This work was supported by the National Institutes of Health, Grant numbers R01MH096767 (PI: Carol Mathews), U01NS040024 (PI: David Pauls/Jeremiah Scharf), K23MH085057 (PI: Jeremiah Scharf), and grants from the TLC Foundation for Body-Focused Repetitive Behaviors and from the Tourette Association of America.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Erica Greenberg, Esther S. Tung, Erin Curley & Nancy J. Keuthen

  2. Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6254, Boston, MA, 02114, USA

    Erica Greenberg, Caitlin Gauvin, Lisa Osiecki, Kelly G. Yang, Angela Essa, Cornelia Illmann, David L. Pauls & Jeremiah M. Scharf

  3. Department of Psychiatry, Youthdale Treatment Centers, University of Toronto and University Health Network, Toronto, ON, Canada

    Paul Sandor

  4. Department of Psychiatry, University of Montreal, Montreal, QC, Canada

    Yves Dion

  5. Cold Spring Harbor Laboratory, Stanley Institute for Cognitive Genomics, Cold Spring Harbor, NY, USA

    Gholson J. Lyon

  6. Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA

    Robert A. King

  7. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

    Sabrina Darrow & Matthew E. Hirschtritt

  8. Hofstra Northwell School of Medicine, Hempstead, NY, USA

    Cathy L. Budman

  9. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Marco Grados

  10. Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA

    Carol A. Mathews

  11. Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, FL, USA

    Carol A. Mathews

  12. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Jeremiah M. Scharf

  13. Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Jeremiah M. Scharf

Authors
  1. Erica Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esther S. Tung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caitlin Gauvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Osiecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kelly G. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erin Curley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela Essa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cornelia Illmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paul Sandor
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yves Dion
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gholson J. Lyon
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert A. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sabrina Darrow
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Matthew E. Hirschtritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Cathy L. Budman
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Marco Grados
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. David L. Pauls
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Nancy J. Keuthen
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Carol A. Mathews
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jeremiah M. Scharf
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Tourette Association of America International Consortium for Genetics

Corresponding author

Correspondence to Jeremiah M. Scharf.

Ethics declarations

Conflict of interest

Drs. Sandor, Dion, Lyon, King, Budman, Grados, Pauls, Mathews, and Scharf have received research support from the Tourette Association of America (TAA). Dr. Budman reports funding for clinical research studies from Neurocrine Pharmaceuticals, Psyadon Pharmaceuticals, Otsuka Pharmaceuticals, Synchroneuron Pharmaceuticals, Teva Pharmaceuticals, and Auspex Pharmaceuticals. She has also been a speaker for the TAA and the Center for Disease Control Partnership and a consultant to Bracket. Dr. Sandor reports unrestricted educational grants from Purdue and Shire, a speaker fee from Purdue, and support for clinical research from Otsuka Pharmaceuticals. Dr. Sandor was also a member of the data safety monitoring committee for Psyadon Pharmaceuticals. Drs. Pauls, Keuthen and Scharf have received grant support from the TLC Foundation for Body-Focused Repetitive Behaviors (BFRBs). Drs. Keuthen and Scharf are members of the Scientific Advisory Board of the TLC Foundation for BFRBs. Dr. Scharf has also received consulting fees from Nuvelation Pharma, travel and grant support from the TAA, and is a member of the Scientific Advisory Board for the TAA. Dr. Mathews has received research support, honoraria, and travel support from the TAA and is the co-chair of the TAA Scientific Advisory Board. Drs. Greenberg, Illmann, Darrow, Hirschtritt, and Ms. Tung, Gauvin, Osiecki, Yang, Curley and Essa report no biomedical financial interests or potential conflicts of interest.

Ethical standards

All research subjects provided written informed consent (written assent was obtained for individuals < 18 along with written parental consent). The study was approved by the relevant IRBs/ethics committees at all sites, and, therefore, has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 93 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greenberg, E., Tung, E.S., Gauvin, C. et al. Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome. Eur Child Adolesc Psychiatry 27, 569–579 (2018). https://doi.org/10.1007/s00787-017-1074-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-017-1074-z

Keywords

Search

Navigation