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Beiter K, Sable K, Arkin L. Ethical considerations when preadolescents request elective or cosmetic dermatologic interventions. J Am Acad Dermatol 2024; 90:1321-1322. [PMID: 37321486 DOI: 10.1016/j.jaad.2023.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Kaylin Beiter
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
| | - Kimberly Sable
- Department of Dermatology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin
| | - Lisa Arkin
- Department of Dermatology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin
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Tros BG, Kemperman PMJH, Kuckulus J, Hoekzema R, Vulink NCC. Body Dysmorphic Disorder and Self-esteem in Adolescents and Young Adults with Acne Vulgaris. Acta Derm Venereol 2023; 103:adv6232. [PMID: 37707293 PMCID: PMC10512965 DOI: 10.2340/actadv.v103.6232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/04/2023] [Indexed: 09/15/2023] Open
Abstract
Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.
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Affiliation(s)
- Benjamin G Tros
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jade Kuckulus
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick Hoekzema
- Department of Dermatology, Huid Medisch Centrum, Amsterdam, The Netherlands
| | - Nienke C C Vulink
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Zambare WV, Tocci E, Sideridis G, Wilhelm S, Keuthen N, Fogler J, Lee MS. The pediatric dermatology psychosocial screen: Promoting psychosocial coping and early identification of mental illness in pediatric dermatology patients. Pediatr Dermatol 2022; 39:226-230. [PMID: 35178722 DOI: 10.1111/pde.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/06/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The psychosocial impact of pediatric skin conditions can be difficult to assess accurately. There is currently no way to formally screen and provide stepped care specifically for psychosocial dysfunction or mental illness during dermatology clinics. The Psychosocial Screening Tool for Pediatric Dermatology (PDPS) was designed to identify patients in need of psychosocial support and to promote multidisciplinary care. METHODS The PDPS was studied at Boston Children's Hospital outpatient dermatology clinics. A pilot study was conducted with 16 participants to assess language and applicability. The validation study included 105 participants aged 8-19 years. Participants completed the PDPS, the Children's Depression Index 2 Short (CDI-2 Short), and three subscales of the Behavior Assessment System for Children 2 (BASC-2) to assess content validity. Model fit from confirmatory factor analysis was evaluated using the root-mean-square error of approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). RESULTS Proper model fit and criterion validity were demonstrated through positively correlating the PDPS and the CDI-2 Short (CFI = 0.972, TLI = 0.969, RMSEA 5.3%) and BASC-2 subscales (RMSEA = 7.2%, CFI = 0.975, TLI = 0.969). Patient resilience was positively correlated with higher scores in each psychosocial domain. CONCLUSIONS The PDPS is an effective screening tool for resilience versus need for early behavioral/mental health intervention in dermatology patients aged 8-19. The PDPS identifies psychosocial dysfunction and problems patients may not disclose otherwise (bullying, self-harm, social supports, neurodermatitis, and body dysmorphic disorder). Additionally, patients can directly indicate interest in various psychosocial health resources on the PDPS, guiding practitioners in providing comprehensive care.
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Affiliation(s)
- Wini V Zambare
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | | | - Georgios Sideridis
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sabine Wilhelm
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nancy Keuthen
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Margaret S Lee
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA
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Mosca M, Martin K, Hong J, Hadeler E, Brownstone N, Koo J. A review of the diagnosis and management of pediatric psychodermatologic conditions: Part II. Pediatr Dermatol 2022; 39:12-16. [PMID: 34964183 DOI: 10.1111/pde.14885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.
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Affiliation(s)
- Megan Mosca
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Kari Martin
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Julie Hong
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Edward Hadeler
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Nicholas Brownstone
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - John Koo
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
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Rabaioli L, Oppermann PDO, Pilati NP, Klein CFG, Bernardi BL, Migliavacca R, Lavinsky-Wolff M. Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Braz J Otorhinolaryngol 2020; 88:539-545. [PMID: 32978118 PMCID: PMC9422649 DOI: 10.1016/j.bjorl.2020.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p < 0.01). CONCLUSION The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.
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Affiliation(s)
- Luísi Rabaioli
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | | | - Natália Paseto Pilati
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Cássia Feijó Gomes Klein
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Bárbara Luiza Bernardi
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Raphaella Migliavacca
- Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Michelle Lavinsky-Wolff
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
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Hammond BA, Reeve EA. A case of body dysmorphic disorder in an adolescent with hypohidrotic ectodermal dysplasia. Pediatr Dermatol 2020; 37:896-899. [PMID: 32643246 DOI: 10.1111/pde.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 11/27/2022]
Abstract
We report the case of an adolescent with hypohidrotic ectodermal dysplasia, who had obsessive-compulsive disorder and was later diagnosed with body dysmorphic disorder (BDD). BDD is a highly distressing, adolescent-onset disorder that may lead to social isolation, the development of comorbid mental health disorders and suicidality. Patients typically lack insight into their BDD and frequently present to dermatologists for medical treatment. In this paper, we address the challenges faced when working with patients with BDD.
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Affiliation(s)
| | - Elizabeth A Reeve
- HealthPartners Medical Group, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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