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Photographic Assessment of Change in Trichotillomania: Psychometric Properties and Variables Influencing Interpretation
Journal of Psychopathology and Behavioral Assessment
  • David C. Houghton, Texas A&M University - College Station
  • Maddison R. Franklin, Texas A&M University - College Station
  • Michael P. Twohig, Utah State University
  • Martin E. Franklin, University of Pennsylvania
  • Scott N. Compton, Duke University School of Medicine
  • Angela M. Neal-Barnett, Kent State University
  • Stephen M. Saunders, Marquette University
  • Douglas W. Woods, Marquette University
Document Type
Format of Original
9 p.
Publication Date

Although photographic assessment has been found to be reliable in assessing hair loss in Trichotillomania, the validity of this method is unclear, particularly for gauging progress in treatment. The current study evaluated the psychometric properties of photographic assessment of change in Trichotillomania. Photographs showing hair loss of adults with Trichotillomania were taken before and after participating in a clinical trial for the condition. Undergraduate college students (N = 211) rated treatment response according to the photos, and additional archival data on hair pulling severity and psychosocial health were retrieved from the clinical trial. Photographic assessment of change was found to possess fair reliability (ICC = 0.53), acceptable criterion validity (r = 0.51), good concurrent validity (r = 0.30–0.36), and excellent incremental validity (ΔR2 = 8.67, p < 0.01). In addition, photographic measures were significantly correlated with change in quality of life (r = 0.42), and thus could be considered an index of the social validity of Trichotillomania treatment. Gender of the photo rater and pulling topography affected the criterion validity of photographic assessment (partial η2 = 0.05–0.11). Recommendations for improving photographic assessment and future directions for hair pulling research are discussed.


Accepted version. Journal of Psychotherapy and Behavioral Assessment, Vol. 38, No. 3 (September 2016): 505-513. DOI. © 2016 Springer. Used with permission.

Douglas W. Woods was affiliated with Texas A & M University at the time of publication.

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Citation Information
David C. Houghton, Maddison R. Franklin, Michael P. Twohig, Martin E. Franklin, et al.. "Photographic Assessment of Change in Trichotillomania: Psychometric Properties and Variables Influencing Interpretation" Journal of Psychopathology and Behavioral Assessment (2016) ISSN: 0882-2689
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