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White matter volume alterations in hair-pulling disorder (trichotillomania)

Abstract

Trichotillomania (TTM) is a disorder characterized by repetitive hair-pulling resulting in hair loss. Key processes affected in TTM comprise affective, cognitive, and motor functions. Emerging evidence suggests that brain matter aberrations in fronto-striatal and fronto-limbic brain networks and the cerebellum may characterize the pathophysiology of TTM. The aim of the present voxel-based morphometry (VBM) study was to evaluate whole brain grey and white matter volume alteration in TTM and its correlation with hair-pulling severity. High-resolution magnetic resonance imaging (3 T) data were acquired from 29 TTM patients and 28 age-matched healthy controls (CTRLs). All TTM participants completed the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS) to assess illness/pulling severity. Using whole-brain VBM, between-group differences in regional brain volumes were measured. Additionally, within the TTM group, the relationship between MGH-HPS scores, illness duration and brain volumes were examined. All data were corrected for multiple comparisons using family-wise error (FWE) correction at p < 0.05. Patients with TTM showed larger white matter volumes in the parahippocampal gyrus and cerebellum compared to CTRLs. Estimated white matter volumes showed no significant association with illness duration or MGH-HPS total scores. No significant between-group differences were found for grey matter volumes. Our observations suggest regional alterations in cortico-limbic and cerebellar white matter in patients with TTM, which may underlie deficits in cognitive and affective processing. Such volumetric white matter changes may precipitate impaired cortico-cerebellar communication leading to a reduced ability to control hair pulling behavior.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Book  Google Scholar 

  • Ashburner, J. (2007). A fast diffeomorphic image registration algorithm. Neuroimage, 38(1), 95–113.

    PubMed  Article  Google Scholar 

  • Baillieux, H., De Smet, H. J., Paquier, P. F., De Deyn, P. P., & Mariën, P. (2008). Cerebellar neurocognition: Insights into the bottom of the brain. Clinical Neurology and Neurosurgery, 110(8), 763–773.

    PubMed  Article  Google Scholar 

  • Baillieux, H., De Smet, H. J., Dobbeleir, A., Paquier, P. F., De Deyn, P. P., & Mariën, P. (2010). Cognitive and affective disturbances following focal cerebellar damage in adults: a neuropsychological and SPECT study. Cortex, 46(7), 869–879.

    PubMed  Article  Google Scholar 

  • Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 28–37.

    Google Scholar 

  • Chamberlain, S. R., Fineberg, N. A., Blackwell, A. D., Robbins, T. W., & Sahakian, B. J. (2006). Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. The American Journal of Psychiatry, 163(7), 1282–1284.

    PubMed  Article  Google Scholar 

  • Chamberlain, S. R., Menzies, L. A., Fineberg, N. A., del Campo, N., Suckling, J., Craig, K., Müller, U., Robbins, T. W., Bullmore, E. T., & Sahakian, B. J. (2008). Grey matter abnormalities in trichotillomania: morphometric magnetic resonance imaging study. The British Journal of Psychiatry, 193, 216–221.

    PubMed  PubMed Central  Article  Google Scholar 

  • Chamberlain, S. R., Hampshire, A., Menzies, L. A., Garyfallidis, E., Grant, J. E., Odlaug, B. L., Craig, K., Fineberg, N., & Sahakian, B. J. (2010). Reduced brain white matter integrity in trichotillomania: a diffusion tensor imaging study. Archives of General Psychiatry, 67, 965–971.

    PubMed  Article  Google Scholar 

  • Chamberlain, S. R., Harries, M., Redden, S. A., Keuthen, N. J., Stein, D. J., Lochner, C., & Grant, J. E. (2018). Cortical thickness abnormalities in trichotillomania: International multi-site analysis. Brain Imaging and Behavior. https://doi.org/10.1007/s11682-017-9746-3.

  • Chen, J., Liu, J., Calhoun, V. D., Arias-Vasquez, A., Zwiers, M. P., Gupta, C. N., Franke, B., & Turner, J. A. (2014). Exploration of scanning effects in multi-site structural MRI studies. Journal of Neuroscience Methods, 230, 37–50.

  • du Toit, P. L., van Kradenburg, J., Niehaus, D., & Stein, D. J. (2001). Comparison of obsessive–compulsive disorder patients with and without comorbid putative obsessive–compulsive spectrum disorders using a structured clinical interview. Comprehensive Psychiatry, 42(4), 291–300.

    PubMed  Article  Google Scholar 

  • Eggert, L. D., Sommer, J., Jansen, A., Kircher, T., & Konrad, C. (2012). Accuracy and reliability of automated gray matter segmentation pathways on real and simulated structural magnetic resonance images of the human brain. PLoS One, 7(9), e45081.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  • Ehling, T., Nijenhuis, E. R., & Krikke, A. P. (2008). Volume of discrete brain structures in complex dissociative disorders: preliminary findings. Progress in Brain Research, 167, 307–310.

    CAS  PubMed  Article  Google Scholar 

  • Fellhauer, I., Zöllner, F. G., J Schröder, J., Degen, C., Kong, L., Essig, M., Thomann, P. A., & Schad, L. R. (2015). Comparison of automated brain segmentation using a brain phantom and patients with early Alzheimer's dementia or mild cognitive impairment. Psychiatry Research: Neuroimaging, 233(3), 299–305.

    PubMed  Article  Google Scholar 

  • Flessner, C. A., Knopik, V. S., & McGeary, J. (2012). Hair pulling disorder (trichotillomania): genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Research, 199, 151e158.

    Article  Google Scholar 

  • Grachev, I. D. (1997). MRI-based morphometric topographic parcellation of human neocortex in trichotillomania. Psychiatry and Clinical Neurosciences, 51, 315–321.

    CAS  PubMed  Article  Google Scholar 

  • Grant, J. E., & Chamberlain, S. R. (2016). Trichotillomania. The American Journal of Psychiatry, 173(9), 868–873.

    PubMed  PubMed Central  Article  Google Scholar 

  • Isobe, M., Redden, S. A., Keuthen, N. J., Stein, D. J., Lochner, C., Grant, J. E., & Chamberlain, S. R. (2018). Striatal abnormalities in trichotillomania: a multi-site MRI analysis. NeuroImage: Clinical, 17, 893–898.

    Article  Google Scholar 

  • Jovicich, J., Czanner, S., Han, X., Salat, D., van der Kouwe, A., Quinn, B., Pacheco, J., Albert, M., Killiany, R., Blacker, D., Maguire, P., Rosas, D., Makris, N., Gollub, R., Dale, A., Dickerson, B. C., & Fischl, B. (2009). MRI-derived measurements of human subcortical, ventricular and intracranial brain volumes: Reliability effects of scan sessions, acquisition sequences, data analyses, scanner upgrade, scanner vendors and field strengths. NeuroImage, 46(1), 177–192.

    PubMed  Article  Google Scholar 

  • Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., Jenike, M. A., & Baer, L. (1995). The Massachusetts General Hospital (MGH) Hairpulling scale, 1: development and factor analyses. Psychotherapy and Psychosomatics, 64, 141–145.

    CAS  PubMed  Article  Google Scholar 

  • Keuthen, N. J., Makris, N., Schlerf, J. E., Martis, B., Savage, C. R., McMullin, K., Seidman, L. J., Schmahmann, J. D., Kennedy, D. N., Hodge, S. M., & Rauch, S. L. (2007a). Evidence for reduced cerebellar volumes in trichotillomania. Biological Psychiatry, 61, 374–381.

    PubMed  Article  Google Scholar 

  • Keuthen, N. J., Flessner, C. A., Woods, D. W., Franklin, M. E., Stein, D. J., & Cashin, S. E. (2007b). Factor analysis of the Massachusetts General Hospital Hairpulling scale. Journal of Psychosomatic Research, 62(6), 707–709.

    PubMed  Article  Google Scholar 

  • Lochner, C., Seedat, S., Hemmings, S. M., Kinnear, C. J., Corfield, V. A., Niehaus, D. J., Moolman-Smook, J. C., & Stein, D. J. (2004). Dissociative experiences in obsessive–compulsive disorder and trichotillomania: Clinical and genetic findings. Comprehensive Psychiatry, 45(5), 384–391.

    PubMed  Article  Google Scholar 

  • Menon, V., Adleman, N. E., White, C. D., Glover, G. H., & Reiss, A. L. (2001). Error-related brain activation during a Go/NoGo response inhibition task. Human Brain Mapping, 12(3), 131–143.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  • Miquel, M., Vazquez-Sanroman, D., Carbo-Gas, M., Gil-Miravet, I., Sanchis-Segura, C., Carulli, D., Manzo, J., & Coria-Avila, G. A. (2016). Have we been ignoring the elephant in the room? Seven arguments for considering the cerebellum as part of addiction circuitry. Neuroscience & Biobehavioral Reviews, 60, 1–11.

    Article  Google Scholar 

  • Moreno-Rius, J., & Miquel, M. (2017). The cerebellum in drug craving. Drug and Alcohol Dependence, 173, 151–158.

    PubMed  Article  Google Scholar 

  • Moulton, E. A., Elman, I., Becerra, L. R., Goldstein, R. Z., & Borsook, D. (2014). The cerebellum and addiction: insights gained from neuroimaging research. Addiction Biology, 19(3), 317–331.

    PubMed  PubMed Central  Article  Google Scholar 

  • O’Sullivan, R. L., Rauch, S. L., Breiter, H. C., Grachev, I. D., Baer, L., Kennedy, D. N., Keuthen, N. J., Savage, C. R., Manzo, P. A., Caviness, V. S., & Jenike, M. A. (1997). Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biological Psychiatry, 42, 39–45.

    PubMed  Article  Google Scholar 

  • Odlaug, B. L., Chamberlain, S. R., Derbyshire, K. L., Leppink, E. W., & Grant, J. E. (2014). Impaired response inhibition and excess cortical thickness as candidate endophenotypes for trichotillomania. Journal of Psychiatry Research, 59, 167–173.

    Article  Google Scholar 

  • Rauch, S. L., Wright, C. I., Savage, C. R., Martis, B., McMullin, K. G., Wedig, M. M., Gold, A. L., & Keuthen, N. J. (2007). Brain activation during implicit sequence learning in individuals with trichotillomania. Psychiatry Research: Neuroimaging, 154(3), 233–240.

    PubMed  Article  Google Scholar 

  • Romer, A. L., Knodt, A. R., Houts, R., Brigidi, B. D., Moffitt, T. E., Caspi, A., & Hariri, A. R. (2018). Structural alterations within cerebellar circuitry are associated with general liability for common mental disorders. Molecular Psychiatry, 23(4), 1084–1090.

    CAS  PubMed  Article  Google Scholar 

  • Roos, A., Fouche, J. P., Stein, D. J., & Lochner, C. (2013). White matter integrity in hairpulling disorder (trichotillomania). Psychiatry Research: Neuroimaging, 211, 246–250.

    PubMed  Article  Google Scholar 

  • Roos, A., Grant, J. E., Fouche, J. P., Stein, D. J., & Lochner, C. (2015). A comparison of brain volume and cortical thickness in excoriation (skin picking) disorder and trichotillomania (hair pulling disorder) in women. Behavioural Brain Research, 279, 255–258.

    PubMed  Article  Google Scholar 

  • Schäfer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C., Kemper, U., Keiper, P., Wedekind, D., Havemann-Reinecke, U., Teunissen, S., Weirich, S., & Driessen, M. (2010). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-a multi-center study. Drug and Alcohol Dependence, 109(1–3), 84–89.

    PubMed  Article  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.

    PubMed  Google Scholar 

  • Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clinical Psychology Review, 32(7), 618–629.

    PubMed  Article  Google Scholar 

  • Stein, D. J., Coetzer, R., Lee, M., Davids, B., & Bouwer, C. (1997). Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Research, 74, 177–182.

    CAS  PubMed  Article  Google Scholar 

  • Stein, D. J., Chamberlain, S. R., & Fineberg, N. A. (2006). An A-B-C model of habit disorders: hair-pulling, skin-picking, and other stereotypic conditions. CNS Spectrums, 11(11), 824e7.

    Article  Google Scholar 

  • Stern, E. R., Welsh, R. C., Gonzalez, R., Fitzgerald, K. D., Abelson, J. L., & Taylor, S. F. (2013). Subjective uncertainty and limbic hyperactivation in obsessive-compulsive disorder. Human Brain Mapping, 34(8), 1956–1970.

    PubMed  Article  Google Scholar 

  • Stoodley, C. J. (2016). The cerebellum and neurodevelopmental disorders. The Cerebellum, 15(1), 34–37.

    CAS  PubMed  Article  Google Scholar 

  • Suzuki, W. A. (2009). Declarative memory system: Anatomy. In L. R. Squire (Ed.), Encyclopedia of neuroscience (pp. 347–356). Oxford: Academic Press.

    Chapter  Google Scholar 

  • Swedo, S. E., Rapoport, J. L., Leonard, H. L., Schapiro, M. B., Rapoport, S. I., & Grady, C. L. (1991). Regional cerebral glucose metabolism of women with trichotillomania. Archives of General Psychiatry, 48(9), 828–833.

    CAS  PubMed  Article  Google Scholar 

  • Woods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., & Walther, M. R. (2006). The trichotillomania impact project (TIP): exploring phenomenology, functional impairment, and treatment utilization. The Journal of Clinical Psychiatry, 67, 1877–1888.

    PubMed  Article  Google Scholar 

  • Zhang, L., Qiao, L., Chen, Q., Yang, W., Xu, M., Yao, X., Qiu, J., & Yang, D. (2016). Gray matter volume of the lingual gyrus mediates the relationship between inhibition function and divergent thinking. Frontiers in Psychology, 7, 1532.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by the National Research Foundation (NRF) of South Africa (grant number CPRR15062211995). Dr. Uhlmann received a Stellenbosch University Subcommittee C postdoctoral fellowship.

Funding

This study was funded by the National Research Foundation (NRF) of South Africa (grant number CPRR15062211995).

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Correspondence to Christine Lochner.

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Author DJS has received research grants and/or consultancy honoraria from Abbott, ABMRF, Astrazeneca, Biocodex, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, National Responsible Gambling Foundation, Novartis, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah, and Wyeth.

The other authors declare no conflict of interest with respect to subjects of the paper.

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Uhlmann, A., Dias, A., Taljaard, L. et al. White matter volume alterations in hair-pulling disorder (trichotillomania). Brain Imaging and Behavior 14, 2202–2209 (2020). https://doi.org/10.1007/s11682-019-00170-z

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  • DOI: https://doi.org/10.1007/s11682-019-00170-z

Keywords

  • Trichotillomania
  • Compulsivity
  • Impulsivity
  • Neuroimaging
  • Voxel-based morphometry