Psychiatric Comorbidities in Pediatric Trichotillomania: A Multicenter Cohort Study

Summary: ABSTRACT Importance: Trichotillomania (TTM) individuals face heightened risks of psychiatric comorbidities, particularly anxiety and depression. Sparse research in pediatric populations necessitates larger studies to assess the frequency and risk of developing psychiatric comorbidities in pediatric TTM patients. Objective: To investigate the risk of developing psychiatric comorbidities in pediatric TTM patients. Design: This retrospective cohort study assessed pediatric patients (<18 years old) with TTM diagnosed between May 18, 2013 and January 1, 2024. Setting: US-based data from the TriNetX global research network Participants: TTM patients (ICD-10 diagnostic category F63.3) aged 18 or younger at diagnosis, and control patients (ICD-10 code Z00.129) matched for age, sex, race, and ethnicity. Propensity score matching yielded 16,590 patients in each cohort. Exposure: Pediatric trichotillomania Main Outcome(s) and Measure(s): Analysis commenced from the day of initial diagnosis, assessing subsequent diagnoses of ADHD, conduct disorders, tic disorders, obsessive-compulsive disorder, anxiety disorders, dissociative, stress-related, and somatoform disorders, mood disorders, and suicide attempts compared to controls. TTM patients were predicted to have a greater risk of developing all measured psychiatric conditions. Results: TTM patients under 18 exhibited significantly greater risks of subsequent diagnoses for ADHD (OR: 2.002; CI 1.841-2.178; p <0.001), conduct disorders (OR: 3.668; 3.2-3.668; p <0.0001), tic disorders (OR: 2.247; 1.826-2.765; p <0.0001), obsessive-compulsive disorder (OR: 11.047; 8.822-13.832; p <0.0001), anxiety disorders (OR: 3.583; 3.387-3.7; p <0.0001), dissociative, stress-related, and somatoform disorders (OR: 6.179; 3.935-9.701; p <0.0001), mood disorders (OR: 2.476; 2.288-2.68; p <0.0001), and suicide attempts (OR: 1.81; 1.121-2.924; p = 0.0139) compared to healthy controls. TTM patients had the greatest risk of psychiatric diagnosis 1 year post index event. Conclusions and Relevance: Pediatric TTM patients exhibit elevated risk of psychiatric comorbidities, suggesting TTM as a potential precursor or risk factor. Timely intervention is crucial, necessitating comprehensive management strategies. The study advocates for tailored interventions, prioritizing behavioral therapy over pharmacological intervention, particularly in pediatric populations. Dermatologists can act as a bridge for these patients to access timely care. Early screening for comorbidities and referral to behavioral health specialists are crucial for improved outcomes in this population.