Abstract
This study aimed to compare the family functioning and parenting styles in adolescents with trichotillomania (TTM) and healthy controls and to assess the relationships between the family functioning, parenting styles, and clinical features of TTM, including the severity of TTM, duration of illness, and concomitant psychiatric symptoms. The study sample consisted of 100 adolescents aged 12-18 years, 50 patients with TTM, and 50 healthy controls. All participants completed a sociodemographic and clinical data form, the Massachusetts General Hospital Hairpulling Scale (MGH-HPS), the Revised Children's Anxiety and Depression Scale-Child Version (RCADS-CV), the Family Assessment Device (FAD), and the Perceived Parental Attitude Scale (PPAS). Results show that adolescents with TTM reported higher levels of comorbid anxiety and depression symptoms than healthy controls, and 64% of adolescents with TTM had at least one comorbid psychiatric disorder. Parents of adolescents with TTM also reported more significant impairment in the affective responsiveness, problem-solving, and general family functioning subscales of the FAD. Adolescents with TTM endorsed significantly more authoritarian perceptions of both parents on the PPAS. While the severity of hairpulling symptoms showed only a positive and significant relationship with the RCADS-CV total internalizing score, the duration of illness was positively and moderately correlated with the impairment in affective responsiveness, problem-solving, and general family functioning subscales of FAD. Finally, the RCADS-CV total internalizing score and the general functioning subscale of FAD were the most important predictors of TTM. The implications of family functioning and parenting styles, future targets for family-focused approaches in TTM, and study limitations are discussed.