title: Obsessive-compulsive skin disorders: a novel classification based on degree of insight.
abstract: Individuals with obsessive-compulsive features frequently visit dermatologists for complaints of the skin, hair or nails, and often progress towards a chronic relapsing course due to the challenge associated with accurate diagnosis and management of their psychiatric symptoms. The current DSM-5 formally recognizes body dysmorphic disorder, trichotillomania, neurotic excoriation and body focused repetitive behavior disorder as psychodermatological disorders belonging to the category of Obsessive-Compulsive and Related Disorders. However there is evidence that other relevant skin diseases such as delusions of parasitosis, dermatitis artefacta, contamination dermatitis, AIDS phobia, trichotemnomania and even lichen simplex chronicus possess prominent obsessive-compulsive characteristics that do not necessarily fit the full diagnostic criteria of the DSM-5. Therefore, to increase dermatologists' awareness of this unique group of skin disorders with OCD features, we propose a novel classification system called Obsessive-Compulsive Insight Continuum. Under this new classification system, obsessive-compulsive skin manifestations are categorized along a continuum based on degree of insight, from minimal insight with delusional obsessions to good insight with minimal obsessions. Understanding the level of insight is thus an important first step for clinicians who routinely interact with these patients.
authors.affiliation: a University of Southern California Keck School of Medicine , Los Angeles , CA , USA.
authors.forename: Tian Hao
authors.initials: TH
authors.lastname: Zhu
authors.affiliation: b Department of Dermatology, Psoriasis and Skin Treatment Center , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Mio
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: c University of Vermont College of Medicine , Burlington , VT , USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Farahnik
authors.affiliation: d University of California Irvine School of Medicine , Irvine , CA , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Abrouk
authors.affiliation: e University of Texas at Austin, Dell Medical School , Austin , TX , USA.|f Seton Family of Hospitals , Austin , TX , USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Reichenberg
authors.affiliation: b Department of Dermatology, Psoriasis and Skin Treatment Center , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Bhutani
authors.affiliation: b Department of Dermatology, Psoriasis and Skin Treatment Center , University of California San Francisco , San Francisco , CA , USA.
authors.forename: John
authors.initials: J
authors.lastname: Koo
mesh_terms: D057215:Body Dysmorphic Disorders / Q000473:pathology / Q000523:psychology; D063726:Delusional Parasitosis / Q000473:pathology / Q000523:psychology; D003872:Dermatitis / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D009450:Neurodermatitis / Q000473:pathology / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000145:classification / Q000473:pathology / Q000523:psychology*; D010698:Phobic Disorders / Q000473:pathology / Q000523:psychology; D012871:Skin Diseases / Q000145:classification / Q000473:pathology / Q000523:psychology*; D014256:Trichotillomania / Q000473:pathology / Q000523:psychology
keywords: Obsessive-compulsive disorder; body dysmorphic disorder; classification; contamination dermatitis; delusions of parasitosis; insight; lichen simplex chronicus; neurotic excoriation; psychodermatology; trichotillomania