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Parental Bonding in Trichotillomania and Skin Picking Disorder

Psychiatric Quarterly volume 93, pages 409–418 (2022)Cite this article

Abstract

Background

One means of understanding the effect of environmental factors on psychiatric disorders is by examining perceived parenting behavior in the childhood of individuals with trichotillomania and skin picking disorder (i.e. body focused repetitive behaviors (BFRBs)). We hypothesized that adults with BFRBs would show higher scores on dimensions of “care” and “overprotection”. Specifically, we predicted that adults with BFRBs would have parents in the “affectionate constraint” quadrant, based on a combination of high care and high protection scores.

Methods

We assessed demographic and clinical differences in 184 adults between the ages of 18 and 65 with Trichotillomania (TTM) (n = 43) and Skin Picking Disorder (SPD) (n = 75), and both (n = 66). The Parental Bonding Instrument (PBI) measured “care” and “overprotection” items. Results from the PBI were compared across groups and with normal control data using independent sample t-tests.

Results

Individuals in the BFRB group had significantly lower maternal and paternal care scores compared to controls. The TTM, SPD, and TTM + SPD (combined) groups all had lower maternal care scores than controls. The TTM + SPD (combined) group had significantly lower paternal care scores and higher maternal protection scores than the normative averages. The most common parenting patterns in subjects with BFRBs were maternal and paternal affectionless control (low care/high protection). From our sample, only 27 % reported optimal maternal parenting and 28 % reported optimal paternal parenting.

Discussion

These preliminary data suggest that low maternal and paternal care may be associated with BFRBs. However, the nature of this relationship should be further explored, as these results do not necessarily mean that affectionless control parenting leads to a predisposition to BFRBs, and there may in fact be other environmental factors at play. Identifying how individuals perceive familial relationships may provide direction for clinicians in developing tools to address the burden caused by BFRBs.

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Acknowledgements

My gratitude and appreciation to Sam Chamberlain for advising on statistical analyses and to Allen Terman for assisting in the preparation of this manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA

    Stephanie Valle, Eve Chesivoir & Jon E. Grant JD, MD, MPH

Authors
  1. Stephanie Valle
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  2. Eve Chesivoir
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  3. Jon E. Grant JD, MD, MPH
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Contributions

SV designed the study, analyzed the data, and drafted the manuscript. EC contributed to the literature review. JG designed the study and drafted the manuscript. All authors edited the manuscript.

Corresponding author

Correspondence to Jon E. Grant JD, MD, MPH.

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Conflict of Interest

Ms. Valle and Ms. Chesivoir report no financial relationships with commercial interests. Dr. Grant has received research grants from the TLC Foundation for Body-Focused Repetitive Behaviors, Otsuka, Biohaven, Promentis, and Avanir Pharmaceuticals. He receives yearly compensation 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.

Ethics Approval/Consent to Participate

Participants were provided with an oral consent form and were instructed to check a box to confirm their interest in completing the survey. Survey responders were compensated for their time. 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. All procedures involving human subjects/patients were approved by the University of Chicago Institutional Review Board.

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Valle, S., Chesivoir, E. & Grant, J.E. Parental Bonding in Trichotillomania and Skin Picking Disorder. Psychiatr Q 93, 409–418 (2022). https://doi.org/10.1007/s11126-021-09961-4

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Keywords

  • Trichotillomania
  • Skin picking
  • Parental bonding
  • Development