Skip to main content
Top
Gepubliceerd in: Cognitive Therapy and Research 1/2024

25-10-2023 | Original Article

Clinical Characteristics, Sleep, and Temperament in Infants and Young Children with Problematic Hair Pulling and Skin Picking

Auteurs: Kevin Pendo, Valerie S. Swisher, Talia Y. Leman, Ariel J. Rissman, Tara S. Peris, John Piacentini, Ivar Snorrason, Emily J. Ricketts

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 1/2024

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Background

This study examined clinical characteristics of problematic hair pulling (HP) and skin picking (SP) in infants and young children and their association with self-soothing, sleep, and temperament.

Methods

An internet survey of parents/caregivers of 0–5-year-olds (n = 384 with data analyzed, of whom 26 experienced HP, 62 experienced SP, and 302 were controls free of HP and SP) assessed demographics and medical history, HP and SP characteristics, contextual factors, self-soothing, sleep patterns, and temperament. Participants were recruited through both HP and SP advocacy and support webpages and general webpages (e.g., parenting groups). Descriptive statistics, chi-square tests of independence, independent samples t-test clinically characterized HP, SP, and control groups. Logistic regression and one-way analysis of covariance controlled for sex and age in analyses.

Results

HP and SP rates were 6.1% (n = 26) and 14.5% (n = 62), respectively. SP presented in 23.1% of children with HP, and HP presented in 9.7% of children with SP. Mean HP and SP onset occurred at 12.2 (SD = 11.2) and 24.1 (SD = 15.8) months, respectively. Contextual factors, including boredom, upset, and awake-in-bed were common in HP and SP. Common caregiver responses included distracting the child, moving the hand away, and telling the child to stop. Few caregivers sought professional help for the child. Children with HP engaged in more hair twirling than controls, and children with SP engaged in more nail biting than controls. Children with HP, but not SP, had more sleep disturbance than controls. In terms of temperament, children with HP displayed sensitivity to stimuli, children with SP exhibited low persistence, and both HP and SP groups displayed serious, observant mood relative to controls.

Conclusions

Findings expand clinical understanding of HP and SP in children aged 0–5 and provide targets (contextual factors, sleep, sensory sensitivity, persistence, and mood) for behavioral interventions. Low rates of treatment seeking highlight the need for expansion of clinical guidelines for HP and SP in this age range.
Literatuur
go back to reference American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.
go back to reference Bohne, A., Wilhelm, S., Keuthen, N. J., Baer, L., & Jenike, M. A. (2002). Skin picking in German students: Prevalence, phenomenology, and associated characteristics. Behavior Modification, 26(3), 320–339.CrossRefPubMed Bohne, A., Wilhelm, S., Keuthen, N. J., Baer, L., & Jenike, M. A. (2002). Skin picking in German students: Prevalence, phenomenology, and associated characteristics. Behavior Modification, 26(3), 320–339.CrossRefPubMed
go back to reference Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Academic Press. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Academic Press.
go back to reference Franklin, M. E., Flessner, C. A., Woods, D. W., Keuthen, N. J., Piacentini, J. C., Moore, P., Stein, D. J., Cohen, S. B., Wilson, M. A., & Board, T.L.C.-S.A. (2008). The Child and Adolescent Trichotillomania Impact Project: Descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. Journal of Developmental & Behavioral Pediatrics, 29(6), 493. https://doi.org/10.1097/DBP.0b013e31818d4328CrossRef Franklin, M. E., Flessner, C. A., Woods, D. W., Keuthen, N. J., Piacentini, J. C., Moore, P., Stein, D. J., Cohen, S. B., Wilson, M. A., & Board, T.L.C.-S.A. (2008). The Child and Adolescent Trichotillomania Impact Project: Descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. Journal of Developmental & Behavioral Pediatrics, 29(6), 493. https://​doi.​org/​10.​1097/​DBP.​0b013e31818d4328​CrossRef
go back to reference Grant, J. E., Peris, T. S., Ricketts, E. J., Bethlehem, R. A., Chamberlain, S. R., O’Neill, J., Scharf, J. M., Dougherty, D. D., Deckersbach, T., Woods, D. W., Piacentini, J., & Keuthen, N. J. (2022). Reward processing in trichotillomania and skin picking disorder. Brain Imaging and Behavior, 16(2), 547–556. https://doi.org/10.1007/s11682-021-00533-5CrossRefPubMed Grant, J. E., Peris, T. S., Ricketts, E. J., Bethlehem, R. A., Chamberlain, S. R., O’Neill, J., Scharf, J. M., Dougherty, D. D., Deckersbach, T., Woods, D. W., Piacentini, J., & Keuthen, N. J. (2022). Reward processing in trichotillomania and skin picking disorder. Brain Imaging and Behavior, 16(2), 547–556. https://​doi.​org/​10.​1007/​s11682-021-00533-5CrossRefPubMed
go back to reference Netsi, E., Van Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., Wulff, K., Jansen, P. W., Jaddoe, V. W., Verhults, F. C., Tiemeier, H., & Ramchandani, P. G. (2015). Does infant reactivity moderate the association between antenatal maternal depression and infant sleep? Journal of Developmental and Behavioral Pediatrics, 36(6), 440–449.CrossRefPubMedPubMedCentral Netsi, E., Van Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., Wulff, K., Jansen, P. W., Jaddoe, V. W., Verhults, F. C., Tiemeier, H., & Ramchandani, P. G. (2015). Does infant reactivity moderate the association between antenatal maternal depression and infant sleep? Journal of Developmental and Behavioral Pediatrics, 36(6), 440–449.CrossRefPubMedPubMedCentral
go back to reference Penzel, F. (2002). A stimulus regulation model of trichotillomania. In Touch, 3(33), 12–14. Penzel, F. (2002). A stimulus regulation model of trichotillomania. In Touch, 3(33), 12–14.
go back to reference Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., Lochner, C., Stein, D. J., Dougherty, D. D., O’Neill, J., Woods, D. W., Keuthen, N. J., & Piacentini, J. (2022). Clinical characteristics of youth with trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-022-01458-wCrossRef Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., Lochner, C., Stein, D. J., Dougherty, D. D., O’Neill, J., Woods, D. W., Keuthen, N. J., & Piacentini, J. (2022). Clinical characteristics of youth with trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder. Child Psychiatry & Human Development. https://​doi.​org/​10.​1007/​s10578-022-01458-wCrossRef
go back to reference Ricketts, E. J., Snorrason, I., Kircanski, K., Alexander, J. R., Stiede, J. T., Thamrin, H., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Walther, M. R., Piacentini, J., Stein, D. J., & Woods, D. W. (2019). A latent profile analysis of age of onset in trichotillomania. Annals of Clinical Psychiatry, 31(3), 169–178.PubMedPubMedCentral Ricketts, E. J., Snorrason, I., Kircanski, K., Alexander, J. R., Stiede, J. T., Thamrin, H., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Walther, M. R., Piacentini, J., Stein, D. J., & Woods, D. W. (2019). A latent profile analysis of age of onset in trichotillomania. Annals of Clinical Psychiatry, 31(3), 169–178.PubMedPubMedCentral
go back to reference Ricketts, E. J., Snorrason, I., Kircanski, K., Alexander, J. R., Thamrin, H., Flessner, C. A., Franklin, M. E., Piacentini, J., & Woods, D. W. (2018). A latent profile analysis of age of onset in pathological skin picking. Comprehensive Psychiatry, 87, 46–52.CrossRefPubMedPubMedCentral Ricketts, E. J., Snorrason, I., Kircanski, K., Alexander, J. R., Thamrin, H., Flessner, C. A., Franklin, M. E., Piacentini, J., & Woods, D. W. (2018). A latent profile analysis of age of onset in pathological skin picking. Comprehensive Psychiatry, 87, 46–52.CrossRefPubMedPubMedCentral
go back to reference Schienle, A., & Wabnegger, A. (2022). Discriminative and affective processing of touch: Associations with severity of skin-picking. Journal of Nonverbal Behavior, 46, 537–545.CrossRefPubMedPubMedCentral Schienle, A., & Wabnegger, A. (2022). Discriminative and affective processing of touch: Associations with severity of skin-picking. Journal of Nonverbal Behavior, 46, 537–545.CrossRefPubMedPubMedCentral
go back to reference Snorrason, I., Ricketts, E. J., Flessner, C. A., Franklin, M. E., Stein, D. J., & Woods, D. W. (2012). Skin picking disorder is associated with other body-focused repetitive behaviors: Findings from an internet study. Annals of Clinical Psychiatry, 24(4), 292–299.PubMed Snorrason, I., Ricketts, E. J., Flessner, C. A., Franklin, M. E., Stein, D. J., & Woods, D. W. (2012). Skin picking disorder is associated with other body-focused repetitive behaviors: Findings from an internet study. Annals of Clinical Psychiatry, 24(4), 292–299.PubMed
go back to reference Snorrason, I., Ricketts, E. J., Stein, A. T., Thamrin, H., Lee, J., Goldberg, H., Hu, Y., & Björgvinsson, T. (2021). Sex differences in age at onset and presentation of trichotillomania and trichobezoar: A 120-year systematic review of cases. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-020-01117-yCrossRef Snorrason, I., Ricketts, E. J., Stein, A. T., Thamrin, H., Lee, J., Goldberg, H., Hu, Y., & Björgvinsson, T. (2021). Sex differences in age at onset and presentation of trichotillomania and trichobezoar: A 120-year systematic review of cases. Child Psychiatry & Human Development. https://​doi.​org/​10.​1007/​s10578-020-01117-yCrossRef
go back to reference Stein, D. J., Flessner, C. A., Franklin, M., Keuthen, N. J., Lochner, C., & Woods, D. W. (2008). Is trichotillomania a stereotypic movement disorder? An analysis of body-focused repetitive behaviors in people with hair-pulling. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 20(4), 194–198. https://doi.org/10.1080/10401230802435625CrossRefPubMed Stein, D. J., Flessner, C. A., Franklin, M., Keuthen, N. J., Lochner, C., & Woods, D. W. (2008). Is trichotillomania a stereotypic movement disorder? An analysis of body-focused repetitive behaviors in people with hair-pulling. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 20(4), 194–198. https://​doi.​org/​10.​1080/​1040123080243562​5CrossRefPubMed
go back to reference Stein, D. J., Grant, J. E., Franklin, M. E., Keuthen, N., Lochner, C., Singer, H. S., & Woods, D. W. (2010). Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety, 27(6), 611–626. https://doi.org/10.1002/da.20700CrossRefPubMed Stein, D. J., Grant, J. E., Franklin, M. E., Keuthen, N., Lochner, C., Singer, H. S., & Woods, D. W. (2010). Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety, 27(6), 611–626. https://​doi.​org/​10.​1002/​da.​20700CrossRefPubMed
go back to reference Tolin, D. F., Diefenbach, G. J., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Moore, P., Piacentini, J., Stein, D. J., Woods, D. W., & Board, T. L. C. S. A. (2008). The trichotillomania scale for children: Development and validation. Child Psychiatry and Human Development, 39(3), 331–349. https://doi.org/10.1007/s10578-007-0092-3CrossRefPubMed Tolin, D. F., Diefenbach, G. J., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Moore, P., Piacentini, J., Stein, D. J., Woods, D. W., & Board, T. L. C. S. A. (2008). The trichotillomania scale for children: Development and validation. Child Psychiatry and Human Development, 39(3), 331–349. https://​doi.​org/​10.​1007/​s10578-007-0092-3CrossRefPubMed
go back to reference Ucuz, I., Cicek, A. U., Cansel, N., Kilic, B., Colak, C., Yazici, I. P., Kilic, F., & Kucukakcali, Z. (2021). Can temperament and character traits be used in the diagnostic differentiation of children with ADHD? The Journal of Nervous and Mental Disease, 209(12), 905–910.CrossRefPubMed Ucuz, I., Cicek, A. U., Cansel, N., Kilic, B., Colak, C., Yazici, I. P., Kilic, F., & Kucukakcali, Z. (2021). Can temperament and character traits be used in the diagnostic differentiation of children with ADHD? The Journal of Nervous and Mental Disease, 209(12), 905–910.CrossRefPubMed
go back to reference Walther, M. R., Snorrason, I., Flessner, C. A., Franklin, M. E., Burkel, R., & Woods, D. W. (2014). The trichotillomania impact project in young children (TIP-YC): Clinical characteristics, comorbidity, functional impairment and treatment utilization. Child Psychiatry and Human Development, 45(1), 24–31. https://doi.org/10.1007/s10578-013-0373-yCrossRefPubMed Walther, M. R., Snorrason, I., Flessner, C. A., Franklin, M. E., Burkel, R., & Woods, D. W. (2014). The trichotillomania impact project in young children (TIP-YC): Clinical characteristics, comorbidity, functional impairment and treatment utilization. Child Psychiatry and Human Development, 45(1), 24–31. https://​doi.​org/​10.​1007/​s10578-013-0373-yCrossRefPubMed
go back to reference Wilton, E. P., Flessner, C. A., Brennan, E., Murphy, Y., Walther, M., Garcia, A., Conelea, C., Dickstein, D. P., Stewart, E., Benito, K., & Freeman, J. B. (2020). A neurocognitive comparison of pediatric obsessive-compulsive disorder and trichotillomania (hair pulling disorder). Journal of Abnormal Child Psychology, 48, 733–744. https://doi.org/10.1007/s10802-020-00627-6CrossRefPubMed Wilton, E. P., Flessner, C. A., Brennan, E., Murphy, Y., Walther, M., Garcia, A., Conelea, C., Dickstein, D. P., Stewart, E., Benito, K., & Freeman, J. B. (2020). A neurocognitive comparison of pediatric obsessive-compulsive disorder and trichotillomania (hair pulling disorder). Journal of Abnormal Child Psychology, 48, 733–744. https://​doi.​org/​10.​1007/​s10802-020-00627-6CrossRefPubMed
go back to reference Woods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., Walther, M. R., & Board, T.-S. (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. The Journal of Clinical Psychiatry, 67(12), 1877–1888. https://doi.org/10.4088/jcp.v67n1207CrossRefPubMed Woods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., Walther, M. R., & Board, T.-S. (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. The Journal of Clinical Psychiatry, 67(12), 1877–1888. https://​doi.​org/​10.​4088/​jcp.​v67n1207CrossRefPubMed
Metagegevens
Titel
Clinical Characteristics, Sleep, and Temperament in Infants and Young Children with Problematic Hair Pulling and Skin Picking
Auteurs
Kevin Pendo
Valerie S. Swisher
Talia Y. Leman
Ariel J. Rissman
Tara S. Peris
John Piacentini
Ivar Snorrason
Emily J. Ricketts
Publicatiedatum
25-10-2023
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 1/2024
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-023-10435-z

Andere artikelen Uitgave 1/2024

Cognitive Therapy and Research 1/2024 Naar de uitgave