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White matter volume alterations in hair-pulling disorder (trichotillomania)

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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 fronto-striatal 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.

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Acknowledgements

This study was supported by the National Research Foundation (NRF) of South Africa (grant number CPRR15062211995). Dr. Uhlmann received a Stellenbosch University Subcommittee C postdoctoral fellowship.

Funding

This study was funded by the National Research Foundation (NRF) of South Africa (grant number CPRR15062211995).

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Authors and Affiliations

  1. MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa

    Anne Uhlmann, Lian Taljaard & Christine Lochner

  2. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Anne Uhlmann, Angelo Dias, Dan J. Stein & Samantha J. Brooks

  3. Department of Neuroscience, Uppsala University, Uppsala, Sweden

    Samantha J. Brooks

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  1. Anne Uhlmann
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  2. Angelo Dias
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  3. Lian Taljaard
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  4. Dan J. Stein
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  6. Christine Lochner
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Correspondence to Christine Lochner.

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Conflict of interest

Author DJS has received research grants and/or consultancy honoraria from Abbott, ABMRF, Astrazeneca, Biocodex, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, National Responsible Gambling Foundation, Novartis, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah, and Wyeth.

The other authors declare no conflict of interest with respect to subjects of the paper.

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Uhlmann, A., Dias, A., Taljaard, L. et al. White matter volume alterations in hair-pulling disorder (trichotillomania). Brain Imaging and Behavior 14, 2202–2209 (2020). https://doi.org/10.1007/s11682-019-00170-z

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