Gupta Madhulika A, Gupta Aditya K
Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Drive, Suite 101, London, Ontario, N6J 1H3, Canada,
Curr Psychiatry Rep. 2014 Jun;16(6):449. doi: 10.1007/s11920-014-0449-9.
Several diagnoses in the new DSM-5 chapter on 'Obsessive-Compulsive and Related Disorders' directly relate to psychodermatology. The new excoriation (skin-picking) disorder (SPD) and trichotillomania (TTM) both manifest as recurrent body-focused repetitive behaviors that have compulsive and dissociative features, the latter being more prevalent in TTM than SPD. The DSM-5 refers to SPD and TTM occurring without full awareness or preceding tension, however does not specifically mention the possible role of dissociation. This has important treatment implications, as patients with high dissociative symptoms are not likely to respond to the standard treatments for obsessive-compulsive disorder. Body dysmorphic disorder (BDD), which is frequently associated with cutaneous body image (CBI) dissatisfaction, is present in 9%-15% of dermatology patients. Treatment guidelines in dermatology are increasingly considering the psychosocial morbidity related to CBI in their treatment outcome measures. The presence of BDD, if unrecognized, may therefore directly affect the dermatologic treatment regimens offered to the patient.
《精神疾病诊断与统计手册》（第五版）（DSM - 5）中关于“强迫及相关障碍”的新章节里，有几种诊断与心理皮肤病学直接相关。新的抓痕（皮肤搔抓）障碍（SPD）和拔毛癖（TTM）都表现为反复出现的、以身体为焦点的重复行为，具有强迫和分离特征，后者在拔毛癖中比在抓痕障碍中更普遍。DSM - 5指出，抓痕障碍和拔毛癖在没有完全意识或之前没有紧张感的情况下发生，但没有特别提及分离的可能作用。这具有重要的治疗意义，因为分离症状严重的患者不太可能对强迫症的标准治疗产生反应。身体变形障碍（BDD）常与皮肤身体意象（CBI）不满相关，在9% - 15%的皮肤科患者中存在。皮肤科的治疗指南在其治疗效果衡量标准中越来越多地考虑与皮肤身体意象相关的心理社会发病率。因此，如果未被识别，身体变形障碍的存在可能会直接影响为患者提供皮肤科治疗方案。
