Elsevier

General Hospital Psychiatry

Volume 29, Issue 3, May–June 2007, Pages 232-235
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus

https://doi.org/10.1016/j.genhosppsych.2007.01.006Get rights and content

Abstract

Objective

Psychogenic factors may play a contributory role in the development or persistence of lichen simplex chronicus (LSC). The objective of this study was to evaluate the psychiatric profile of patients with LSC including depression and dissociative experiences.

Method

Dermatology outpatients with a LSC (n=30) were compared with outpatients with tinea in which psychological factors are regarded as negligible (n=30). All subjects were given psychiatric scales including the Symptom Checklist-90-Revised (SCL-90-R), Hamilton Rating Scale for Depression (HAM-D) and Dissociative Experience Scale (DES).

Results

All mean SCL-90 scores for general psychopathology were higher in the LSC compared to the control group. HAM-D and DES scores were significantly higher in the LSC group (P<.05) as well. In addition, the number of patients whose total DES score of 30 and above was higher in the LSC group.

Conclusions

Psychiatric symptoms appear relatively common among patients with LSC. Further research is needed to confirm the possible role of dissociative tendencies in the etiology of LSC.

Introduction

Psychological causes have been suggested for many skin conditions, such as urticaria, pruritus, atopic dermatitis, psoriasis and alopecia areata [1], [2]. Lichen simplex chronicus (LSC) is a type of neurodermatitis which is classified under the title “psychological factor affecting medical condition” in DSM-IV[3]. LSC, also called circumscribed neurodermatitis, is a troublesome, common pruritic disorder resulting from repeated rubbing and scratching [4]. The underlying stimulus for the development of LSC is pruritus. However, the underlying pruritogenic stimuli in many LSC cases often remain undetermined. It is believed that psychogenic factors play an important contributory role in the development or perpetuation of chronic itchy dermatose's lesions [5], [6]. In patients with no underlying medical or dermatological condition, the scratching may begin unconsciously and evolves into a compulsive ritual, which may cause the lichenification of the skin [7].

Dissociation refers to a lack of normal integration of thoughts, feelings and experiences into the stream of consciousness and memory that occurs on a continuum ranging from minor normative dissociations to psychiatric conditions [8]. The concept of a continuum of dissociation from normal experience to psychopathology has been challenged. More recent work distinguishes between physiological and pathological dissociation [9]. The association between psychic trauma, posttraumatic symptoms, psychic dissociation and somatoform disorders is currently well documented [10]. Psychological trauma refers to events (such as sexual assault, earthquake or combat) that overwhelm an individual's capacity to cope. Psychological trauma may result in chronic and recurring dermatological symptoms that persist after the trauma subsides. Gupta and Gupta [11] have shown that itching, like pain and numbness, may be a symptom of somatoform dissociation.

Somatization, dissociation and depression all are distinct constructs, but they correlate to a considerable extent with each other [12]. It is also known that approximately 40% of dermatological diseases are accompanied by depression and anxiety [13].

To date to our knowledge, there has not been a study specifically investigating the possible relationship between LSC and psychiatric symptoms including dissociative and depressive symptoms in the literature. Therefore, we decided to study the prevalence of psychiatric symptoms and the possible relationships between dissociative experiences, depression and LSC.

Section snippets

Setting and sample

This cross-sectional study was conducted between June 2004 and June 2005. All patients in this study were recruited from the University Hospital dermatology outpatients unit. Written informed consent was taken from all patients. Thirty consecutive patients with LSC (13 females and 17 males; mean age, 42.3 years; range, 21–64 years) and 30 voluntary subjects with tinea as controls (12 females and 18 males; mean age, 38.1 years; range, 19–60 years) were included in the study. Six other subjects

Results

Three subjects were excluded from the study because of uncooperativeness during the test procedure. One of them had a severe obsessive compulsive personality disorder. The two groups were similar in terms of age, gender, education, employment and marital status (for all parameters P>.05). Sociodemographic results of the subjects are shown in Table 1. The mean duration of LSC was 7.3 years (S.D.±6.3) and ranged between 11 months and 24 years.

All mean SCL-90 scores for general psychopathology

Discussion

In this study, higher SCL-90 scores in the LSC patient population than in the tinea patient population correspond to higher degree of general psychopathological symptoms in LSC patients. In concordance with the present study findings, SCL-90 scores for dermatology outpatients have been previously reported to be higher than those for outpatients in all other clinics [20], [21]. Substantial elevation of the somatization subscale of the SCL-90-R especially needs to be stressed in this regard.

In

Conclusions

Dissociative experiences and psychiatric symptoms are common in LSC patients implying a possible association between LSC and dissociation and psychiatric problems. Further studies should investigate the prevalence of psychiatric disorders, especially posttraumatic stress disorder and dissociative disorder, using specific structured interview in a large sample of LSC patients to clarify this issue.

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