Skin manifestations of mental disorders

Along the spectrum of mental disorders, there are some conditions that manifest themselves through the skin, and are reflections of true mental health issues. It can be very difficult to help these patients as they are often adamant that their skin lesions are true dermatological conditions rather than self-induced.

Trichotillomania describes hair pulling, which results in fractured hair and bald patches. This may be as a result of a habit or tic which the individual needs pointing out to them and may be relatively easy to stop. However, it may also be as a result of some underlying psychopathology possibly related to anxiety.

Patients may deliberately inflict damage to their skin and then consciously try to deceive about the real nature of the lesions—this could be thought of as a form of cutaneous Munchausen syndrome. Those who have true dermatitis artefacta are seemingly unaware of the true nature of their lesions. The lesions in both instances may seem peculiar and not appear like any ‘normal’ pathological process; however, in some cases, the patient may recreate the symptoms of a previously experience condition. This is a form of self-harm and may be as a result of stressful or anxiety provoking experiences that are occurring in the individual’s lives. Referral to a clinical psychologist will be helpful, as they may be able to help the person resolve the experiences leading to the self-harming behaviour.

Delusional parasitosis is extremely difficult to treat as the patient is absolutely convinced that they are infested with insects or worms. They may endeavour to produce ‘evidence’ of such infestation by digging debris out from under their skin.