Family environment in adolescent trichotillomania

• TTM vs. control youth endorsed greater family conflict and less support.
• TTM severity and distress were correlated with impairment in family functioning.
• Mothers of TTM youth reported more anxiety, depression and anger.
• Mothers of TTM youth reported more parenting stress.

We examined family environment variables and parenting stress in a cohort of adolescents with trichotillomania (TTM; N=49), their parents (N=55) and matched control adolescents (N=23) and their parents (N=23). TTM youth vs. controls endorsed significantly more expression of anger, aggression and conflict in their families and less family support on the Family Relationship Index (FRI) of the Family Environment Scale (FES). Pulling distress but not severity was correlated with these variables. Greater pulling severity, distress or both were correlated with impairment on the cohesion subscale of the FES and the task accomplishment and affective expression subscales of the Family Assessment Measure (FAM). Mothers of TTM youth vs. controls endorsed more anxiety, depression and anger, plus more total parenting stress and problems in their offspring on the Stress Index for Parents of Adolescents (SIPA). On the FES, mothers of TTM youth vs. controls reported less emphasis on intellectual and cultural orientation and less organization in the family. TTM youth and their mothers were discordant in their ratings of several family environment variables. These findings warrant further study and merit attention when designing treatment interventions for adolescents with TTM.