Impaired Executive Functioning In Pediatric Trichotillomania (Hair Pulling Disorder)

Flessner CA1, Brennan E1, Murphy YE1, Francazio S1.
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Abstract
BACKGROUND:
No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, science’s understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant-free sample of children with HPD.
METHODS:
Sixteen and 23 children between 9 and 17 years of age meeting DSM-5 diagnostic criteria for HPD or classified as a healthy control, respectively, were recruited (N = 39) to complete structured interviews, self-reports, and a subset of tests from the Cambridge Automatic Neurocognitive Test Assessment Battery (CANTAB) assessing cognitive
flexibility/reversal learning (intradimensional/extradimensional; IED), working memory (spatial span; SSP), and planning and organization (Stocking of Cambridge; SOC).
RESULTS:
Hierarchical regression analyses indicated that, after controlling for appropriate covariates, diagnostic status predicted impaired performance on both the IED (reversal learning only) and SOC (planning and organization) but failed to predict cognitive flexibility or working memory capacity. Correlational analyses revealed that pulling severity was strongly related to working memory capacity, while disparate relationships between pulling styles (automatic, focused pulling) were evident with respect to working memory and planning and organization.
CONCLUSIONS:
Children with HPD performed more poorly on tasks of executive functioning as compared to controls. Correlational analyses suggest potentially distinct pathophysiology underlying automatic and focused pulling warranting further research. Limitations and future areas of inquiry are discussed.