Classification of psychodermatological disorders: Proposal of a new international classification

INTRODUCTION

Several classifications of psychodermatology disorders have been proposed, with most of them based on two to four main disorder category groups. However, there is, to date, no classification that has resulted from a consensus established by psychodermatology experts. The DSM-5-TR (Diagnostic and statistical manual of mental disorders (5th ed.), Text Revision) and the ICD-11 (International classification of diseases (11th revision)) also do not provide a systematized approach of psychodermatology disorders. Taking into consideration that classifications are a key pillar for a comprehensive approach to the pathologies of each branch of medicine, the proposal of a classification in psychodermatology appeared as a central need for the recognition of psychodermatological disorders, in an attempt to improve their recognition and, in that sense, to find a common language for the development of this subspecialty that crosses dermatology and psychiatry.

METHODS

Previously published classifications in psychodermatology were critically reviewed and discussed by expert opinion from an international multidisciplinary panel of 16 experts in psychodermatology and a new classification system is proposed, considering classical concepts in general dermatology and psychopathology.

RESULTS

Two main categories of disorders are presented (a main group related to primary mental health disorders and another main group related to primary skin disorders), which are subsequently subdivided into subgroups considering pathophysiological and phenomenological similarities, including key aspects of dermatological examination, namely the presence of visible skin lesions (primary and secondary skin lesions) and psychopathological correlates.

CONCLUSION

This new classification aims to unify previous classifications, systematize the disorders that belong to psychodermatology and highlight their tenuous boundaries, to improve their management. It has been built and approved by the Psychodermatology Task Force of the European Academy of Dermatology and Venereology (EADV), the European Society for Dermatology and Psychiatry (ESDaP) and the Association for Psychoneurocutaneous Medicine of North America (APMNA).

Deconstructing the components model of addiction: an illustration through "addictive" use of social media

The components model of addiction posits that all addictions share six components, namely salience, tolerance, mood modification, relapse, withdrawal, and conflict. This highly influential model has resulted in the development of numerous psychometric instruments that measure addictive behaviors according to these criteria. However, recent research suggests that, in the context of behavioral addictions, certain components constitute peripheral features that do not distinguish non-pathological from pathological behavior. Using "addictive" use of social media as a representative example, we examined this perspective by testing whether these six components actually assess central features of addiction, or whether some of them constitute peripheral features that are not indicative of a disorder. Four independent samples totaling 4,256 participants from the general population completed the Bergen Social Media Addiction Scale, a six-item psychometric instrument derived from the components model of addiction to assess social media "addiction". By performing structural equation modeling and network analyses, we showed that the six components did not form a unitary construct and, crucially, that some components (i.e., salience, tolerance) were not associated with measures assessing psychopathological symptoms. Taken together, these results suggest that psychometric instruments based on the components model conflate central and peripheral features of addiction when applied to behavioral addictions. This implies that such instruments pathologize involvement in appetitive behaviors. Our findings thus call for renewing the conceptualization and assessment of behavioral addictions.

The Skin We Live in: Pigmentation Traits and Tanning Behaviour in British Young Adults, an Observational and Genetically-Informed Study

Skin cancer incidence has been increasing worldwide, representing a particularly high burden for populations of European ancestry. Outdoor and indoor tanning using ultraviolet (UV) radiation devices are major risk factors for skin cancer. While tanning behaviours can be modified by targeted interventions to reduce skin cancer rates, there is insufficient evidence on the motivations for tanning preferences and their relationship with pigmentation phenotypes. The present observational and genetically-informed study investigates motives for tanning and the role that pigmentation phenotypes play on outdoor and indoor tanning behaviour in British young adults. This study included 3722 participants from the Avon Longitudinal Study of Parents and Children in South West England, with data on pigmentation features, tanning ability and preferences, and SNP genotypes. Liking to tan and outdoor tanning were strongly influenced by pigmentary traits and tanning ability. However, the association of these phenotypes with UV indoor tanning was weaker. Our results provide evidence to support the implementation of skin cancer preventative interventions that consider individual biological characteristics and motives for undergoing outdoor and indoor tanning.

An addiction to seeking fortune-telling services: a case report

The paper describes a case report of a 36-years old female patient suffering from an addiction to seeking fortune-telling services, which is a type of behavioral addiction, or non-substance addiction. This condition is characterized by the addiction to various "occult services", fortune tellers and other representatives of nontraditional practices who are usually manipulative and self-serving. The authors reveal that this case report of fortune telling addiction possesses all of six components universal for addictions.In light of the increasing prevalence of various behavioral addictions, clinical psychiatrists should be aware of this phenomenon.

The Love Addiction Inventory: Preliminary Findings of the Development Process and Psychometric Characteristics

Although the existence of dysfunctional love relationships is well known and the term “love addiction” dates back to the 1970s, empirical studies on this topic are still limited. The biggest problem is arguably is the lack of a clear definition of the love addiction construct and the lack of psychometric instruments for the assessment of its symptoms. The aim of the present study was to develop and examine the psychometric characteristics of a self-report scale assessing love addiction using the components model of behavioral addiction. Two studies based on the splitting of a total sample of 663 participants involved in an intimate relationship (for at least for 6 months) were recruited to examine the psychometric characteristics of the newly developed love addiction scale and its six-item short-form. In the first study, an exploratory factor analysis (EFA) was conducted with a sample of 329 participants. In the second study, a confirmatory factor analysis (CFA) approach was used with a sample of 334 participants engaged in a romantic relationship. In both studies, reliability and concurrent validity were also examined. Results suggested that the factor structure of the Love Addiction Inventory and its six-item short-form is in line with the theoretical framework and showed good reliability and concurrent validity. The LAI in both short and longer forms are psychometrically robust and can be used to assess love addiction in future studies.