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Current Research

Genetics Consortium | TLC Research Grant Awards: Funded Projects | TTM Family Study | Research Poster Abstracts

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TLC’s International Consortium for the Study of Trichotillomania and Related Conditions

TLC has embarked on an ambitious international collaborative research project to collect clinical and genetic data from people with trichotillomania and related disorders, and their families. The goal of the Consortium is to better understand the underlying risk factors contributing to the expression of trichotillomania. The data collected by conducting in-person interviews with subjects will also validate the results of the TLC Trichotillomania Impact Project (TIP), which was conducted through an internet survey.

Summer 2011 update >>

TLC believes fostering collaboration is the best way to promote progress in this field. The project will create a repository of genetic information (blood samples, DNA and cell lines) and clinical data (in-depth interviews) which can be used by researchers worldwide, now and in the future, to examine the underlying causes of trichotillomania and related disorders.

Dr. David Paul's laboratory in the Psychiatric and Neurodevelopmental Genetics Unit (PNGU) in the Center for Human Genetic Research at the Massachusetts General Hospital will be the coordinating site for data collection and management. Access to the data and DNA included in the Repository will be available to all contributors and other qualified investigators in the larger scientific community.

The Pilot Study for this Consortium was successfully led by Nancy Keuthen, Ph.D. and David Pauls, Ph.D. Our thanks to Drs. Keuthen and Pauls, all the members of our Scientific Advisory Board who advised on the process, and to all the members of the trich community who participated. TLC’s Scientific Advisory Board has a long history of collegial, collaborative work, which set the stage for this new, much larger-scale project. We look forward to launching new blood & data collection sites in the coming year. (We will keep you posted!)

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TLC Research Grant Award

Fostering research is fundamental to TLC’s mission to end the suffering caused by hair pulling and skin picking disorders. Thanks to TLC-member donations, TLC is able to provide small research grants each year. Research is the key to finding better treatments and a cure.

For More Information

• If you have questions about this program, please contact TLC.
• If you'd like to submit a proposal for the 2012 cycle, read the TLC Research Grant Program Guidelines.
• If you are interested in participating in a research study, click here.
• A gift of any size to TLC’s Research Fund makes possible our wide range of programs to support research, foster collaboration between specialists, develop new talent, and inform the scientific community.

2011Research Grant Program:
Funded Project and Updates from Past Recipients

For a complete overview of this and TLC's other current research studies,  subscribe to TLC's Quarterly Newsletter, by becoming a TLC member >>

2011 Grant Award Recipient

Testing for Biomarkers & Mechanisms of NAC Efficacy in a Mouse Model of Trichotillomania
Amy Lossie, PhD
Assistant Professor, Department of Animal Science, Purdue University
Adjunct Assistant Professor, Department of Medicine, Indiana University School of Medicine

Dr. Lossie’s research project explores the ‘how and why’ behind Dr. Jon Grant’s exciting independent research studies demonstrating the efficacy of N-acetylcysteine (NAC) for treating the symptoms of Trichotillomania in adults. Dr. Michael H. Bloch is also now studying NAC’s efficacy in children, thanks to a TLC research grant.

Dr. Lossie’s project focuses on two goals: 1. Identifying how NAC works in the brain to treat symptoms of TTM, and 2. Developing potential blood-and urine-based tests, called biomarkers, that could lead to screens that predict risk for developing TTM, as well as help in the identification, diagnosis, and personalized treatment of individuals with TTM.

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Update: N-Acetylcysteine for the Treatment of TTM in Children

Principal Investigators: Michael H. Bloch MD, MS
Clinical Research Coordinator: Kaitlyn E. Panza, BA
Funded by 2009 Grant Cycle

Our clinical trial of N-acetylcysteine (NAC) for pediatric trichotillomania is enrolling 40 children, between the ages of 8-17, with TTM. Each child is randomized to take either NAC or a placebo (an inactive pill) for 12 weeks. We began enrolling participants in this trial on November 1, 2009, and in the 20 months since recruitment began we have screened 81 children and enrolled 31 participants. Of the 31 participants randomized in the study, 24 have completed the trial, 2 dropped out early (neither due to side effects) and 5 are currently participating. We need only 9 more participants and then we can begin to analyze the data and determine whether the promising treatment for TTM works in children.

We are hoping to complete recruitment for this study by the end of 2011. If you would like more information about our study, please contact Kaitlyn Panza at (203) 737-4809 or kaitlyn.panza@yale.edu. Thank you again for your support and the support of TLC.

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Update: Computerized Cognitive Training Programs for TTM

Han Joo Lee, PhD
Assistant Professor, Department of Psychology
University of Wisconsin-Milwaukee

The objective of this study is to examine the feasibility of computerized cognitive training programs (CTPs) for enhancing response inhibition capabilities among individuals with trich, thereby reducing TTM symptoms.

This project is currently recruiting children with significant hair pulling problems in order to test the effectiveness of a computerized cognitive training program that aims to increase the individual's ability to resist the urges for pulling.

Participants undergo an 8-session computerized treatment program over a 4-week period, and its short-term and long-term effects at 1 month follow-up are evaluated. We aim to recruit 20 children with trichotillomania for this research project.

Five children have already completed the procedure, and there are currently 6 children who are participating in this study. More children are being evaluated to ascertain their eligibility for participating in the study.

Upon establishing efficacy, CTPs may be easily integrated into various contexts; examples include CTPs as an adjunctive intervention to existing behavioral and/or pharmacological treatments, an instrument to identify and help at-risk individuals for preventative training, a stand-alone short-term intervention, and a remote web-based self-help intervention. We are actively recruiting participants and expect to complete the recruitment by the end of this year (see page 12 for information).

Update: Functional Magnetic Resonance Imaging (fMRI) TTM in the Resting State and During a Response-Inhibition Task

Principal Investigator: Matthew P. White, MD
Department of Psychiatry, Stanford University, Palo Alto, CA

 

Dr. White's functional MRI study compares subjects with Trichotillomania to subjects with Obsessive-Compulsive Disorder and a third group of Healthy Controls (no OCD or TTM). The goal of the study is to compare ways in which brain activity and regional inter-connectivity may be different between these three groups. I hope that by demonstrating such differences I can help to establish a neurobiological model for TTM. The study might also show ways in which TTM is similar or different from OCD. The findings may inform classification and treatment directions for TTM.

Dr. White has now completed imaging and preliminary data analysis for 15 subjects with Trichotillomania and 20 “healthy control” subjects. Some early findings were presented at the annual TLC conference this year. They are quite exciting and are currently being written up for publication! Expect publication late this year or early 2012.

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Trichotillomania Family Study

David Pauls, PhD
Director, Psychiatric & Neurodevelopmental Genetics Unit
Massachusetts General Hospital

A  privately-fudned study currently underway at Massachusetts General Hospital (MGH) the study is led by Dr. Nancy Keuthen, Co-Director of the Trichotillomania Clinic, Psychiatric Neuroscience Program, and Dr. David Pauls, Director of the Psychiatric and Neurodevelopmental Genetics Unit, at MGH.

Fred Bartlett (Chaplain, retired) made the decision to privately fund an important project very close to his heart, The TTM Family Study. Fred was moved to do this project out of his belief that in addition to biological study, researching the impact of certain familial dynamics, home environment, and personality factors might also shed important light on many facets of trichotillomania. Thus, the TTM Family Study was created to study a broad range of family and environmental data while simultaneously collecting genetic samples, which would then be generously contributed to the TLC Genetics Bio-Bank.

In July, 2011, Dr. Nancy Keuthen reported, “We have just completed enrollment in our MGH/Harvard family study protocol (100 TTM families with an adult proband in 51 of the families and an adolescent in 49 of the families). We have also collected data on 48 healthy control families (23 adolescent and 25 adult families). All study participants are well characterized with a range of structured interviews and self-report scales. We are in the process of completing data entry and best estimate diagnoses (two clinicians independently diagnose and then achieve final consensus).We hope to complete data analyses by the end of the summer.

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Research Poster Abstracts Presented at the 2011 Conference

For a complete overview of this and TLC's other current research studies,  subscribe to TLC's Quarterly Newsletter, by becoming a TLC member >>

The 2011 Conference saw the debut of a new program for the annual event: TLC Poster Sessions. Poster sessions, a venue in which researchers share and advertise their work on 6 x 4 ft. posters using a combination of text and graphic elements, provide an opportunity for colleagues, peers, and patient attendees to ask one-on-one questions from the researcher themselves.

Thanks to the vision of TLC Scientific Advisory Board member Carol Novak, MD, TLC staff organized a Request for Proposals that was distributed to universities nationwide. Submissions were ranked by TLC-SAB members, all were accepted! Generous funding from a private donation underwrote much of the expenses related to the program. Below, we’ve provided a summary of the posters.

Developmental Factors in Trichotillomania and Its Treatment

Aubrey Edson, BA1, Kristin L. Benavides, BA1, Addie Goss, BA2, Martin Franklin, PhD1
1University of Pennsylvania, Dept. of Psychiatry, 2Bryn Mawr College

A recent randomized controlled trial examining the efficacy of behavior therapy for pediatric trichotillomania employed a patient sample with a broad age range (7–17), which raised a question about whether young children and older children would respond similarly to the behavioral intervention. In particular, it is unclear whether the younger children have the cognitive capacity and ability to introspect enough to understand concepts like “urges” and benefit from awareness training, a key aspect of behavior therapy.

Trichodaganomania: Compulsive Habit of Biting One’s Own Hair

Mohamed Jafferany, MD
Dept. of Psychiatry, Synergy Medical Education Alliance

The most common cause of self-inflicted hair loss is Trichotillomania and its variants like Trichoteiromania or Trichotemnomania. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revised (DSM-IV -TR) classifies Trichotillomania as an impulse control disorder not elsewhere classified and defines it as recurrent pulling out of one’s hair resulting in a noticeable hair loss, with feelings of pleasure, gratification or relief when pulling out the hair; while both Trichoteiromania and Trichotemnomania have not been classified in DSM-IV-TR and have not been reported in American textbooks. Trichoteiromania is characterized by the compulsive rubbing of one’s own hair and producing an area of hair loss, and Trichotemnomania is characterized by the compulsive habit of cutting or shaving the hair. We are reporting a case of the compulsive habit of biting one’s own hair producing a noticeable patch of loss of hair and we suggest the name Trichodaganomania from the Greek word “daganein” (to bite). To our knowledge this is the first report of this type of self-inflicted hair loss.

The Trichotillomania Learning Center Retreat 2010: Assessment of Attendee Experience

Christine Lochner, PhD, Dan Stein, PhD
Department of Psychiatry, University of Cape Town, South Africa

The impressions and experiences of attendees of the annual Trichotillomania Learning Center (TLC) retreats, as well as the impact of attendance on, and the stigma experienced because of, hair-pulling and other body-focused repetitive behaviors (BFRB’s), have not been formally assessed or documented. Attendees were given the chance to provide feedback of their satisfaction with and experiences at the 2010 TLC retreat. They were also encouraged to complete a scale assessing the stigma they felt because of their (or their significant other’s) hair-pulling / BFRB’s.

Does Trichotillomania Produce Attentional Bias to Hair-Related Words?

Stevenson, J., Holman, J., O’Donnell, P., Scheepers, C., and Sereno, S.
Institute of Psychology, University of Glasgow.

Our study examined the role of attentional bias (AB) to hair-related words in TTM.

Clinical Severity and Neurocognition in Childhood-Onset Trichotillomania

Brian L. Odlaug, BA, Jon E. Grant, JD, MD, MPH
University of Minnesota, Twin Cities
Department of Psychiatry, Ambulatory Research Center

This study sought to examine clinical similarities and differences in individuals with childhood onset TTM using an array of clinical measures and neurocognitive testing.

Styles of Pulling in Children and Adolescents with Trichotillomania

Kristin Benavides1, Aubrey Edson1, Adeline Goss2, & Martin Franklin, PhD1
1 University of Pennsylvania, Department of Psychiatry
2 Bryn Mawr College

This study explored differences in pulling style between younger children (ages 10-13) and adolescents (ages 14-17) who were currently enrolled in a randomized controlled trial comparing Behavior Therapy to Supportive Counseling.

The Validity of DSM-IV Criteria B and C of Trichotillomania: Evidence from a Clinical Study

Christine Lochner, PhD1; Dan Stein, PhD 1, 2 Douglas Woods, PhD 3, Martin E. Franklin, PhD4 , Elizabeth Loerke, PhD5, Nancy J. Keuthen, PhD 5

1MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
2 Department of Psychiatry and Mental Health,
University of Cape Town, South Africa
3Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
4Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
5Massachusetts General Hospital / Harvard Medical School,
Boston, MA, USA

The purpose of this study was to examine the requirement of DSM-IV-TR Criteria B and C for a diagnosis of TTM in a large sample of hair-pullers.

Controlled Trial of Habit Reversal Training for TTM in Youth

Omar Rahman, PhD, Adam Lewin, PhD, Eric Storch, PhD
University of South Florida

Controlled trials with behaviorally oriented treatment, such as habit reversal therapy (HRT), for trichotillomania have produced promising results in adults. However, treatment models for TTM in children have yet to be established. The present study examined the efficacy of HRT for the treatment of childhood TTM.

Outpatient Dermatologist Knowledge of Psychodermatology: Results of a Survey

Lisa Zakhary MD, PhD2 , Sarah Gee MD2 , Daniela Kroshinsky MD2, Alexandra Kimball MD2, and Nancy Keuthen PhD1
1 Department of Psychiatry, Massachusetts General Hospital,
2 Department of Dermatology, Massachusetts General Hospital

This study identifies the specific gaps in psychodermatologic knowledge among dermatologists in a busy outpatient practice, with specific focus on level of training.

Open-label Trial of Aripiprazole in the Treatment of Trichotillomania

Matthew White. MD
Department of Psychiatry and Behavioral Sciences
Stanford University Medical Center

Serotonin reuptake inhibitors have been disappointing in the treatment of trichotillomania (TTM). Recent evidence suggests that medications that modulate dopamine may be helpful in this disorder. This study was designed to explore whether the D2 partial agonist aripiprazole would be effective in the treatment of TTM. •

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