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MORGELLONS PSYCHODERMATOLOGY

It is estimated that approximately one-third of patients seeking treatment of skin complaints have associated psychological stress or psychiatric disease.1 The field of psychodermatology studies the overlap of psychology/psychiatry and dermatology.2 Psychophysiologic skin disorders are primary skin diseases that can be precipitated or exacerbated by psychosocial stress, such as psoriasis, atopic dermatitis, and acne. Such skin diseases are also known to lead to and/or exacerbate psychiatric disorders such as anxiety and depression,3-5 which are referred to as secondary psychiatric disorders. On the other hand, in primary psychiatric skin disorders, there is an underlying psychiatric component that causes self-induced physical findings on the skin.6 Underlying psychiatric issues, such as anxiety, depression, obsessive-compulsive disorder (OCD), and psychosis, result in destructive manipulation of the skin, hair, or nails, often as an expression of highly dysregulated emotions.7 Lastly, cutaneous sensory disorders are conditions in which the patient has various abnormal sensations on the skin, such as itching, burning, stinging, biting, and crawling, in the absence of any diagnosable dermatologic, neurologic, medical, or psychiatric diagnosis.8 Table 100-1 shows the categorization of psychodermatologic disorders. Although these categories are extremely useful in conceptualizing psychodermatologic disorders, it is important to note that there can be considerable overlap or coexistence of these conditions. This chapter focuses on primary psychiatric skin disease, which broadly includes delusional, obsessive-compulsive, and factitious skin disorders (Table 100-2).

TABLE 100-1Psychodermatology: Categorization of Psychodermatologic Disorders2
TABLE 100-2Primary Psychiatric Skin Disorders

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