Stewart S Evelyn, Jenike Michael A, Keuthen Nancy J
McLean Hospital, Boston, Mass., USA.
J Clin Psychiatry. 2005 Jul;66(7):864-9. doi: 10.4088/jcp.v66n0709.
Chronic hair pulling and trichotillomania are putative obsessive-compulsive spectrum disorders. This study determined the prevalence of hair pulling in an inpatient obsessive-compulsive disorder (OCD) population and compared clinical characteristics and treatment response between subgroups with and without comorbid hair pulling.
Patients with severe DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to an OCD residential treatment facility between August 2000 and July 2003 were included. Clinician-rated (Yale-Brown Obsessive Compulsive Scale) and patient-rated (Massachusetts General Hospital Hairpulling Scale, Beck Depression Inventory, and Posttraumatic Diagnostic Scale) measures were administered at index evaluation. OCD patients with and without moderate to severe hair pulling were statistically compared on clinical and treatment characteristics and treatment response.
Of the OCD subjects, 18.8% (N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to severe hair pulling, and 7.8% (N = 12) had severe hair pulling comparable to that of a specialty trichotillomania clinic population. OCD patients with moderate to severe hair pulling were more likely to be women (p < .001), endorse > 1 comorbid tic (p < .05), and have earlier-onset OCD (p = .001). This cohort also had fewer contamination obsessions (p = .04) and checking compulsions (p = .04) and was more likely to be receiving stimulant (p = .006) or venlafaxine (p = .02) medication than those patients without hair pulling. Posttraumatic Diagnostic Scale scores were nearly significantly higher in the OCD + hair pulling group (p = .08). OCD treatment response was unaffected by the presence of comorbid hair pulling.
Hair pulling is a highly common comorbidity in severe OCD. Women and early-onset OCD patients appear to be more vulnerable to comorbid hair pulling. OCD sufferers with comorbid hair pulling also exhibit an increased risk for tics and may present with different OCD symptomatology.
慢性拔毛行为和拔毛癖被认为是强迫谱系障碍。本研究确定了住院强迫症（OCD）患者中拔毛行为的患病率，并比较了合并拔毛行为和未合并拔毛行为的亚组之间的临床特征和治疗反应。
纳入2000年8月至2003年7月期间连续入住一家OCD住院治疗机构的、经DSM-IV确诊为重度OCD的患者（N = 154）。在首次评估时进行临床医生评定（耶鲁-布朗强迫量表）和患者自评（麻省总医院拔毛量表、贝克抑郁量表和创伤后诊断量表）。对有和没有中度至重度拔毛行为的OCD患者在临床和治疗特征以及治疗反应方面进行统计学比较。
在OCD受试者中，18.8%（N = 29）认可有任何拔毛行为，15.6%（N = 24）有中度至重度拔毛行为，7.8%（N = 12）有与专业拔毛癖门诊患者相当的重度拔毛行为。有中度至重度拔毛行为的OCD患者更可能为女性（p <.001），认可有超过1种共病抽动（p <.05），且OCD起病更早（p =.001）。该队列中污染强迫观念（p =.04）和检查强迫行为（p =.04）较少，且与没有拔毛行为的患者相比，更可能正在接受兴奋剂（p =.006）或文拉法辛（p =.02）治疗。创伤后诊断量表评分在OCD + 拔毛组中几乎显著更高（p =.08）。OCD的治疗反应不受合并拔毛行为的影响。
拔毛行为在重度OCD中是一种非常常见的共病。女性和早发性OCD患者似乎更容易合并拔毛行为。合并拔毛行为的OCD患者出现抽动的风险也增加，并且可能表现出不同的OCD症状。
