Photographic Assessment of Change in Trichotillomania: Psychometric Properties and Variables Influencing Interpretation

  • David C. HoughtonEmail author
  • Maddison R. Franklin
  • Michael P. Twohig
  • Martin E. Franklin
  • Scott N. Compton
  • Angela M. Neal-Barnett
  • Stephen M. Saunders
  • Douglas W. Woods


Although photographic assessment has been found to be reliable in assessing hair loss in Trichotillomania, the validity of this method is unclear, particularly for gauging progress in treatment. The current study evaluated the psychometric properties of photographic assessment of change in Trichotillomania. Photographs showing hair loss of adults with Trichotillomania were taken before and after participating in a clinical trial for the condition. Undergraduate college students (N = 211) rated treatment response according to the photos, and additional archival data on hair pulling severity and psychosocial health were retrieved from the clinical trial. Photographic assessment of change was found to possess fair reliability (ICC = 0.53), acceptable criterion validity (r = 0.51), good concurrent validity (r = 0.30–0.36), and excellent incremental validity (ΔR 2 = 8.67, p < 0.01). In addition, photographic measures were significantly correlated with change in quality of life (r = 0.42), and thus could be considered an index of the social validity of Trichotillomania treatment. Gender of the photo rater and pulling topography affected the criterion validity of photographic assessment (partial η 2 = 0.05–0.11). Recommendations for improving photographic assessment and future directions for hair pulling research are discussed.


Hair pulling Psychometrics Assessment Behavioral observation 



Research reported in this paper was supported by the NIMH of the National Institutes of Health under Award number R01MH080966 (Woods, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the Trichotillomania Leaning Center for assisting in recruiting as well as the participants in this study. The authors would also like to thank Steve Hayes, Thilo Deckersbach, Flint Espil, Mike Walther, Chris Bauer, Shawn Cahill, Jason Levine, Emily Ricketts, Bryan Brandt, Zach Hosale, Joe Rohde, Valerie Esser, Olivia Smith, Abel Mathew, Colleen McFarland, and Carley Richardson for their assistance on this project.

Compliance with Ethical Standards

Conflict of Interest

David C. Houghton, Maddison R. Franklin, Michael P. Twohig, Martin E. Franklin, Scott N. Compton, Angela M. Neal-Barnett, Stephen M. Saunders and Douglas W. Woods declare that they have no conflict of interest.

Experiment Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • David C. Houghton
    • 1
    Email author
  • Maddison R. Franklin
    • 1
  • Michael P. Twohig
    • 2
  • Martin E. Franklin
    • 3
  • Scott N. Compton
    • 4
  • Angela M. Neal-Barnett
    • 5
  • Stephen M. Saunders
    • 6
  • Douglas W. Woods
    • 1
  1. 1.Department of PsychologyTexas A & M UniversityCollege StationUSA
  2. 2.Department of PsychologyUtah State UniversityLoganUSA
  3. 3.Department of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamUSA
  5. 5.Department of PsychologyKent State UniversityKentUSA
  6. 6.Department of PsychologyMarquette UniversityMilwaukeeUSA

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