The psychiatric significance of dermatitis artefacta

Abstract

A total of 71 patients (12 males and 59 females) who attended the University Skin Clinic of Basle in the years 1956-1982, have been investigated by a dermatologist, a psychiatrist and a psychologist. Among 55 female patients (group I and II) 14 had a suicide attempt in their history. Of the 39 female patients of group I 25 (64%) had suffered from a stressful childhood event. Of group I (39 female patients) 19 (48.7%) had had psychiatric therapy in the past or at the time of investigation; 23 patients (59%) had suffered from depressions either in the past or at the time of investigation. Among group II (16 patients) 11 (68.7%) had had psychiatric therapy in the past or at the time of investigation. The psychological test investigation (Colour Pyramid Test and Rosenzweig Picture-Frustration Test) revealed artefact patients to be in a state of considerable depressive-aggressive tension without being able to handle their emotions and impulses in an adequate manner.

Factitious Disease in the Field of Dermatology

“…The injuries are usually inflicted on the scale of the human hand (fig. 3); owing to the preponderance of right-handers, the self-inflicted injuries are found predominant ly on the left half of the body [29], Prognosis A larger patient collective, consisting of 71 persons with factitious skin lesions, was inves tigated by Hanel et al [26,30]; follow-up examinations in 39 cases confirmed the re sults stated above. Fourteen out of 55 patients included in the study had attempted suicide.…”

“…Many authors emphasize that factitious disorders can progress, in some cases over years, or exhibit a recidivistic course [26,31,32,46] and call attention to the life-threaten ing nature of the symptomatology [43,47], These statements are based, in many cases, on descriptions of individual cases or on the course of therapy observed in only a few per sons. Very few comprehensive follow-up stud ies have been published.…”

“…The ratio of men to women is generally said to be 8:1 [23], In a survey of 59 published papers, Hollender and Abraham [25] found 116 women and 14 men. Hanel et al [26] counted 59 women and 12 men in a prognos tic study of 71 patients suffering from facti tious disorders.…”

The Biography of the Factitious-Disorder Patient

“…In 4 out of 6 of their patients, Harnoss et al [4] found early object losses caused by divorce or the death of a parent; this was also true of 44% of the 30 patients studied by Haenel et al [5] who came from a 'broken home' situation. Carney and Brown [6] state that 61 % of their group of 42 patients were 'emotionally de prived in childhood' without describing the exact circumstances; similarly, Sussman and Hyler [7] report that 'the usual history reveals that one or both parents are seen as rejecting figures who are unable to form close relation ships' [p. 1244], Parents of this kind are absent emotionally rather than physically.…”

Clinical Picture of Self-Inflicted Skin Lesions

“…In general, patients are willing to acknowledge their part in creation of the lesions. Most often, these patients present a personality with perfectionistic and compulsive traits, obsessive-compulsive disorder or depression [Fruensgaard, 1984;Gupta et al, 1987;Haenel et al, 1984;Stein and Hollander, 1992]. Psychosocial stressors have been reported to proceed development of neurotic excoriations in 30-98% of the patients [Fruensgaard, 1984;Gupta et al, 1987;Parsad and Saini, 1997].…”