Skip to main content
Erschienen in: Die Psychotherapie 4/2020

29.06.2020 | Verhaltenstherapie | CME

Dermatillomanie

Symptomatik, Ätiologie und Therapie des pathologischen Bearbeitens der Haut

verfasst von: Dr. Christina Gallinat, Prof. Dr. Alexandra Martin, Prof. Dr. Jennifer Schmidt

Erschienen in: Die Psychotherapie | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Dermatillomanie ist eine psychische Störung, die durch das zwanghafte Bearbeiten der eigenen Haut gekennzeichnet ist sowie mit erheblichen medizinischen Risiken und psychosozialen Beeinträchtigungen einhergeht. Seit 2013 ist sie als eigenständige Diagnose im DSM‑5 aufgeführt und wurde ebenso in die ICD-11 aufgenommen. Die Lebenszeitprävalenz wird aktuell auf 1,4 % geschätzt. In der Praxis wird das Störungsbild aufgrund mangelnder Kenntnis der Diagnose und des fehlenden Einbezugs in die klinische Standarddiagnostik oft übersehen. Als Behandlung 1. Wahl gilt die kognitive Verhaltenstherapie, für die aktuell die stärkste Evidenz vorliegt. Allerdings besteht sowohl in Bezug auf Behandlungsansätze als auch hinsichtlich grundlagenwissenschaftlicher Fragestellungen noch erheblicher Forschungsbedarf. Dieser Beitrag beschreibt die Psychopathologie des Störungsbildes und umreißt den aktuellen Forschungsstand zu Ätiologie, Diagnostik und Behandlung.
Literatur
Zurück zum Zitat American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing, Washington, DC American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing, Washington, DC
Zurück zum Zitat Arnold LM, Mutasim DF, Dwight MM et al (1999) An open clinical trial of fluvoxamine treatment of psychogenic excoriation. J Clin Psychopharmacol 19:15–18PubMed Arnold LM, Mutasim DF, Dwight MM et al (1999) An open clinical trial of fluvoxamine treatment of psychogenic excoriation. J Clin Psychopharmacol 19:15–18PubMed
Zurück zum Zitat Beesdo-Baum K, Zaudig M, Wittchen H‑U (2019) Strukturiertes Klinisches Interview für DSM-5®-Störungen – Klinische Version. Deutsche Bearbeitung des Structured Clinical Interview for DSM-5® Disorders – Clinician Version von Michael B. First, Janet B.W. Williams, Rhonda S. Karg, Robert L. Spitzer. Hogrefe, Göttingen Beesdo-Baum K, Zaudig M, Wittchen H‑U (2019) Strukturiertes Klinisches Interview für DSM-5®-Störungen – Klinische Version. Deutsche Bearbeitung des Structured Clinical Interview for DSM-5® Disorders – Clinician Version von Michael B. First, Janet B.W. Williams, Rhonda S. Karg, Robert L. Spitzer. Hogrefe, Göttingen
Zurück zum Zitat Bohne A, Wilhelm S, Keuthen NJ et al (2002) Skin Picking in German Students: Prevalence, Phenomenology, and Associated Characteristics. Behav Modif 26:320–339PubMed Bohne A, Wilhelm S, Keuthen NJ et al (2002) Skin Picking in German Students: Prevalence, Phenomenology, and Associated Characteristics. Behav Modif 26:320–339PubMed
Zurück zum Zitat Dilling H, Mombour W, Schmidt MH (Hrsg) (2016) World Health Organization: Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F) Diagnostische Kriterien für Forschung und Praxis. Hogrefe, Bern Dilling H, Mombour W, Schmidt MH (Hrsg) (2016) World Health Organization: Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F) Diagnostische Kriterien für Forschung und Praxis. Hogrefe, Bern
Zurück zum Zitat Dixon LJ, Snorrason I (2019) Prevalence and clinical characteristics of skin picking among adults with skin disease symptoms. J Obsessive Compuls Relat Disord 22:100454 Dixon LJ, Snorrason I (2019) Prevalence and clinical characteristics of skin picking among adults with skin disease symptoms. J Obsessive Compuls Relat Disord 22:100454
Zurück zum Zitat Falkai P, Wittchen H‑U (2014) Diagnostisches und Statistisches Manual Psychischer Störungen – DSM-5®: Deutsche Ausgabe. Hogrefe, Göttingen Falkai P, Wittchen H‑U (2014) Diagnostisches und Statistisches Manual Psychischer Störungen – DSM-5®: Deutsche Ausgabe. Hogrefe, Göttingen
Zurück zum Zitat First MB, Williams JBW, Karg RS et al (2015) Structured Clinical Interview for DSM-5—Research Version (SCID‑5 for DSM‑5, Research Version; SCID-5-RV). American Psychiatric Association, Arlington, VA First MB, Williams JBW, Karg RS et al (2015) Structured Clinical Interview for DSM-5—Research Version (SCID‑5 for DSM‑5, Research Version; SCID-5-RV). American Psychiatric Association, Arlington, VA
Zurück zum Zitat Flessner CA, Woods DW (2006) Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 30:944–963PubMed Flessner CA, Woods DW (2006) Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 30:944–963PubMed
Zurück zum Zitat Flessner CA, Mouton-Odum S, Stocker AJ et al (2007) StopPicking.com: Internet-based treatment for self-injurious skin picking. Dermatol Online J 13:3PubMed Flessner CA, Mouton-Odum S, Stocker AJ et al (2007) StopPicking.com: Internet-based treatment for self-injurious skin picking. Dermatol Online J 13:3PubMed
Zurück zum Zitat Gallinat C, Moessner M, Haenssle HA et al (2019a) Help-seeking experiences in individuals affected by skin picking. J Obsessive Compuls Relat Disord 23:100483 Gallinat C, Moessner M, Haenssle HA et al (2019a) Help-seeking experiences in individuals affected by skin picking. J Obsessive Compuls Relat Disord 23:100483
Zurück zum Zitat Gallinat C, Moessner M, Haenssle HA et al (2019b) An internet-based self-help intervention for skin picking (SaveMySkin): Pilot randomized controlled trial. J Med Internet Res 21:e15011PubMedPubMedCentral Gallinat C, Moessner M, Haenssle HA et al (2019b) An internet-based self-help intervention for skin picking (SaveMySkin): Pilot randomized controlled trial. J Med Internet Res 21:e15011PubMedPubMedCentral
Zurück zum Zitat Gallinat C, Keuthen NJ, Backenstrass M (2016) Ein Selbstbeurteilungsinstrument zur Erfassung von Dermatillomanie: Reliabilität und Validität der deutschsprachigen Version der Skin Picking Scale-Revised. Psychother Psychosom Med Psychol 66:249–255PubMed Gallinat C, Keuthen NJ, Backenstrass M (2016) Ein Selbstbeurteilungsinstrument zur Erfassung von Dermatillomanie: Reliabilität und Validität der deutschsprachigen Version der Skin Picking Scale-Revised. Psychother Psychosom Med Psychol 66:249–255PubMed
Zurück zum Zitat Grant JE, Chamberlain SR (2017) Clinical correlates of symptom severity in skin picking disorder. Compr Psychiatry 78:25–30PubMedPubMedCentral Grant JE, Chamberlain SR (2017) Clinical correlates of symptom severity in skin picking disorder. Compr Psychiatry 78:25–30PubMedPubMedCentral
Zurück zum Zitat Grant JE, Chamberlain SR, Redden SA et al (2016a) N‑acetylcysteine in the treatment of excoriation disorder a randomized clinical trial. Jama Psychiatry 73:490–496PubMed Grant JE, Chamberlain SR, Redden SA et al (2016a) N‑acetylcysteine in the treatment of excoriation disorder a randomized clinical trial. Jama Psychiatry 73:490–496PubMed
Zurück zum Zitat Grant JE, Redden SA, Leppink EW et al (2016b) Psychosocial dysfunction associated with skin picking disorder and trichotillomania. Psychiatry Res 239:68PubMed Grant JE, Redden SA, Leppink EW et al (2016b) Psychosocial dysfunction associated with skin picking disorder and trichotillomania. Psychiatry Res 239:68PubMed
Zurück zum Zitat Harries MD, Chamberlain SR, Redden SA et al (2017) A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity. Psychiatry Res Neuroimaging 269:26–30PubMed Harries MD, Chamberlain SR, Redden SA et al (2017) A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity. Psychiatry Res Neuroimaging 269:26–30PubMed
Zurück zum Zitat Hayes SL, Storch E, L., Berlanga L (2009) Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord 23:314–319 Hayes SL, Storch E, L., Berlanga L (2009) Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord 23:314–319
Zurück zum Zitat Houghton DC, Tommerdahl M, Woods DW (2019) Increased tactile sensitivity and deficient feed-forward inhibition in pathological hair pulling and skin picking. Behav Res Ther 120:103433PubMed Houghton DC, Tommerdahl M, Woods DW (2019) Increased tactile sensitivity and deficient feed-forward inhibition in pathological hair pulling and skin picking. Behav Res Ther 120:103433PubMed
Zurück zum Zitat Keuthen NJ, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L, O’sullivan RL, Jenike MA (2000) Repetitive Skin-Picking in a Student Population and Comparison With a Sample of Self-Injurious Skin-Pickers. Psychosomatics 41(3):210–215PubMed Keuthen NJ, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L, O’sullivan RL, Jenike MA (2000) Repetitive Skin-Picking in a Student Population and Comparison With a Sample of Self-Injurious Skin-Pickers. Psychosomatics 41(3):210–215PubMed
Zurück zum Zitat Keuthen NJ, Deckersbach T, Wilhelm S et al (2001a) The Skin Picking Impact Scale (SPIS): Scale development and psychometric analyses. Psychosomatics 42:397–403PubMed Keuthen NJ, Deckersbach T, Wilhelm S et al (2001a) The Skin Picking Impact Scale (SPIS): Scale development and psychometric analyses. Psychosomatics 42:397–403PubMed
Zurück zum Zitat Keuthen NJ, Wilhelm S, Deckersbach T et al (2001b) The Skin Picking Scale. Scale construction and psychometric analyses. J Psychosom Res 50:337–341PubMed Keuthen NJ, Wilhelm S, Deckersbach T et al (2001b) The Skin Picking Scale. Scale construction and psychometric analyses. J Psychosom Res 50:337–341PubMed
Zurück zum Zitat Keuthen NJ, Koran L, M., Aboujaoude E et al. (2010) The prevalence of pathologic skin picking in US adults. Compr Psychiatry 51:183–186 Keuthen NJ, Koran L, M., Aboujaoude E et al. (2010) The prevalence of pathologic skin picking in US adults. Compr Psychiatry 51:183–186
Zurück zum Zitat Machado MO, Köhler CA, Stubbs B et al (2018) Skin picking disorder: prevalence, correlates, and associations with quality of life in a large sample. CNS Spectr 23:311–320PubMed Machado MO, Köhler CA, Stubbs B et al (2018) Skin picking disorder: prevalence, correlates, and associations with quality of life in a large sample. CNS Spectr 23:311–320PubMed
Zurück zum Zitat Mansueto CS, Townsley Stemberger RM, Mccombs TA et al (1997) Trichotillomania: A comprehensive behavioral model. Clin Psychol Rev 17:567–577PubMed Mansueto CS, Townsley Stemberger RM, Mccombs TA et al (1997) Trichotillomania: A comprehensive behavioral model. Clin Psychol Rev 17:567–577PubMed
Zurück zum Zitat Mathew AC, Davine TP, Snorrason I et al (2020) Body-focused repetitive behaviors and non-suicidal self-injury: A comparison of clinical characteristics and symptom features. J Psychiatr Res 124:115–122PubMed Mathew AC, Davine TP, Snorrason I et al (2020) Body-focused repetitive behaviors and non-suicidal self-injury: A comparison of clinical characteristics and symptom features. J Psychiatr Res 124:115–122PubMed
Zurück zum Zitat Mehrmann L, Hunger A, Gerlach A (2017) Pathologisches Hautzupfen/-quetschen (Skin Picking). Erste Ergebnisse zur Psychometrie störungsspezifischer Messinstrumente. Z Psychiatr Psych Ps 46:23 Mehrmann L, Hunger A, Gerlach A (2017) Pathologisches Hautzupfen/-quetschen (Skin Picking). Erste Ergebnisse zur Psychometrie störungsspezifischer Messinstrumente. Z Psychiatr Psych Ps 46:23
Zurück zum Zitat Monzani B, Rijsdijk F, Cherkas L et al (2012) Prevalence and heritability of skin picking in an adult community sample: A twin study. Am J Med Genet 159B:605–610PubMed Monzani B, Rijsdijk F, Cherkas L et al (2012) Prevalence and heritability of skin picking in an adult community sample: A twin study. Am J Med Genet 159B:605–610PubMed
Zurück zum Zitat Monzani B, Rijsdijk F, Harris J et al (2014) The structure of genetic and environmental risk factors for dimensional representations of DSM‑5 obsessive-compulsive spectrum disorders. Jama Psychiatry 71:182–189PubMed Monzani B, Rijsdijk F, Harris J et al (2014) The structure of genetic and environmental risk factors for dimensional representations of DSM‑5 obsessive-compulsive spectrum disorders. Jama Psychiatry 71:182–189PubMed
Zurück zum Zitat Morgan JR, Storch E, L., Woods D, W. et al. (2010) A preliminary analysis of the phenomenology of skin-picking in Prader-Willi Syndrome. Child Psychiatry Hum Dev 41:448–463 Morgan JR, Storch E, L., Woods D, W. et al. (2010) A preliminary analysis of the phenomenology of skin-picking in Prader-Willi Syndrome. Child Psychiatry Hum Dev 41:448–463
Zurück zum Zitat Moritz S, Fricke S, Treszl A et al (2012) Do it yourself! Evaluation of self-help habit reversal training versus decoupling in pathological skin picking: A pilot study. J Obsessive Compuls Relat Disord 1:41–47 Moritz S, Fricke S, Treszl A et al (2012) Do it yourself! Evaluation of self-help habit reversal training versus decoupling in pathological skin picking: A pilot study. J Obsessive Compuls Relat Disord 1:41–47
Zurück zum Zitat Neziroglu F, Rabinowitz D, Breytman A et al (2008) Skin picking phenomenology and severity comparison. J Clin Psychiatry 10:306–312 Neziroglu F, Rabinowitz D, Breytman A et al (2008) Skin picking phenomenology and severity comparison. J Clin Psychiatry 10:306–312
Zurück zum Zitat Odlaug BL, Grant JE (2008) Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry 30:61–66PubMed Odlaug BL, Grant JE (2008) Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry 30:61–66PubMed
Zurück zum Zitat Odlaug BL, Hampshire A, Chamberlain SR et al (2016) Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study. Br J Psychiatry 208:168–174PubMedPubMedCentral Odlaug BL, Hampshire A, Chamberlain SR et al (2016) Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study. Br J Psychiatry 208:168–174PubMedPubMedCentral
Zurück zum Zitat Ricketts EJ, Snorrason I, Kircanski K et al (2018) A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry 87:46–52PubMedPubMedCentral Ricketts EJ, Snorrason I, Kircanski K et al (2018) A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry 87:46–52PubMedPubMedCentral
Zurück zum Zitat Roberts S, O’Connor K, Bélanger C (2013) Emotion regulation and other psychological models for body-focused repetitive behaviors. Clin Psychol Rev 33(6):745–762PubMed Roberts S, O’Connor K, Bélanger C (2013) Emotion regulation and other psychological models for body-focused repetitive behaviors. Clin Psychol Rev 33(6):745–762PubMed
Zurück zum Zitat Schienle A, Übel S, Wabnegger A (2018) Visual symptom provocation in skin picking disorder: an fMRI study. Brain Imaging Behav 12:1504–1512PubMedPubMedCentral Schienle A, Übel S, Wabnegger A (2018) Visual symptom provocation in skin picking disorder: an fMRI study. Brain Imaging Behav 12:1504–1512PubMedPubMedCentral
Zurück zum Zitat Schumer MC, Bartley CA, Bloch MH (2016) Systematic review of pharmacological and behavioral treatments for skin picking disorder. J Clin Psychopharmacol 36:147–152PubMedPubMedCentral Schumer MC, Bartley CA, Bloch MH (2016) Systematic review of pharmacological and behavioral treatments for skin picking disorder. J Clin Psychopharmacol 36:147–152PubMedPubMedCentral
Zurück zum Zitat Snorrason I, Ólafsson RP, Flessner CA et al (2012b) The Skin Picking Scale-Revised: Factor structure and psychometric properties. J Obsessive Compuls Relat Disord 1:133–137 Snorrason I, Ólafsson RP, Flessner CA et al (2012b) The Skin Picking Scale-Revised: Factor structure and psychometric properties. J Obsessive Compuls Relat Disord 1:133–137
Zurück zum Zitat Snorrason I, Ólafsson RP, Houghton DC et al (2015) ‘Wanting’ and ‘liking’ skin picking: A validation of the Skin Picking Reward Scale. Jo Behav Addict 4:250–262 Snorrason I, Ólafsson RP, Houghton DC et al (2015) ‘Wanting’ and ‘liking’ skin picking: A validation of the Skin Picking Reward Scale. Jo Behav Addict 4:250–262
Zurück zum Zitat Snorrason I, Smári J, Ólafsson RP (2010) Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry 41:238–245PubMed Snorrason I, Smári J, Ólafsson RP (2010) Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry 41:238–245PubMed
Zurück zum Zitat Snorrason I, Smári J, Ólafsson RP (2011) Motor inhibition, reflection impulsivity, and trait impulsivity in pathological skin picking. Behav Ther 42:521–532PubMed Snorrason I, Smári J, Ólafsson RP (2011) Motor inhibition, reflection impulsivity, and trait impulsivity in pathological skin picking. Behav Ther 42:521–532PubMed
Zurück zum Zitat Snorrason I, Belleau EL, Woods D, W. (2012a) How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clin Psychol Rev 32:618–629 Snorrason I, Belleau EL, Woods D, W. (2012a) How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clin Psychol Rev 32:618–629
Zurück zum Zitat Tucker BTP, Woods D, W., Flessner CA et al. (2011) The skin picking impact project: Phenomenology, interference, and treatment utilization of pathological skin picking in a population based sample. J Anxiety Disord 25:88–95 Tucker BTP, Woods D, W., Flessner CA et al. (2011) The skin picking impact project: Phenomenology, interference, and treatment utilization of pathological skin picking in a population based sample. J Anxiety Disord 25:88–95
Zurück zum Zitat Twohig MP, Hayes SC, Masuda A (2006) A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behav Res Ther 44:1513–1522PubMed Twohig MP, Hayes SC, Masuda A (2006) A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behav Res Ther 44:1513–1522PubMed
Zurück zum Zitat Walther MR, Flessner CA, Conelea CA et al (2009) The Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS): Initial development and psychometric properties. J Behav Ther Exp Psychiatry 40:127–135PubMed Walther MR, Flessner CA, Conelea CA et al (2009) The Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS): Initial development and psychometric properties. J Behav Ther Exp Psychiatry 40:127–135PubMed
Zurück zum Zitat Wilhelm S, Keuthen NJ, Deckersbach T et al (1999) Self-injurious skin picking: Clinical characteristics and comorbidity. J Clin Psychiatry 60:454–459PubMed Wilhelm S, Keuthen NJ, Deckersbach T et al (1999) Self-injurious skin picking: Clinical characteristics and comorbidity. J Clin Psychiatry 60:454–459PubMed
Zurück zum Zitat World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. World Health Organization, Geneva World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. World Health Organization, Geneva
Zurück zum Zitat World Health Organization (2019) International statistical classification of diseases and related health problems. https://icd.who.int/. Zugegriffen: 4. Apr. 2020 World Health Organization (2019) International statistical classification of diseases and related health problems. https://​icd.​who.​int/​. Zugegriffen: 4. Apr. 2020
Metadaten
Titel
Dermatillomanie
Symptomatik, Ätiologie und Therapie des pathologischen Bearbeitens der Haut
verfasst von
Dr. Christina Gallinat
Prof. Dr. Alexandra Martin
Prof. Dr. Jennifer Schmidt
Publikationsdatum
29.06.2020
Verlag
Springer Medizin
Schlagwort
Verhaltenstherapie
Erschienen in
Die Psychotherapie / Ausgabe 4/2020
Print ISSN: 2731-7161
Elektronische ISSN: 2731-717X
DOI
https://doi.org/10.1007/s00278-020-00437-7

Weitere Artikel der Ausgabe 4/2020

Die Psychotherapie 4/2020 Zur Ausgabe

Schwerpunkt: Gruppenpsychotherapie – Originalien

Wechselseitige Effekte von Gruppenkohäsion und Symptomen