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Reward processing in trichotillomania and skin picking disorder

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Abstract

Trichotillomania (hair pulling disorder) and skin picking disorder are common and often debilitating mental health conditions, grouped under the umbrella term of body focused repetitive behaviors (BFRBs). Although the pathophysiology of BFRBs is incompletely understood, reward processing dysfunction has been implicated in the etiology and sustention of these disorders. The purpose of this study was to probe reward processing in BFRBs. 159 adults (125 with a BFRB [83.2% (n = 104) female] and 34 healthy controls [73.5% (n = 25) female]) were recruited from the community for a multi-center between-group comparison using a functional imaging (fMRI) monetary reward task. Differences in brain activation during reward anticipation and punishment anticipation were compared between BFRB patients and controls, with stringent correction for multiple comparisons. All group level analyses controlled for age, sex and scanning site. Compared to controls, BFRB participants showed marked hyperactivation of the bilateral inferior frontal gyrus (pars opercularis and pars triangularis) compared to controls. In addition, BFRB participants exhibited increased activation in multiple areas during the anticipation of loss (right fusiform gyrus, parahippocampal gyrus, cerebellum, right inferior parietal lobule; left inferior frontal gyrus). There were no significant differences in the win-lose contrast between the two groups. These data indicate the existence of dysregulated reward circuitry in BFRBs. The identified pathophysiology of reward dysfunction may be useful to tailor future treatments.

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Data available upon request.

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Funding

This study was funded by the Body-Focused Precision Medicine Initiative Granted by The TLC Foundation for Body-Focused Repetitive Behaviors to University of Chicago (Dr. Grant), Massachusetts General Hospital (MGH)/Harvard (Dr. Keuthen), and University of California, Los Angeles (UCLA) (Dr. Piacentini). Dr. Chamberlain’s involvement in this study was funded by a Wellcome Trust Clinical Fellowship (Refs. 110049/Z/15/Z & 110049/Z/15/A). The TLC Foundation for Body-Focused Repetitive Behaviors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This study was completed with support from the REDCap project at the University of Chicago, which is hosted and managed by the Center for Research Informatics and funded by the Biological Sciences Division and by the Institute for Translational Medicine, CTSA Grant Number UL1 TR000430 from the National Institutes of Health.

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Authors and Affiliations

Authors

Contributions

JEG, TP, ER, SRC, JS, DD, DW, JP, NJK all made substantial contributions to the conception or design of the work as well as the acquisition, analysis, or interpretation of data; they all aided in drafting the work, gave final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jon E. Grant.

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Conflict of interest

Dr. Grant has received research grants from Biohaven, Promentis, and Otsuka Pharmaceuticals. Dr. Grant receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain consults for Promentis; and receives stipends from Elsevier for editorial journal work. The other authors report no conflicts. Dr. Dougherty receives research support and honoraria from Medtronic, Inc. Dr. Woods has received royalties from Oxford University Press and Springer Press. Dr. Piacentini has received research grants from NIMH, the Tourette Association of America, and Pfizer. He receives travel support and honoraria from the Tourette Association of America and the International OCD Foundation and book royalties from Guilford Publications and Oxford University Press. Dr Keuthen has received prior research grants from The TLC Foundation for Body-Focused Repetitive Behaviors and royalties from New Harbinger, Inc. The remaining authors have nothing to disclose.

Ethical approval

The Institutional Review Boards for the University of Chicago, University of California, Los Angeles, and Massachusetts General Hospital/Harvard Medical School approved the study and the informed consent. Data sharing agreements were arranged across all sites and neuroimaging equipment was synced across the sites. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Prior to obtaining written informed consent, the investigators provided a complete description of the study, discussed potential risks, and answered questions regarding the study. After that, participants provided written informed consent.

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Grant, J.E., Peris, T.S., Ricketts, E.J. et al. Reward processing in trichotillomania and skin picking disorder. Brain Imaging and Behavior 16, 547–556 (2022). https://doi.org/10.1007/s11682-021-00533-5

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  • DOI: https://doi.org/10.1007/s11682-021-00533-5

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