Psychiatric–Medical ComorbidityPsychopathology, depression and dissociative experiences in patients with lichen simplex chronicus
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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More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus
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Genital Lichen Sclerosus and its Mimics
2017, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Patients often complain that their symptoms are worse at night. Psychological factors such as depression or obsessive compulsive disorder may contribute to lichen simplex chronicus.25 With vulvar lichen simplex chronicus, women typically complain of intense pruritus in the groin area.
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2017, Polish Annals of MedicineCitation Excerpt :They applied SCL-90 and HAM-D test and also dissociative experiences scale (DES), a 28-item, self-administered questionnaire for screening of dissociative disorders to a group of Turkish patients with LSC and controls. Scores of the all tests were significantly higher in LSC group.19 Radmanesh et al. evaluated psychological status in 65 patients with psychogenic pruritus (including LSC, prurigo nodularis and neurotic excoriation) by a semi-structured interview and concluded that all of them had affective disorders including depressions, anxieties, and mixed anxiety and depressive disorders.
Dissociation and conversion symptoms in dermatology
2017, Clinics in DermatologyCitation Excerpt :Psychogenic factors, including depression and dissociation, have been recognized as playing a central role in both lichen simplex chronicus and prurigo nodularis.37,38 A study of psychologic factors in 30 lichen simplex chronicus patients and 30 patients with tinea identified significantly higher psychopathologic scores, including high somatization and dissociation scores, in the lichen simplex chronicus patients, with dissociation scores that were in the pathologic range,38 usually encountered in dissociative disorders. Some other CSDs that may be associated with dissociation and conversion symptoms6,39 include vulvodynia, glossodynia, stomatodynia, some trichodynias, and some instances of sensitive, hyperreactive, or irritable skin.