Reliability and Validity of a Photo Rating Measure of Alopecia
Numerous studies of trichotillomania (TTM) incorporate measures of the extent of alopecia (hair loss) resulting from hair pulling. This study used data from a clinical trial of stepped care for TTM to provide further evidence pertaining to a 1–7 alopecia rating scale (Tolin et al. 2002). Ratings were based on photographs of participants’ (N = 60) most severely affected pulling site. Alopecia rating proved highly acceptable (88 % completed the assessment), stable (10-week retest reliability r for wait-listed participants = 0.63), and convergently valid (r = 0.51 with an interviewer’s rating of hair loss based on live observation). Alopecia ratings were not significantly related to self-rated social impairment resulting from TTM, nor with total symptom severity. Hair regrowth rate varies by sex, age, and pulling site, so alopecia rating cannot serve as a direct marker of TTM treatment progress. Nonetheless, it appears to be a reliable and valid measure of a consequence of pulling that is of great concern to people with TTM. Future research should examine its potential treatment utility as a means of giving patients feedback on the side effects of progress they are making in therapy.
KeywordsAlopecia Trichotillomania Measurement Hair pulling
This research was supported by National Institute of Mental Health Grant 1R15MH086852-01.
We are grateful to Charley Mansueto for consultation on the project and to Sam Nelson and Natalie Rusch for assistance in conducting the research.
Conflict of Interest
The authors declare that they have no conflicts of interest to report.
Study procedures were approved by the American University Institutional Review Board, and participants were treated in accordance with the APA ethical code. All participants provided informed consent to the research procedures.
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