Excoriation disorder is a mental disorder characterized by a recurring urge to choose your own skin, often leading to damage.
Research shows that the drive to choose is similar to repetitive behavior that focuses on the body, but others argue that for some conditions it is more similar to substance abuse disorder. Two main strategies for treating this condition are pharmacological and behavioral interventions.
Video Excoriation disorder
Classification
Since DSM-5 (2013), excoriation disorders are classified as "L98.1 Excoriation (skin-picking) disorder" in ICD-10; and is no longer classified in "Impulse control disorder" (f63) ".
Excoriation disorders are defined as "recurrent and compulsive skin removal resulting in tissue damage".
The most official name is "dermatillomania" for some time. In the fifth release of the Diagnostic and Statistical Manual of Mental Disorders in May 2013, excoriation disorders are classified as separate under "Compulsive Obsessions and Related Disorders" and are called "skin-picking disorders".
Equation with other conditions
The inability to control the urge to choose is similar to the urge to pull its own hair, trichotillomania. Researchers have noted the following similarities between trichotillomania and disruption of excoriation: the symptoms are ritualistic but no previous obsessions; there are similar triggers for compulsive action; both conditions seem to play a role in modifying the level of passion of the subject; and age of onset for both similar conditions. There is also a high level of comorbidity between those who have trichotillomania and those with excoriation disorders. The striking difference between these conditions is that skin picking seems to be dominated by women whereas trichotillomania is more prevalent across all sexes.
The research also shows that the disruption of excoriation can be regarded as a type of obsessive compulsive disorder (OCD). Excoriation and OCD disorders are similar because they involve "recurrent involvement in behavior with reduced control" and also generally lower anxiety.
However, Odlaug and Grant have suggested that the disruption of excoriation is more similar to substance abuse disorder than OCD. They argue that the disruption of excoriation differs from OCD in the following fundamental ways: (1) there are more women with excoriation disorders; (2) excoriation disorders may be inherently pleasing while OCD is not; (3) treatments that are generally effective for patients with OCD (i.e., SSRI and exposure therapy) are unsuccessful in patients with excoriation disorders; and (4) unlike OCD, choosing skin is rarely driven by obsessive thoughts. Odlaug and Grant have acknowledged the following similarities between individuals with dermatillomania and patients with addiction: (1) the urge to engage in negative behavior despite knowing the dangers; (2) lack of control over problematic behavior; (3) a strong impulse to engage in behavior before engagement; and (4) feelings of pleasure when engaging in behavior or feeling relief or reducing anxiety after engaging in behavior. One study supporting the theory of addiction chose to find that 79% of patients with excoriation disorders reported favorable feelings when choosing.
Odlaug and Grant also argue that dermatillomania can have several different psychological causes, which would explain why some patients appear to be more likely to have symptoms of OCD, and others, from addiction. They suggest that treating certain cases of excoriation as an addiction may produce more success than treating them as OCD forms.
Maps Excoriation disorder
Signs and symptoms
Shoot episodes are often preceded or accompanied by tension, anxiety, or stress. In some cases, after choosing, the affected person may feel depressed. During these moments, there is usually a compulsive urge to pick, squeeze, or scratch on the surface or area of ​​the body, often at the site of the perceived skin defect. When choosing one can feel a sense of relief or satisfaction.
The most commonly chosen area is the face, but other locations often include the arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, and extremities such as nails, cuticles, and toenails. Most patients with reports of excoriation disorders have a major area of ​​the body they focus on, but they will often move to other areas of the body to allow their primary taking areas to heal. Individuals with excoriation disorders vary in their picking behavior; some do it briefly several times a day while others can do one retrieval session that can last for hours. The most common way to choose is to use a finger even though a small percentage of people use tools such as tweezers or needles.
Skin selection often occurs as a result of several other trigger causes. Some common triggers feel or check for irregularities in the skin and feel anxious or other negative feelings.
Complications arising from the disruption of excoriation include: infection at the site of taking, tissue damage, and septicemia. The damage caused by picking can be so severe that it requires a skin graft. Picking that can cause severe epidermal abscess. Severe cases of excoriation disorder can cause life-threatening injuries. For example, in one case a woman reported taking a hole through her bridge of her nose, which required surgery to be repaired, and a 48-year-old woman taking it through the skin on her neck exposing the carotid artery. Pain in the neck or back may result from prolonged bending positions while engaging in behavior. In addition to physical injury, disruption of the excoriation can cause scarring and severe physical disabilities.
Excoriating disorders can cause feelings of great helplessness, guilt, shame, and embarrassment to the individual, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorders provide suicidal ideas in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalization in 15% of individuals with this condition.
Cause
There are many different theories about the causes of excoriation disorders including biological and environmental factors.
The general hypothesis is that excoriation disorder is often a coping mechanism to cope with an increase in the level of turmoil, arousal or stress within an individual, and that the individual has a stress response disorder. A behavior study review found support in this hypothesis that skin-picking appears to be maintained by auto reinforcement in individuals.
Unlike neurological theories, there are some psychologists who believe that choosing behavior can be the result of the suppressed anger felt by authoritarian parents. A similar theory suggests that arrogant parents can cause behavior to develop in their children.
Neurological
There is limited knowledge of neurobiology that promotes impaired excoriation, and there has been no neuroimaging studies in patients with impaired excoriations.
People who experience excoriation disorders along with other undiagnosed conditions report different motivations to choose them. Those with OCD and excoriation disorders reported that they would take their skin due to the perceived contamination of the skin, while those with body dysmorphic disorder (BDD) and excoriation disorders were reportedly choosing to correct perceived perceived skin.
Studies have shown a link between dopamine and the drive to choose. Drugs such as cocaine and methamphetamine which are dopamine agonists, which increase the pharmacological effects of dopamine, have been shown to cause uncontrollable voting in the user. These drugs can create a sensation of formication, which feels like something that crawls above or below the skin. In addition, drugs such as naltrexone have shown some benefits in reducing picking behavior. Thus, the disruption of excoriation may result from dopamine reward function dysfunction.
There may be other neurological explanations for the disruption of excoriation: individuals with this condition have fewer motor-inhibition controls, but show no sign of differences in cognitive flexibility, when compared to individuals without conditions. Motorized inhibitory control is a function of the right lateral frontostriatal series, which includes the lower frontal caleal cortex and the lower right bilateral. Motor-inhibitor control disturbances are similar to those of neurological conditions that have problems suppressing inappropriate behavior, such as abusing methamphetamine.
Diagnosis
There is controversy over the creation of separate categories in the DSM-5 for excoriation disorder (skin picking). The two main reasons for objecting to the inclusion of an excori- sation disorder in DSM-5 are: (1) that the excori- sation disorder may only be a symptom of a different underlying disorder, eg OCD or BDD, and (2) that excoriation disorders are merely bad habits and that by letting this disorder to get its own separate category will force DSM to include a variety of bad habits as a separate syndrome, for example, nail biting and nose. Stein argues that the excoriation disorder does not qualify as a separate syndrome and should be classified as its own category because: (1) excoriation disorders occur as a primary disorder and not as part of a larger disturbance; (2) excoriation disorders have a clear clinical picture; (3) there is data collection on clinical features and diagnostic criteria for this condition; (4) there is sufficient data to make this as a separate category for the disruption of excoriation; (5) the incidence rate for high excoriation disorders within the population; (6) diagnostic criteria for the disease have been proposed; (7) the classification of the disruption of the excoriation as a separate condition will lead to better research and better treatment outcomes; and (8) classification as a separate condition will cause more awareness of the disorder and encourage more people to get treatment.
Because the disruption of excoriation is different from other conditions and the disorders that lead to skin picking, it is important that the diagnosis of excoriation disorders considers various other medical conditions as possible causes before diagnosing patients with the disorder of excoriation. There are various conditions that cause itching and skin including: eczema, psoriasis, diabetes, liver disease, Hodgkin's disease, polycythemia vera, systemic lupus, and Prader-Willi syndrome.
To better understand the disruption of excoriation, researchers have developed various scales to categorize skin-taking behavior. These include the Skincare Impact Scale (SPIS), and Milwaukee Inventory for Adult Skin Dimensions. SPIS was created to measure how skin picking affects individuals socially, behaviorally, and emotionally.
In the fifth release of the Diagnostic and Statistical Manual of Mental Disorders in May 2013, the disorder is classified as its own separate condition under "Compulsive Obsessions and Related Disorders" and is termed "skin-picking disorder".
Treatment
Knowledge of effective treatments for excoriation disorders is rare despite the prevalence of these conditions. There are two main classes of therapy for excoriation disorders: pharmacological and behavioral.
Individuals with excoriation disorders often do not seek treatment for their condition largely because of feelings of shame, alienation, lack of awareness, or the belief that such conditions can not be cured. One study found that only 45% of individuals with excoriated disorders had ever sought treatment and only 19% had ever received dermalogic treatments. Another study found that only 30% of individuals with this disorder sought treatment.
Medication
There are several different classes of pharmacologic care agents that have support for treating excoriation disorders: (1) SSRIs; (2) opioid antagonists; and (3) glutamatergic agents. In addition to this class of drugs, several other pharmacological products have been tested in small trials as well.
SSRIs have been shown to be effective in OCD treatment and this has provided arguments in favor of treating excoriation disorders with similar therapies. Unfortunately, clinical studies have not provided clear support for this, as there have been no large double-blind placebo-controlled trials of SSRI therapy for excori- sory disorders. Overview of treatment of impaired disorders has shown that the following drugs may be effective in reducing the behavior of choosing: doxepin, clomipramine, naltrexone, pimozide, and olanzapine. A small study of fluoxetine, SSRI, in treating excoriation disorders showed that the drug reduced certain aspects of skin-taking, compared with placebo, but full remission was not observed. One small study of patients with excoriation disorders treated with citalopram, other SSRIs, showed that those taking the drug significantly reduced their scores on the Obsessive Yale-Brown Compulsive Scale compared with placebo, but no significant reduction in the analogs. the scale of choosing behavior.
Although there has been no human studies on opioid antagonists for the treatment of excoriation disorders, there is research showing that this product can reduce self-chewing in dogs with acral lick, which some people suggest is a good animal model for a focused body. repetitive behavior. In addition, there are case reports that support the use of this opioid antagonist to treat excoriation disorders. Opioid antagonists work by affecting dopamine circuits, thereby reducing the pleasing effect of plucking.
Another class of possible pharmacological treatments are glutamatergic agents such as n-acetyl cysteine ​​(NAC). These products have shown some ability to reduce other problem behaviors such as cocaine and trichotillomania addiction. Several case studies and several small NAC studies have shown a decline in the choice of treatment with NAC, compared with placebo.
Excori- sory disorders, and trichotillomania have been treated with inositol.
Topiramate, an anti-epileptic drug, has been used to treat the disorder of excoriation; in a small individual study with Prader-Willi syndrome, was found to reduce skin picking.
Counseling
Behavioral care includes training of habitual reversal, cognitive behavioral therapy, acceptable acceptance-behavior therapy and acceptance and commitment therapy (ACT).
Several studies have shown that the habitual reversal training associated with awareness training reduces skin-taking behavior in individuals with impaired excoriations who have no psychological disabilities. Habit reversal training can include awareness raising and competitive response training. For example, in one competive response training study requires participants to make a closed fist for a minute instead of choosing or responding to conditions that normally provoke voting behavior.
Disabled development
There are several different behavioral interventions that have been tested for treating excoriation disorders in people with developmental disabilities.
One method is to ask individuals to wear protective clothing that limits a patient's ability to pick on his body, such as a glove or face mask.
Other behavioral care attempts to change behavior through the provision of different incentives. Under the Reinforcement of Differential Behavior of Others (DRO), patients are rewarded if able to distance themselves from the behavior of choosing for a certain time. Unlike the DRO, Differential Reinforcement of Incompatible Behavior (DRI) rewards individuals for engaging in alternative behaviors that can not occur physically at the same time as problem behavior (eg sitting on your hands instead of picking on your skin). Finally, the reinforcement of alternative behavioral differentials values ​​behaviors that are not always incompatible with the target behavior but serve the same function as the target behavior (eg, giving people with competing behavior to fill their time rather than choosing the skin).
All of these techniques have been reported to have some success in small studies, but none have been tested in a population large enough to provide definitive evidence of their effectiveness.
Biofeedback
Temporary evidence indicates that devices that provide feedback when activity occurs can be useful.
Prognosis
Typically, individuals with impaired excoriations find that the disorder interferes with daily life. Influenced by shame, embarrassment and humiliation, they can take action to hide their distractions by not leaving home, wearing long sleeves and even hot underwear, or covering the visible damage to the skin with cosmetics and/or bandages.
Epidemiology
The prevalence of impaired excoriation is not well understood.
Estimated prevalence of the condition ranges from 1.4 to 5.4% in the general population. One US telephone survey found that 16.6% of respondents "took their skin to a point of real tissue damage" and that 1.4% would qualify as meeting the requirements of the excori- sation disorder. Other community surveys found a 5.4% rate of excoriated disruption. A survey of students found 4%. One study found that among adults who were not disabled, 63% of individuals were involved in some form of skin picking and 5.4% were involved in serious skin removal. Finally, a survey of dermatologic patients found that 2% suffered from a disruption of excoriation.
In some patients, the disruption of excoriation begins with the onset of acne in adolescence, but coercion continues even after the acne is gone. Skin conditions such as keratosis pilaris, psoriasis, and eczema can also provoke behavior. In patients with acne, skin care is not proportional to the severity of acne. Certain stress events including marital conflicts, friend or family deaths, and unwanted pregnancies have been linked to the onset of the condition. If a disruption of excoriation does not occur during adolescence, the age of general onset is between the ages of 30 and 45. In addition, many cases of excoriation disorders have been documented to begin in children under the age of 10. A small survey of patients with an excoriation disorder found that 47, 5% of them have an early onset of excori- sory disorders that begin before age 10. Traumatic childhood events can initiate behavior.
Excoriation disorders are statistically more common in women than in men.
Excoriation disorders have high rates of comorbidity with other psychiatric conditions, especially with mood and anxiety disorders. A survey of patients with excoriation disorder found that 56.7% also had DSM-IV Axis-I disorders and 38% had alcohol or drug abuse issues. Studies have shown the following rates of psychiatric conditions found in patients with excoriation disorders: trichotillomania (38.3%), substance abuse (38%), major depressive disorder (approximately 31.7% to 58.1%), anxiety disorder 23% to 56%), obsessive-compulsive disorder (approximately 16.7% to 68%), and body dysmorphic disorder (about 26.8% to 44.9%). There is also a higher excoriation disruption rate in patients in psychiatric facilities; A study of juvenile psychiatric inpatients found that excoriation disorders existed in 11.8% of patients. It is also present at high levels with some other conditions: 44.9% of patients with dysmorphic disorders of the body also have excoriation disorders; 8.9% of patients with OCD had excoriated disorders; and 8.3% of patients with trichotillomania experienced excoriation disorders.
Skin picking is also common in those with certain developmental defects; for example, Prader-Willi syndrome and Smith-Magenis syndrome. Research has shown that 85% of people with Prader-Willi syndrome are also involved in skin picking. Children with developmental disabilities also have an increased risk for excoriation disorders.
Excori- sory disorders also correlate with "social, occupational, and academic disorders, an increase in medical and mental health problems (including anxiety, depression, obsessive-compulsive disorder)... and financial burden". Excoriation disorders also have high rates of comorbidity with difficulty in work and marriage.
Substance abuse is often present, and individuals with impaired excoriations are twice as likely to have first-degree relatives who have substance abuse disorders than those who do not have the condition.
Some cases of repetitive behavior that focus on the body also show heredity.
History
The mention of the first known excoriation disorder to be discovered in 1898 by the French dermatologist Louis-Anne-Jean Brocq, describes a female patient with an uncontrolled acne pickup.
Society and culture
Excoriation disorders have been the subject of several episodes of Obsessed , a television documentary series focusing on the treatment of anxiety disorders. Exoriation disorders are shown as anxiety symptoms of Nina Sayers and OCD in the film Black Swan.
See also
- Dermatophagia
- Morgellons
References
Further reading
- Grant JE, Odlaug BL (August 2009). "Update on pathological skin selection". Curr Psychiatry Rep . 11 (4): 283-8. doi: 10.1007/s11920-009-0041-x. PMID 19635236.
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Singer HS (2011). "Disturbance of stereotypical movements". Handb Clin Neurol . 100 : 631-9. doi: 10.1016/B978-0-444-52014-2.00045-8. PMID 21496612. - Stein DJ, Grant JE, Franklin ME, et al. (June 2010). "Trichotillomania (hairdressing disorder), skin-taking disorder, and stereotypical movement disorder: towards DSM-V". Depression Anxiety . 27 (6): 611-26. doi: 10.1002/da.20700. PMID 20533371.
- Stratton, Mary-Margaret, BA (February 2018). "Stop Picking On Me". CS1 maint: Many names: list of authors (links)
External links
Source of the article : Wikipedia
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