Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Abstract

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

Not only compulsivity: The SAPAP3-KO mouse reconsidered as a comorbid model expressing a spectrum of pathological repetitive behaviors

“…Hence, scratching in Sapap3 -/mice demonstrates tic-like elements but cannot be entirely defined as such. This tic-close but not entirely tic-like status makes scratching similar to pathological hair-pulling and skin-picking, which has propagated a wave of clinical discussion concerning these phenotypes in human trichotillomania patients as well as frequently comorbid OCD and/or Tourette Syndrome patients with hair-pulling and/or skin-picking pathologies (5). Interestingly, although no direct link was found between genetic SAPAP3 variants and OCD, identified single nucleotide polymorphisms were associated with grooming disorders such as pathologic nail biting, pathologic skin picking, and/or trichotillomania, an obsessive-compulsive related disorder (50,51).…”

“…The exact nature of pathological RB is not always trivial to distinguish and comorbidities impede correct diagnosis and appropriate treatment. This applies especially to three neuropsychiatric disorders with high comorbidity (1)(2)(3): Tourette Syndrome (TS), a childhood-onset neurodevelopmental disorder characterized by tics, Obsessive Compulsive Disorder (OCD), a heterogeneous disorder, of which the most typical form is characterized by obsessions and obsession-dependent compulsions (4), as well as trichotillomania (TTM), which has proven difficulty in its classification as belonging to a ticor compulsive-like nature (5). Tics, defined as sudden, rapid, recurrent, non-rhythmic motor events (4), and compulsions, defined as non-rhythmic, but less sudden RBs are easily confounded in clinical practice (3,6).…”

Astrocytic VMAT2 in the developing prefrontal cortex is required for normal grooming behavior in mice

“…Rodent self-grooming is now widely recognised as a suitable behavioural output for studying the neural circuits underlying the generation of complex patterns of repetitive behaviours that may be relevant to human psychiatric disorders (4) and, over the last ten years, it has been suggested that some transgenic mice characterised by aberrant repetitive grooming behaviour can be used as models of OCD or OCD spectrum disorders. The grooming behaviour of VMAT2-deficient mice has some similarities to that identified in mice lacking synapse-associated protein 90/postsynaptic density protein 5-associated protein 3 (SAPAP3-/-) (67), which essentially consists of a pathologically increased number of short grooming sessions. The complex sequenced structure of mouse self-grooming is characterised by repeated stereotyped movements or "syntactic chains" (68) that start of a series of elliptical bilateral paw strokes near the nose (paw and nose grooming) and a series of unilateral paw strokes from the mystacial vibrissae to below the eye (face grooming), followed by a series of simultaneous bilateral strokes backwards and upwards (head grooming) and body licking.…”

«Doctora, yo como pelo». Tricotilomanía con tricofagia

“…se asoció a los tics y al síndrome de Gilles de la Tourette, pero en el DSM-V se incluyó dentro del espectro de los trastornos obsesivo-compulsivos (TOC) y de los trastornos relacionados TOC: acumulación, excoriación y dismórfico corporal. Actualmente, no existe un acuerdo unánime en relacionarlo con los tics o con los TOC [6][7][8] . Son cinco los criterios que se deben cumplir para un diagnóstico de tricotilomanía: a) arrancarse el cabello de modo recurrente; b) intentos repetidos e infructuosos de detener el tirón de pelo; c) causa malestar; d) interferir en alguna área de la vida del que lo padece; e) no es atribuible a otra causa médica o trastorno mental 4,6 .…”