Advertisement

The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A): Development of an Instrument for the Assessment of “Focused” and “Automatic” Hair Pulling

  • Christopher A. Flessner
  • Douglas W. WoodsEmail author
  • Martin E. Franklin
  • Susan E. Cashin
  • Nancy J. Keuthen
  • Trichotillomania Learning Center-Scientific Advisory Board (TLC-SAB)
Article

Abstract

This article describes the development of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), which was designed to assess “automatic” and “focused” pulling subtypes of trichotillomania (TTM). Participants reporting symptoms of TTM (n = 1,697) completed an internet survey; participants were later randomly assigned to either Exploratory (n = 848) or Confirmatory (n = 849) Analyses. Exploratory Analyses examined the development and psychometric properties of the MIST-A. Results of an exploratory factor analysis revealed a two-factor solution. Factor 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of ten and five items respectively, with both scales demonstrating adequate internal consistency and good construct and discriminant validity. Subsequent confirmatory factor analysis demonstrated support for the scale’s underlying factor structure. The MIST-A provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, although replication using a clinically ascertained sample is necessary.

Keywords

Focused Automatic Pulling Trichotillomania 

Notes

Acknowledgement

This project was funded by the Trichotillomania Learning Center (TLC). We would like to thank Renee Goodwin, Ph.D. and the participants for their assistance on this project.

References

  1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, (4th Ed.), Text Revision. Washington, D. C: Author.Google Scholar
  2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  3. Azrin, N. H., & Nunn, R. G. (1973). Habit Reversal: a method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619–628.PubMedCrossRefGoogle Scholar
  4. Begotka, A. M., Woods, D. W., & Wetterneck, C. T. (2004). The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 17–24.PubMedCrossRefGoogle Scholar
  5. Bollen, K. A. (1989). Structural equations with latent variables. New York, NY: Wiley.Google Scholar
  6. Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the depression anxiety stress scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79–89.PubMedCrossRefGoogle Scholar
  7. Bryant, F. B., & Yarnold, P. R. (1995). Principal-components analysis and exploratory and confirmatory factor analysis. In L. G. Grimm, & P. R. Yarnold (Eds.) Reading and understanding multivariate statistics (pp. 99–136). Washington, D.C.: American Psychological Association.Google Scholar
  8. Christenson, G. A., & Mackenzie, T. B. (1994). Trichotillomania. In M. Hersen, & R. T. Ammerman (Eds.) Handbook of prescriptive treatment for adults (pp. 217–235). New York, NY: Plenum Press.Google Scholar
  9. Christenson, G. A., Mackenzie, T. B., & Mitchell, J. E. (1991a). Characteristics of 60 adult chronic hair pullers. American Journal of Psychiatry, 148, 365–370.PubMedGoogle Scholar
  10. Christenson, G. A., Pyle, R. A., & Mitchell, J. E. (1991b). Estimated lifetime prevalence of trichotillomania in college students. Journal of Clinical Psychiatry, 52, 415–417.PubMedGoogle Scholar
  11. Cohen, L. J., Stein, D. J., Simeon, D., Spadaccini, E., Rosen, J., Aronowitz, B., et al. (1995). Clinical profile, comorbidity, and treatment history in 123 hair pullers: A survey study. Journal of Clinical Psychiatry, 56, 319–326.PubMedGoogle Scholar
  12. Diefenbach, G. J., Mouton-Odum, S., & Stanley, M. A. (2002). Affective correlates of trichotillomania. Behaviour Research and Therapy, 40, 1305–1315.PubMedCrossRefGoogle Scholar
  13. du Toit, P. L., van Kradenburg, J., Niehaus, D. J. H., & Stein, D. J. (2001). Characteristics and phenomenology of hair-pulling: An exploration of subtypes. Comprehensive Psychiatry, 42, 247–256.PubMedCrossRefGoogle Scholar
  14. Flessner, C. A., & Woods, D. W. (2006). Phenomenological characteristics, social problems, and economic impact associated with chronic skin picking (CSP). Behavior Modification, 30, 944–963.PubMedCrossRefGoogle Scholar
  15. Franklin, M. E., Tolin, D. F., & Diefenbach, D. (2006). Trichotillomania. In E. Hollander, & D. J. Stein (Eds.) Clinical manual of impulse control disorders (pp. 149–173). Washington, D.C.: American Psychiatric Publishing, Inc.Google Scholar
  16. Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative of six preconceptions about internet questionnaires. American Psychologist, 59, 93–104.PubMedCrossRefGoogle Scholar
  17. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2001). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York, NY: Guilford Press.Google Scholar
  18. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  19. Jaisoorya, T. S., Janardhan-Reddy, Y. C., & Srinath, S. (2003). The relationship of obsessive– compulsive disorder to putative spectrum disorders: Results from an Indian study. Comprehensive Psychiatry, 44, 317–323.PubMedCrossRefGoogle Scholar
  20. Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., et al. (1995). The Massachusetts General Hospital (MGH) hairpulling scale: 1. Development and factor analysis. Psychotherapy and Psychosomatics, 64, 141–145.PubMedCrossRefGoogle Scholar
  21. Leon, A. C., Olfson, M., Portera, L., Farber, L., & Sheehand, D. V. (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine, 27, 93–105.PubMedCrossRefGoogle Scholar
  22. Linehan, M. M. (1993). Cognitive–behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press.Google Scholar
  23. Lochner, C., Simeon, D., Niehaus, D. J. H., & Stein, D. J. (2002). Trichotillomania and skin- picking: A phenomenological comparison. Depression and Anxiety, 15, 83–86.PubMedCrossRefGoogle Scholar
  24. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression and anxiety stress scales (2nd Ed.). Sydney, Australia: Psychological Foundation of Australia.Google Scholar
  25. Mackenzie, T. B., Ristvedt, S. L., Christenson, G. A., Smith Lebow, A., & Mitchell, J. E. (1995). Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 26, 9–16.PubMedCrossRefGoogle Scholar
  26. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd Ed.). New York: McGraw-Hill.Google Scholar
  27. Reeve, E. A., Bernstein, G. A., & Christenson, G. A. (1992). Clinical characteristics and psychiatric comorbidity in children with trichotillomania. Journal of the American Academy of Children and Adolescent Psychiatry, 31, 132–138.CrossRefGoogle Scholar
  28. Stevens, J. P. (2002). Applied multivariate statistics for the social sciences (4th Ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  29. Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th Ed.). Boston, MA: Allyn and Bacon.Google Scholar
  30. Wetterneck, C. T., Woods, D. W., Norberg, M. M., & Begotka, A. M. (2006). The social and economic impact of trichotillomania: Results from two nonreferred samples. Behavioral Interventions, 21, 97–109.CrossRefGoogle Scholar
  31. Winchel, R. M., Jones, J. S., Molcho, A., Parson, B., Stanley, B., & Stanley, M. (1992). The psychiatric institute trichotillomania scale (PITS). Psychopharmacology Bulletin, 28, 463–476.PubMedGoogle Scholar
  32. Woods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Stein, D., Goodwinn, R. G., et al. (2006). Trichotillomania Impact Project (TIP): Exploring the Functional Impact of Trichotillomania and its Treatment in Adults. Journal of Clinical Psychiatry, 67, 1877–1888.PubMedCrossRefGoogle Scholar
  33. Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal as a treatment for trichotillomania. Behavior Research and Therapy, 44, 639–656.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Christopher A. Flessner
    • 1
  • Douglas W. Woods
    • 1
    • 4
  • Martin E. Franklin
    • 2
  • Susan E. Cashin
    • 1
  • Nancy J. Keuthen
    • 3
  • Trichotillomania Learning Center-Scientific Advisory Board (TLC-SAB)
  1. 1.University of Wisconsin-MilwaukeeMilwaukeeUSA
  2. 2.University of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Massachusetts General Hospital/Harvard Medical SchoolBostonUSA
  4. 4.Department of PsychologyUniversity of Wisconsin-MilwaukeeMilwaukeeUSA

Personalised recommendations