Is it the parents’ fault?
We know how impairing BFRBs can be but know little about risk factors that lead to them. Some research points to genetics, others to neurological malfunctions, while still others to psychological causes with little to no research about the family environment and its role in the development of BFRBs like skin picking disorder.
There is already evidence showing that children of anxious or depressed parents tend to experience anxiety and depression because of genetic and environmental factors. Often, people with skin-picking disorder also have anxiety or depression but the evidence is less clear when trying to figure out of the anxiety causes the skin-picking or vice versa. While genetics play a large role in the mental health disorders people develop, the environment is also a strong factor in that it not only has an epigenetic effect but also a cognitive and behavioral effect. Epigenetics is the influence of the environment on gene activation and explains why twins raised apart have different diseases and mental health disorders despite having the same genes.
A recent study looked at other disorders and sought to determine if anxiogenic parenting contributes to the development of BFRBs. Anxiogenic is a term that describes something as provoking or causing anxiety. Anxiogenic parenting refers to a style that induces and promotes anxiety in children. Families with parents who use this style of parenting may have high levels of conflict, inconsistent boundaries, and rules, overly-control of a child’s behavior, unclear emotional boundaries, or manipulation. Overall, it is not a very effective parenting style.
The assumption for the study is that BFRBs and anxiety are closely related and children with higher levels of anxiety tend to have more severe behaviors. Additionally, dysfunctional parent-child relationships often lead to children developing maladaptive coping methods which may not always be healthy. Since BFRBs tend to start between the ages of 9 and 13, not only is the family environment influential in the onset of the disorder, but also for the early recognition and treatment.
Results suggest that anxiogenic parenting did not predict whether a child would develop BFRBs in general, but when the considered specific BFRBs, the data changed. Parents who scored high on the assessment for anxiogenic parenting were more likely to report their child engaged in skin picking. Further, the higher the angiogenic parenting score, the more severe the skin picking behaviors. In contrast, anxiogenic parenting scores did not correlate with hair pulling or lip/cheek biting.
Another interesting finding was that the parents level of accommodation and emotional warmth were correlated with the severity of BFRB behaviors. For example, parents who scored low in emotional warmth reported children with more severe behaviors. Researchers suggested that children may use BFRBs as a way to handle emotional regulation to replace the lack of emotional connection from the parents.
Whether this information is useful or not remains to be seen. As one of the first studies of its kind, it needs to stand up to replication and validation to confirm the findings. Also, the levels of anxiogenic parenting were measured using an online survey which used self-report. Essentially, parents answered questions about their parenting habits and the relationship with their child and self-report is subject to bias.
One thing this research does support is the use of family treatment for children diagnosed with skin picking. The relationship between anxiety and skin picking disorder is consistent, and one of the modes of treatment is figuring out how to reduce a child’s anxiety. Whether the parent’s style of interacting with their child is anxiety-provoking by itself, parents need to learn how to help their child reduce anxiety. Therefore, during treatment for skin-picking disorder, there should be a family therapy component where parents not only learn more about their child’s disorder but also how to interact with the child more effectively and in ways that will decrease anxiety. By changing familial behavior patterns and reducing triggering events, the child will be more likely to respond positively to treatment. Children who engage in treatment early tend to have better outcomes and improved quality of life through adolescence and adulthood.
Murphy, Y. E., Brennan, E., & Flessner, C. (2019). Anxiogenic parenting practices as predictors of pediatric body-focused repetitive behaviors. Journal of Obsessive-Compulsive and Related Disorders, 21, 46-54. https://www.sciencedirect.com/science/article/pii/S2211364918301209