Richard L. O’Sullivan

The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and Factor Analyses

We developed the MGH Hairpulling Scale to provide a brief, self-report instrument for assessing repetitive hairpulling. Seven individual items, rated for severity from 0 to 4, assess urges to pull, actual pulling, perceived control, and associated distress. We administered the scale to 119 consecutive patients with chronic hairpulling. Statistical analyses indicate that the seven items form a homogenous scale for the measurement of severity in this disorder.

The Massachusetts General Hospital (MGH) Hairpulling Scale: 2. Reliability and Validity

Assessment of symptom severity and change in chronic hairpulling has been limited by the absence of a psychometrically validated clinical rating scale. The Massachusetts General Hospital Hairpulling Scale demonstrated test-retest reliability, convergent and divergent validity, and sensitivity to change in hairpulling symptoms.

Near-Fatal Skin Picking From Delusional Body Dysmorphic Disorder Responsive to Fluvoxamine

Received September 17, 1996; revised September 25, 1996; accepted May 21, 1997. From the Psychiatric Neuroscience Program, Massachusetts General Hospital–East CNY–9, Harvard Medical School, Charlestown, Massachusetts; and Butler Hospital and the Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island. Address correspondence and reprint requests to Dr. O’Sullivan, Massachusetts General Hospital, Department of Psychiatry, Bldg. 149, 13th Street, Charlestown, MA 02129. Copyright 1999 The Academy of Psychosomatic Medicine. Skin picking as a manifestation of psychopathology, while an underrecognized problem, is receiving increased attention in the medical and psychiatric literature. Sometimes described as neurotic excoriations, skin picking is a relatively frequent manifestation of body dysmorphic disorder (BDD), a distressing or impairing preoccupation with a minimal or nonexistent defect in one’s appearance. Skin picking also occurs in other psychiatric disorders, including trichotillomania and obsessivecompulsive disorder (OCD), as well as various medical and developmental conditions. Morbidity may be considerable, including psychological distress, skin infections, scarring, and surgical intervention. Many of these patients first present for treatment to a primary care physician, dermatologist, or surgeon, rather than a psychiatrist. We report a case of severe skin picking attributable to delusional BDD, which resulted in considerable medical morbidity and a nearly fatal outcome. To our knowledge, this is the first report of decreased skin picking in delusional BDD with fluvoxamine.

Trichotillomania: Current Issues in Conceptualization and Treatment

Trichotillomania is a little-known disorder with wider prevalence and more significant consequences than previously believed. While sharing similarities with obsessive-compulsive disorder, compelling differences from it have also been noted. This fact, coupled with recognized overlap with other obsessive-compulsive spectrum disorders, has resulted in the ongoing evolution of our conceptualization of this illness. While empirical evidence supports the use of behavioral treatment and pharmacotherapy, considerable research is still needed before we can promise highly effective interventions tailored to the individual hairpuller. This review will summarize the evidence supporting, as well as challenging, a hypothesized link with obsessive-compulsive disorder. Current treatment approaches will be reviewed, as well as evidence for their efficacy. Suggestions will be made for future directions in this field.

Inhibition of Normal Murine Hematopoiesis by Leukemic Cells

Inhibition of normal mouse hemopoietic stem cells by leukemic cells (C1498) was observed with use of in vitro agar and in vivo diffusion-chamber cultures. The C1498 cells were unresponsive to colony-stimulating activity, and, above a critical threshold, they inhibited normal granulocyte progenitors in agar culture. C1498 cells added to normal marrow in diffusion chambers progressively reduced granulocyte progenitors. The larger, more rapidly growing, C1498 cells showed the most inhibitory effect. Transmembrane culture of C1498 cells adjacent to normal marrow in double diffusion chambers for five to 14 days led to reduction of recovery of granulocyte progenitors (72 +/- 7 per cent of control) and pluripotent stem cells (45 +/- 7 per cent of control) from the normal marrow chambers. These results indicate that leukemic mouse cells inhibit normal mouse-marrow stem cells by releasing a diffusible substance, and this inhibition occurs primarily at the level of the pluripotent stem cell.

The Relationship of Menstrual Cycle and Pregnancy to Compulsive Hairpulling

BACKGROUND Trichotillomania (TTM) or compulsive hairpulling is a cyclical disorder that presents predominantly in females. Anecdotal reports of symptom worsening in the premenstruum and during pregnancy led us to retrospectively study the role of these events in hairpulling behavior. METHODS Questionnaires assessing demographics, current hairpulling behavior, and the reported effects of menstruation and pregnancy on urges, actual hairpulling and behavioral control were administered to clinic patients and volunteers at a hairpulling conference. The MGH Hairpulling Scale, Beck Depression Inventory and Beck Anxiety Inventory were also completed. Data from 59 hairpullers were analyzed. RESULTS Premenstrual symptom exacerbation was reported for actual hairpulling urge intensity and frequency, and ability to control pulling and was alleviated during menstruation and shortly thereafter. The impact of pregnancy was less unidirectional, with both symptom exacerbation and lessening reported. CONCLUSIONS The menstrual cycle appears to affect compulsive hairpulling and deserves recognition in both the assessment and treatment of this disorder. The impact of pregnancy on TTM is less clear.

Stem Cell Migration Induced by Erythropoietin or Haemolytic Anaemia: the Effects of Actinomycin and Endotoxin Contamination of Erythropoietin Preparations

Summary. The injection of erythropoietin or the induction of anaemia with phenylhydrazine leads to changes in murine pluripotent and granulocyte‐macrophage stem cells indicating migration from marrow to spleen. In order to evaluate the interrelationship between erythroid differentiation and stem cell migration we have selectively suppressed erythroid differentiation with actinomycin D. Anaemia or EP injection resulted in stem cell changes consistent with migration; actinomycin blocked these changes in anaemic but not EP injected mice while blocking erythropoiesis in both groups.

The Role of Colony Stimulating Activity in Modulating Murine Diffusion Chamber Granulopoiesis

. We studied the effects of high circulating Colony Stimulating Activity (CSA) levels and irradiation induced marrow hypoplasia in CF1 and C57B1/6J host mice upon granulopoiesis in intraperitoneal diffusion chamber (DC) cultures. Serial endotoxin injections resulted in marked elevation of circulating CSA for the first half of an 8 d culture period, and CSA was shown to diffuse into the chamber environment; yet this manipulation alone did not significantly accelerate DC cell growth. Pre‐irradiation of the host mice produced no elevation of circulating CSA during the early phase of culture, but resulted in significant stimulation of DC granulopoiesis. Fluctuations in circulating inhibitors of in vitro granulopoiesis did not correlate well with DC cellularity. We conclude that endogenous CSA elevation does not provide an effective stimulus per se for granulocyte‐monocyte proliferation within DC culture and cannot be solely responsible for mediating the exuberant DC granulopoietic response seen in the pre‐irradiated host.