White matter volume alterations in hair-pulling disorder (trichotillomania)
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ORIGINAL RESEARCH
White matter volume alterations in hair-pulling disorder (trichotillomania) Anne Uhlmann 1,2 & Angelo Dias 2 & Lian Taljaard 1 & Dan J. Stein 2 & Samantha J. Brooks 2,3 & Christine Lochner 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
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 frontostriatal 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. Keywords Trichotillomania . Compulsivity . Impulsivity . Neuroimaging . Voxel-based morphometry
Introduction Individuals with trichotillomania (TTM, or hair-pulling disorder) recurrently pull out hair, resulting in hair loss and feelings of shame and embarrassment. The condition is associated with significant distress and/or impaired functioning in several Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11682-019-00170-z) contains supplementary material, which is available to authorized users. * Christine Lochner [email protected] 1
MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
2
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
3
Department of Neuroscience, Uppsala University, Uppsala, Sweden
domains (American Psychiatric Association 2013; Woods et al. 2006). Recently, TTM was reclassified from an impulse con
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