Examining DSM Criteria for Trichotillomania in A Dimensional Framework: Implications for DSM-5 And Diagnostic Practice

Authors

David C. Houghton, Texas A&M UniversityFollow
Steve Balsis, Texas A&M University
Dan J. Stein, University of Cape TownFollow
Scott N. Compton, Duke University School of Medicine
Michael P. Twohig, Utah State University
Stephen M. Saunders, Marquette UniversityFollow
Martin E. Franklin, University of PennsylvaniaFollow
Angela M. Neal-Barnett, Kent State UniversityFollow
Douglas W. Woods, Marquette UniversityFollow

Document Type

Article

Language

eng

Format of Original

8 p.

Publication Date

7-2015

Publisher

Elsevier (WB Saunders)

Source Publication

Comprehensive Psychiatry

Source ISSN

0010-440x

Original Item ID

DOI: 10.1016/j.comppsych.2015.04.011, PubMed Central: PMCID: PMC4459902

Abstract

Background: Diagnosis of Trichotillomania (TTM) requires meeting several criteria that aim to embody the core pathology of the disorder. These criteria are traditionally interpreted monothetically, in that they are all equally necessary for diagnosis. Alternatively, a dimensional conceptualization of psychopathology allows for examination of the relatedness of each criterion to the TTM latent continuum.

Objectives: First, to examine the ability of recently removed criteria (B and C) to identify the latent dimensions of TTM psychopathology, such that they discriminate between individuals with low and high degrees of hair pulling severity. Second, to determine the impact of removing criteria B and C on the information content of remaining diagnostic criteria. Third, to determine the psychometric properties of remaining TTM diagnostic criteria that remain largely unchanged in DSM-5; that is, whether they measure distinct or overlapping levels of TTM psychopathology. Fourth, to determine whether information content derived from diagnostic criteria aid in the prediction of disease trajectory (i.e., can relapse propensity be predicted from criteria endorsement patterns).

Method: Statistics derived from Item Response Theory were used to examine diagnostic criteria endorsement in 91 adults with TTM who underwent psychotherapy.

Results: The removal of two criteria in DSM-5 and psychometric validity of remaining criteria was supported. Additionally, individual trait parameters were used to predict treatment progress, uncovering predictive power where none previously existed.

Conclusions: Diagnostic criteria for TTM should be examined in dimensional models, which allow for nuanced and sensitive measurement of core symptomology in treatment contexts.

Comments

Accepted version. Comprehensive Psychiatry, Vol 60 (July 2015): 9-16. DOI. © 2015 Elsevier Inc. Used with permission.

Douglas W. Woods was affiliated with Texas A&M University at the time of publication.

Recommended Citation

Houghton, David C.; Balsis, Steve; Stein, Dan J.; Compton, Scott N.; Twohig, Michael P.; Saunders, Stephen M.; Franklin, Martin E.; Neal-Barnett, Angela M.; and Woods, Douglas W., "Examining DSM Criteria for Trichotillomania in A Dimensional Framework: Implications for DSM-5 And Diagnostic Practice" (2015). Psychology Faculty Research and Publications. 191.
https://epublications.marquette.edu/psych_fac/191