Brain Imaging and Behavior

, Volume 12, Issue 2, pp 477–487 | Cite as

The relationship between microstructural alterations of the brain and clinical measurements in children and adolescents with hair pulling disorder

  • Geon Ho Bahn
  • Minha Hong
  • Kyung Mi Lee
  • Chanhee Lee
  • Chang-Woo Ryu
  • Ji-Ah Lee
  • Soonchan Park
  • Eui Jong Kim
  • Geon-Ho Jahng
Original Research


Several studies have evaluated gray matter abnormalities and white matter integrity in adults with hair pulling disorder (HPD). However, no prior studies have defined the relationship between neuroimaging parameters and clinical measurements in children and adolescents with HPD. The purposes of this study were to determine the correlation between magnetic resonance imaging (MRI) indices and clinical measurements in children and adolescents with HPD, and to compare HPD patients with age- and sex- matched healthy controls (HC). Pediatric HPD patients (n = 9) and HC subjects (n = 10), aged 9–17 years, were recruited. Three-dimensional T1-weighted structural MRI (3D T1W) and diffusion-tensor imaging (DTI) scans were obtained for each subject. Gray matter and white matter volumes were calculated from 3D T1W. Fractional anisotropy (FA) and average diffusion coefficients (Dav) were mapped from DTI. Voxel-based and region-of-interest correlations between MRI indices and clinical measurements were analyzed. In addition, two-sample t-tests were used to compare voxel-based tissue volumes, FA, and Dav maps between the two groups. Alterations in both brain tissue volume and white matter integrity were associated with symptom severity, especially in the precuneus, anterior cingulate, temporal cortex, and frontal cortex regions. FA values in HPD patients were significantly higher than those observed in HC subjects, particularly in the cerebellum and cuneus regions. Alterations of brain tissue volumes and microstructural changes are associated with severity of clinical symptoms in children and adolescents with HPD. Fractional anisotropy is the most sensitive method to distinguish pediatric HPD patients from healthy children. The results of this study can facilitate use of MRI indices to follow the transition from pediatric HPD to adult HPD.


Hair pulling disorder brain tissue volume white matter integrity correlation child and adolescent 



This study was supported by a grant (2014R1A2A2A01002728) from the National Research Foundation (NRF) of Korea funded by the Ministry of Science, ICT and Future Planning (MSIP), Republic of Korea.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Supplementary material

11682_2017_9716_MOESM1_ESM.docx (4.6 mb)
ESM 1 (DOCX 4688 kb)


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Psychiatry, Subdivision of Child & Adolescent Psychiatry, Kyung Hee University Hospital, College of MedicineKyung Hee UniversitySeoulRepublic of Korea
  2. 2.Department of Psychiatry, Seonam University, College of MedicineMyongji HospitalGoyangRepublic of Korea
  3. 3.Department of Radiology, Kyung Hee University Hospital, College of MedicineKyung Hee UniversitySeoulRepublic of Korea
  4. 4.Department of Radiology, Kyung Hee University Hospital at Gangdong, College of MedicineKyung Hee UniversitySeoulRepublic of Korea
  5. 5.Department of PsychiatryGana HospitalBusanRepublic of Korea

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