2016 Volume 57 Issue 2 Pages 298-309
Skin is recognized as the boundary between an individual and society. Skin is also known to impact social and psychiatric conditions. The social aspect of skin characteristics has been gaining attention especially when it comes to hair-pulling or skin-picking disorders. These disorders, which target skin, hair or nails, have been investigated and described in the revised version of DSM-5 as “body-focused repetitive behaviors”(BFRB).
Most patients with BFRB have psychiatric problems. However, most will visit a dermatologist, and not a psychiatrist, although the psychiatric symptoms and recurrent BFRBs are difficult to manage for dermatologists who do not typically have psychiatric knowledge. The untreated psychiatric symptoms, including targeting of the skin, will eventually result in skin damage such as lesions, infection, and scars.
DSM-5-revised describes a new categorization of obsessive-compulsive and related disorders (OCRDs). Hair-pulling disorder known as trichotillomania is now categorized as an OCRD, whereas it was previously recognized as an impulse-control disorder under DSM-IV. Additionally, excoriation (skin-picking) disorder and body-focused repetitive behavior disorder, recognized as a new unit in diagnosis, have also been categorized as OCRDs. These revisions in diagnostic criteria reflect significance of the close relationships between BFRB and OCRDs, as well as the importance of psychosomatic dermatology and psychodermatology, which examine the clinical relationships between dermatology and psychiatry.
This study reviews literature that is relevant to hair-pulling and skin-picking disorders, as well as scratching behavior, especially that which occurs in patients with atopic dermatitis (AD). The paper also investigates the clinical characteristics and treatment of a patient with hair-pulling disorder and AD treated in a child psychiatry clinic, demonstrating the benefits of placing greater focus on psychodermatology, and the importance of collaboration between child psychiatrists and dermatologists.
