Dear Editor,
We read with great interest the article “A Case-Control Study of Trichotillomania Patients Using a National Database” by Parikh et al. [1]. The authors adeptly utilized national database data and made significant efforts in exploring factors associated with trichotillomania (TTM) in patients. However, we would like to offer some constructive comments to provide a more comprehensive view and enhance the article’s relevance and impact in the field.
First, as a mental illness [2] TTM involves a substantial degree of subjective thinking. The article’s reliance on a health data database from voluntary adult participants raises concerns. “Voluntariness” is a distinct issue within mental illness. Thus, the sample should be followed up or surveyed to gain a better understanding. To this end, we suggest including a self-report form [3]. The use of a self-report form to supplement the database can enrich the data beyond what the national database offers.
Second, the case-control study design in the article has limitations in consideration. Although it was matched for age, gender, and ethnicity, other uncontrolled confounders may exist. We propose that more subgroup analyses, such as by different education levels, occupational types, and household income levels, would be beneficial. These aspects merit more in-depth investigation.
As social workers, this article has inspired us to carefully reference research findings to avoid stereotypical approaches when dealing with TTM patients. We hope that in the future, social work can offer treatment options to a broader range of patients, such as designing relaxation and cognitive behavioral therapy intervention [4] groups, or conducting community education and advocacy, so as to not confine TTM to a mere skin-related problem.
In conclusion, we commend the authors for their work and concur that it is crucial to recognize that TTM is more than a skin condition. Our suggestions aim to further improve an already excellent article. We anticipate seeing researchers, clinicians, and social workers collaborating in the future to achieve the swift eradication of TTM.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
W.Z. asked questions. W.Z. and S.X. worked on writing – original draft prepared and written – reviewed and edited.
