Monosymptomatic hypochondriacal syndromes in dermatology

Pathological skin picking in individuals with body dysmorphic disorder

“…Studies have shown, however, that 2% of dermatology patients and 3.8% of college students suffer from PSP [1,4]. Interpretation of these prevalence rates is complicated by the fact that PSP may be a symptom of several conditions: obsessive-compulsive disorder (OCD; picking to remove contaminants) [1], genetic disorders such as Prader-Willi syndrome [8] or delusional disorders such as delusions of parasitosis (picking to remove imagined parasites) [9].…”

Delusional Bromidrosis in Psychotherapy – a Case Study

“…It was our impression that this insight-oriented strategy did help the patient to reverse these projective defenses [32] and led to a better understanding of his symptomatology. It should be amply clear that the interpretations outlined above should not be offered prematurely, before some kind of positive transference has been established (about the technical difficulties encountered in psychotherapies with these patients see [6]). It should also be noted that the combination of psychotherapy with dermatological treatment, including (in cases of intensive psychotherapy) dermatological physical examinations by a person different from the psychotherapist, can offer a stable frame for psychodynamic interpretations of these psychosomatic conditions.…”

“…With regard to delusional bromidrosis (synonyms for which are subjective bromidrosis, autodysosmorphobia, bromosis, delusion of malodor, dysosmosis, pseudo-bromidrosis, bromidrosiphobia, olfactory reference syndrome, delusional disorder of the somatic type), few reports have been given with reference to the psychological background [29] (from a perspective of social psychology [18], psychopathology [1,5,6,8,20,21], and psychodynamics [3,27,28,32]). Rich casematerial is presented by Vie and Souriac [34] permitting interpretational approaches to the psychodynamics involved in conditions, which are associated with the firm conviction that the body of the affected person is 'stinking' offensively.…”

The Use of Psychotropic Drugs in Dermatology

“…Alternatively, one may take the agnostic view, explaining that although we know the drug to be effective, we cannot say exactly why it works. Another approach is to explain the patient's symptoms in terms of the release of neuropeptides that can Excessive anxiety or worry, more days than not Person finds it difficult to control worry Worry is associated with at least three of the following 6 symptoms restlessness, or felling keyed up and on edge being easily fatigued difficulty in concentrating, or mind going blank irritability muscle tension sleep disturbance Worry causes significant distress and/or impairment in social, occupational, or other important areas of functioning Condition is not caused by substance abuse, a medical condition such as hyperthyroidism, or a more pervasive psychiatric disorder be identified in the skin, which may be modulated by the drugs that we suggest [1,14,19,21]. Side-effects from any of these drugs can be minimized by starting treatment with a very low daily dose.…”

“…The characteristic symptoms of anxiety, depression, obsessions and compulsions, delusions and hallucinations, body dysmorphic disorder (BDD) and dermatitis artefacta will be found in tables 3-8 [3]. Two areas in our understanding of the disorders referred to, and listed in the first category in table 1 and 2, require clarification, if treatment is to be effective: firstly, 'monosymptomatic hypochondriasis' refers to a syndrome in which a circumscribed symptom -albeit an all-consuming symptomarises in a patient who otherwise functions relatively well [1,23, 24,27,34]. It is important for us to determine whether this symptom has the characteristics of a true delusion -a false perception that requires an antipsychotic drug -or whether it rather represents an intrusive and uncontrollable worry about some possible abnormality -an obsessive-compulsive symptom -that instead requires a drug in the SSRI family of antidepressants, the anti-obsessive-compulsive drugs [3,4,21,23, 24,27,[29][30][31]34].…”