Abstract
Currently there is no “gold standard” treatment outcome measure for trichotillomania (TTM), a disorder characterized by repetitive hair pulling resulting in noticeable hair loss. The goal of the current study was to evaluate the psychometric properties of TTM measures of differing assessment methods: self-report, clinician-rated summary scales, and clinician-rated global severity scales. Data collected from 28 patients with TTM indicated mixed psychometric properties for current scales. Internal consistency was strong for self-report but not clinician-rated summary scales. One clinician-rated summary scale total and subjective ratings of hair loss demonstrated good interrater agreement. Although convergent validity was good within measurement type, self-report did not correlate with clinician-rated global severity scales, perhaps because of absence of hair loss severity assessment on the self-report measure. A multimethod assessment including one of each type of measure reviewed in this paper, along with self-monitoring and measures of hair loss severity, is recommended for a comprehensive best practice approach to TTM assessment.
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References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
Barabasz, M. (1987). Trichotillomania: A new treatment. The International Journal of Clinical and Experimental Hypnosis, 35, 146–154.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory (2nd ed.). San Antonio, TX: Psychological Corporation, Harcourt, Brace.
Bornstein, P. H., & Rychtarik, R. G. (1978). Multicomponent behavioral treatment of trichotillomania: A case study. Behaviour Research and Therapy, 16, 217–220.
Christenson, G. A., MacKenzie, T. B., & Mitchell, J. E. (1991). Characteristics of 60 adult chronic hair pullers. American Journal of Psychiatry, 148, 365–370.
Dahlke, F., Lohaus, A., & Gutzmann, H. (1992). Reliability and clinical concepts underlying global judgments in dementia: Implications for clinical research. Psychopharmacology Bulletin, 28, 425–432.
Dahlquist, L. M., & Kalfus, G. R. (1984). A comparison of relaxation training and competing response training to eliminate hair pulling and nail biting. Journal of Behavior Therapy and Experimental Psychiatry, 15, 67–70.
Diefenbach, G. J., Reitman, D., & Williamson, D. A. (2000). Trichotillomania: A challenge to research and practice. Clinical Psychology Review, 20, 289–309.
Diefenbach, G. J., Tolin, D. F., Franklin, M. E., & Anderson, E. R. (2003, November). The Trichotillomania Scale for Children (TSC): A new self-report measure to assess pediatric hair pulling. Paper presented at the Annual Meeting of the Association for Advancement of Behavior Therapy, Boston, MA.
Diefenbach, G. J., Tolin, D. F., Hannan, S. E., Crocetto, J. S., & Worhunsky, P. (2003, November). Trichotillomania: Impact on Daily Functioning and Quality of Life. Paper presented at the Annual Meeting of the Association for Advancement of Behavior Therapy, Boston, MA.
Diefenbach, G. J., Tolin, D. F., Maltby, N., Hannan, S., & Crocetto, J. S. (2003, November). Group treatment for trichotillomania: CBT versus supportive therapy. In M. E. Franklin & N. J. Keuthen (Chairs), New Developments in Trichotillomania Research. Symposium conducted at the Annual Meeting of the Association for Advancement of Behavior Therapy, Boston, MA.
Elliott, A. J., & Fuqua, R. W. (2000). Trichotillomania: Conceptualization, measurement, and treatment. Behavior Therapy, 31, 529-545.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID I/P, version 2.0). New York: Biometrics Research Department.
Franklin, M. E., Tolin, D. F., & Diefenbach, G. J. (in press). Trichotillomania. In E. Hollander & D. J. Stein (Eds.), Handbook of impulse control disorders. Washington, DC: American Psychiatric Press.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.
Guy, W. (1976). Assessment manual for psychopharmacology. Washington, DC: U.S. Government Printing Office.
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 analyses. Psychotherapy and Psychosomatics, 64, 141–145.
Leon, A. C., Shear, M. K., Klerman, G. L., Portera, L., Rosenbaum, J. F., & Goldenberg, I. (1993). A comparison of symptom determinants of patient and clinician global ratings in patients with panic disorder and depression. Journal of Clinical Psychopharmacology, 13, 327–331.
Mansueto, C. S., Stemberger, R. M. T., Thomas, A. M., & Golomb, R. G. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567–577.
Ninan, P. T., Rothbaum, B. O., Marsteller, F. A., Knight, B. T., & Eccard, M. B. (2000). A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. Journal of Clinical Psychiatry, 61, 47–50.
O’Sullivan, R. L., Keuthen, N. J., Hayday, C. F., Ricciardi, J. N., Buttolph, M. L., Jenike, M. A., et al. (1995). The Massachusetts General Hospital (MGH) Hairpulling Scale: 2. Reliability and validity. Psychotherapy and Psychosomatics, 64, 146–148.
Rothbaum, B. O., & Ninan, P. T. (1994). The assessment of trichotillomania. Behaviour Research and Therapy, 32, 651–662.
Rothbaum, B. O., Opdyke, D. C., & Keuthen, N. J. (1999). Assessment of trichotillomania. In D. J. Stein, G. A. Christenson, & E. Hollander (Eds.), Trichotillomania (pp. 285–298). Washington, DC: American Psychiatric Press.
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, R. E., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Sprinkle, S. D., Daphne, L., Insko, S. L., Atkinson, G., Jones, G. L., Logan, A. R., et al. (2002). Criterion validity, severity cut scores, and test–retest reliability of the Beck Depression Inventory-II in a university counseling center sample. Journal of Counseling Psychology, 49, 381–385.
Stanley, M. A., Breckenridge, J. K., Snyder, A. G., & Novy, D. M. (1999). Clinician-rated measures of hair pulling: A preliminary psychometric evaluation. Journal of Psychopathology and Behavioral Assessment, 21, 157–170.
Swedo, S. E., Rapoport, J. L., Leonard, H., Lenane, M., & Cheslow, D. (1989). Obsessive-compulsive disorder in children and adolescents. Clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry, 46, 335–341.
Tarnowski, K. J., Rosen, L. A., McGrath, M. L., & Drabman, R. S. (1987). A modified habit reversal procedure in a recalcitrant case of trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry, 18, 157–163.
Tolin, D. F., Franklin, M. E., Diefenbach, G. J., & Gross, A. (2002, November). Cognitive-behavioral therapy for pediatric trichotillomania: An open trial. Paper Presented at the Association for Advancement of Behavior Therapy, Reno, NV.
Winchel, R. M., Jones, J. S., Molcho, A., Parsons, B., Stanley, B., & Stanley, M. A. (1992a). The Psychiatric Institute Trichotillomania Scale (PITS). Psychopharmacology Bulletin, 28, 463–476.
Winchel, R. M., Jones, J. S., Molcho, A., Parsons, B., Stanley, B., & Stanley, M. A. (1992b). Rating the severity of trichotillomania: Methods and problems. Psychopharmacology Bulletin, 28, 457–462.
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Diefenbach, G.J., Tolin, D.F., Crocetto, J. et al. Assessment of Trichotillomania: A Psychometric Evaluation of Hair-Pulling Scales. J Psychopathol Behav Assess 27, 169–178 (2005). https://doi.org/10.1007/s10862-005-0633-7
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DOI: https://doi.org/10.1007/s10862-005-0633-7