© Borgis - New Medicine 1/2011, s. 17-18
Dermatitis Artefacta as a Spectrum of Borderline Personality Disorder – case report
Department of Clinical Psychiatry, Nicolaus Copernicus University Toruń, Medical University Bydgoszcz, Poland
Head of Department: prof. Aleksander Araszkiewicz, MD, PhD
Dermatitis artefacta refers to conditions in which patient self-inflicts excoriations with their own nails, sharp instruments, burning cigarettes or chemicals. There are instances in which recognition of this disorder is difficult. Histological findings are not characteristic and diagnosis depends on the clinical presentation. The differential diagnosis of cutaneous lesions is extensive, depending on the lesion type. Diagnosis of dermatitis arteficialis was based on clinical grounds, including bizarre-looking lesions, sites accessible to the patients and absence of other dermatologic diseases to explain the dermatosis. Knowledge of the psycho-dermatological diseases can contribute to more profitable therapy in both dermatology and psychiatry.
Dermatitis artefacta means self-inflicted lesions of the skin. Various psychosocial conflicts and unconscious motivating factors have been held responsible for this self-destructive activity (1). Dermatitis artefacta may represent one of Borderline Personality Disorders (BPD). Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and deregulated behaviors, such as non-suicidal self-injury and binge-eating (2). The development and exacerbation of Borderline Personality Disorders spectrum are associated with deregulation of the hypothalamic pituitary adrenal (HPA) axis, which is measured by aberrant levels of cortisol secretion (3). These symptoms are related to dysfunction of fronto-limbic circuits. Among subcortical limbic structures, the amygdala mediates the most extensive range of social and emotional processes (4). Patients suffering from BPD exhibit exaggerated amygdala responses to social and emotional stimuli. Biological basis of BPD has focused primarily on the relationships between dysfunctional behaviors and serotonin (5-HT) deregulation (5).
Emotional problems as the cause of skin lesions have been described in specialist literature over the last few years (6). Various types and methods of producing the skin lesions depend on the patient’s background and education. Clinical manifestation of self-inflicted dermatitis may be difficult to diagnose (7). Histological findings are not characteristic and diagnosis depends on the clinical presentation. Differential diagnosis of cutaneous lesions is extensive, depending on the lesion type. Below there is presented a case of dermatitis artefacta in a man who was diagnosed with a Borderline Personality Disorders (8).
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