The Role of Stress in Dermatitis Artefacta

Abstract

Dermatitis Artefacta (DA) is a primary psychiatric disorder with secondary skin manifestations; its prevalence is highest among adolescents and adults under the age of 30, with females being predominantly affected. The self-inflicted skin lesions can have wide ranging, bizarre morphological features, determined by the manner in which they are created. They do not conform to any known pattern of dermatoses and can appear as blisters, purpura, ulcers, chemical and thermal burns etc. The lesions are located on easily accessible parts of the body.

This chapter discusses the epidemiology and clinical features of DA, role of stress, psychiatric comorbidity, and various modalities of treatment. In particular, the chapter details the psychosocial, biological, and physical impacts of trauma, and includes the association of DA with anorexia nervosa, depression, psychosis, personality disorders, emotional immaturity, emotional disturbance during formative years and suicide. Treatment modalities include an empathic, non-judgmental doctor-patient relationship, psychotherapies, antidepressants, antianxiety medications; and neuroleptics. Complementary nonpharmacologic adjuvant therapies include acupuncture, cognitive-behavioral therapy, biofeedback, aromatherapy and hypnosis. The prognosis of DA varies, and is most likely related to the nature of the underlying psychiatric disorder. In some instances, recovery occurs after the initial psychiatric treatment, whereas in other cases, the disorder may persist for decades. DA can be chronic and generally appears to wax and wane with the circumstances of the patient’s life.