title: Emotional regulation, dissociation, and the self-induced dermatoses: clinical features and implications for treatment with mood stabilizers.
abstract: The self-induced dermatoses (such as trichotillomania, pathologic skin picking or neurotic excoriations, dermatitis artefacta, onychophagia and onychotillomania), which are caused as a result of excessive manipulation of the skin, hair, and nails by the patient, can contribute to significant morbidity and can even complicate the course of a primary dermatologic condition such as acne (eg, in acne excoriée) and some pruritic dermatoses. Reports on the self-induced dermatoses in the past decade have tended to focus upon the specific motor behaviors involved in self-inducing the lesions (ie, skin picking or hair pulling) rather than address the common psychopathologic factors underlying the self-injurious behaviors. In the current psychiatric nosology (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) the self-induced dermatoses are classified as Impulse Control Disorders and Stereotypic Movement Disorders, and this classification does not adequately consider the fact that in most patients with self-induced dermatoses, the frequency and severity of the self-injurious behaviors are directly related to acute or chronic problems with emotional regulation and dissociation. This may be part of the reason that there is a relative paucity of effective treatments for these disorders. The skin and its appendages are well innervated with a dense network of afferent sensory nerves and efferent autonomic nerves, and the integumentary system is frequently the focus of tension-reducing and emotion-regulating behaviors, especially during states of autonomic nervous system hyperarousal. This factor is important in the pathogenesis of the self-induced dermatoses. Mood-stabilizing agents, such as lithium carbonate, that are used to treat disorders of emotional regulation have not been adequately studied in the management of the self-induced dermatoses and may prove to be very helpful in the management of these disorders.
authors.affiliation: Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Dr, Suite 101, London, ON, N6J 1H3, Canada. magupta@uwo.ca
authors.forename: Madhulika A
authors.initials: MA
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004644:Emotions / Q000187:drug effects*; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016728:Self-Injurious Behavior / Q000523:psychology*; D012871:Skin Diseases / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate