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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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Zagami M, Klepper E, Wienecke E, Andrzejewski M, Sikder A, Ahmed A, Robinson H. A review of psychocutaneous disorders from a psychotherapeutic perspective—Toolkit for the dermatologist. SKIN HEALTH AND DISEASE 2023. [PMID: 37538328 PMCID: PMC10395638 DOI: 10.1002/ski2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. Aim The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. Methods We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. Results The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Conclusions Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.
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Affiliation(s)
- Mary Zagami
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Edward Klepper
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Eric Wienecke
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | | | - Ahmed Sikder
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Ali Ahmed
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Howard Robinson
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
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Millington GWM, Shobajo MT, Wall J, Jafferany M. Somatization in dermatology. SKIN HEALTH AND DISEASE 2022; 2:e164. [PMID: 36479272 PMCID: PMC9720197 DOI: 10.1002/ski2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 06/07/2023]
Abstract
Medically unexplained dermatologic symptoms, such as pruritus, numbness and burning are known as somatization. These cutaneous symptoms can be very difficult to treat because of an absence of an objective explanation and they may not fit neatly into any known dermatological or psychiatric condition. These disorders are more commonly encountered in primary care and in dermatology, rather than in psychiatry. Certain skin disorders, for example, pruritus, could be a manifestation of somatization and others may predispose to somatic symptoms, for example, atopic dermatitis and psoriasis. Although there has been increasing research in the interconnection between psychiatry and dermatology, psychodermatology is a relatively new crossover discipline in clinical practice and recognition of psychodermatological conditions, such as cutaneous somatic disorders, can be difficult. Somatization may occur with or without the existence of a dermatological disease. When a dermatological disorder is present, somatization should be considered when the patient is worrying too much about their skin, spending too much time and energy on it and especially if the patient also complains of many non-cutaneous symptoms. Purely cutaneous somatic conditions include for example, the genital pain syndromes or Gardner-Diamond syndrome, characterized by unexplained bruising, which usually affects women. Effective management tools may include mindfulness therapies, pharmacotherapy with selective serotonin reuptake inhibitors, tricyclic antidepressants and cognitive conduct therapy. Electroconvulsive therapy can also be considered in extremely rare cases for treatment of severe somatization on a background of mood disorders. This paper discusses somatization, its relationship to immunodermatoses and its relevance to clinical practice.
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Affiliation(s)
- George W. M. Millington
- Norwich Medical SchoolNorwichUK
- Dermatology DepartmentNorfolk and Norwich University HospitalNorwichUK
| | - Morinola T. Shobajo
- Department of DermatologyUniversity of Illinois at Chicago College of MedicineChicagoIllinoisUSA
| | | | - Mohammad Jafferany
- Department of PsychiatryCentral Michigan University/CMU Medical Education PartnersSaginawMichiganUSA
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Greenberg JL, Jacobson NC, Hoeppner SS, Bernstein EE, Snorrason I, Schwartzberg A, Steketee G, Phillips KA, Wilhelm S. Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes. J Psychiatr Res 2022; 152:7-13. [PMID: 35700586 PMCID: PMC9447469 DOI: 10.1016/j.jpsychires.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/14/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
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Affiliation(s)
- Jennifer L. Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Corresponding author. (J.L. Greenberg)
| | - Nicholas C. Jacobson
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Anna Schwartzberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Gail Steketee
- Boston University School of Social Work, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA,New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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Kang WH, Loo MY, Leong XM, Ooi YF, Teo WQ, Neoh TJ, Ling WC. Body dysmorphic disorder and depression among male undergraduate students in a Malaysian University. Front Psychiatry 2022; 13:977238. [PMID: 36245882 PMCID: PMC9553528 DOI: 10.3389/fpsyt.2022.977238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Body dysmorphic disorder (BDD) and depression have been reported to be both prevalent among young people worldwide, resulting in serious implications in their quality of life and social functioning. This is worrying especially in men where mental disorders are often overlooked and under-researched. This study aims to determine the proportion of male university students with symptoms suggestive of body dysmorphic disorder and depression, as well as their perception on their body image. METHODS In this cross-sectional study, 1,308 male students between the aged of 17-26 years in a private university in Malaysia via self-administered online questionnaire comprising the Patient Health Questionnaire (PHQ)-9, the Body Dysmorphic Disorder Questionnaire (BQQD) and the Body Self-Image Questionnaire (BSIQ), in addition to their sociodemographic parameters. Data analyses were performed with Mann Whitney test, chi square test and Fisher's exact test. RESULTS 3.3 and 54.2% of the students had symptoms suggestive of BDD and depression respectively, with up to 9.02% of the students reporting having moderate to severe depression. There was a significant association between BDD symptoms and students staying alone, whilst depression was significantly associated with studying in the rural campus. Furthermore, a significant association was demonstrated between presence of BDD and depression symptoms. Most of the students were dissatisfied with their whole body, especially their height. CONCLUSION The proportion of BDD and depression symptoms among male students in our university is quite high. Universities and the public health sector should develop better support service targeting male university students.
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Affiliation(s)
- Waye Hann Kang
- Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Min Yee Loo
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Xue Min Leong
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Yi Fan Ooi
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Wen Qi Teo
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Teng Jun Neoh
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Wei Chih Ling
- Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
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Torales J, Melgarejo O, González I, García O, Barrios I, Jafferany M. Psychopharmacology in dermatology: Treatment of primary psychiatric conditions in dermatology. Dermatol Ther 2020; 33:e13557. [DOI: 10.1111/dth.13557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Julio Torales
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Osvaldo Melgarejo
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Israel González
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Oscar García
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Iván Barrios
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Mohammad Jafferany
- Department of Psychiatry Central Michigan University Mount Pleasant Michigan USA
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