抓搔症的诊断与干预
The Diagnosis and Treatment for Dermatillomania
DOI: 10.12677/AP.2013.34031, PDF, HTML, XML, 下载: 3,223  浏览: 13,732 
作者: 杜建政*, 冯朱晓：广州大学心理学系
关键词: 抓搔症；强迫症；Dermatillomania; Obsessive-Compulsive Disorder
摘要: 抓搔症首次写入DSM-5，被纳入强迫性障碍和相关障碍章节。抓搔症主要表现为重复性和强迫性的抓搔，并导致皮肤损伤。虽然与强迫性障碍和相关障碍有诸多联系，但抓搔症的临床表现、诊断标准和治疗方法，都与其他精神疾病有很大区别。抓搔症患者往往对自己的行为感到尴尬和羞愧，并因而失于治疗。目前，对抓搔症的治疗，主要从药物治疗和行为干预两个方面着手。
Abstract: Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused. Dermatillomania will be written into DSM-V. Dermatillomania can cause feeling of guilt, shame, and embarrassment in individuals, and this increases the risk of self-harm. Some theories regarding the causes of dermatillomania have been proposed. The two main methods for treating dermatillomania are pharmacological and behavioral intervention.
文章引用：杜建政, 冯朱晓 (2013). 抓搔症的诊断与干预. 心理学进展, 3(4), 201-207. http://dx.doi.org/10.12677/AP.2013.34031

参考文献

[1] American Psychiatric Association. (2012). DSM-5: The future of psy- chiatric diagnosis. Retrieved February 16, 2013. http://www.dsm5.org/Pages/Default.aspx
[2] Arbabi, M., Farnia, V., Balighi, K., Mohammadi, M. R., Nejati-Safa1, A. A., Yazdchi, K., et al. (2008). Efficacy of citalopram in treatment of pathological skin picking,a randomized double blind placebo controlled trial. Acta Medical Iranica, 46, 367-372.
[3] Arnold, L. M., Auchenbach, M. B., & McElroy, S. L. (2001). Psycho- genic excoriation: Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs, 15, 351- 359.
[4] Arnold, L. M., McElroy, S. L., Mutasim, D. F., Dwight, M. M., Lamerson, C. L., & Morris, E. M. (1998). Characteristics of 34 adults with psychogenic excoriation. The Journal of Clinical Psychiatry, 59, 509-514.
[5] Aron, A. R., Fletcher, P. C., Bullmore, E. T., Sahakian, B. J., & Rob- bins, T. W. (2003). Stop-signal inhibition disrupted by damage to right inferior frontal gyrus in humans. Nature Neuroscience, 6, 115- 116.
[6] Bergstrom, K. G. (2008). Cutaneous clues to drug addiction. Journal of Drugs Dermatology, 7, 303-305.
[7] Bienvenu, O. J., Samuels, J. F., Riddle, M. A., Hoehn-Saric, R., Liang, K. Y., Cullen, B. A. M., et al. (2000). The relationship of obsessive- compulsive disorder to possible spectrum disorders: Results from a family study. Society of Biological Psychiatry, 48, 287-293.
[8] Bloch, M. R., Elliott, M., Thompson, H., & Koran, L. M. (2001). Fluoxetine in pathologic skin-picking: Open-label and double-blind results. Psychosomatics, 42, 314-319.
[9] Bohne, A., Wilhelm, S., Keuthen, N. J., Baer, L., & Jenike, M. A. (2002). Skin picking in German students: Prevalence, phenomenol- ogy, and associated characteristics. Behavior Modification, 26, 320- 339.
[10] Chamberlain, S. R., Blackwell, A. D., Fineberg, N. A., Robbins, T. W., & Sahakian, B. J. (2005). The neuropsychology of obsessive com- pulsive disorder: The importance of failures in cognitive and behavi- oural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews, 29, 399-419.
[11] Chamberlain, S. R., Fineberg, N. A., Blackwell, A. D., Robbins, T. W., & Sahakian, B. J. (2006). Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. American Journal of Psychiatry, 163, 1282-1284.
[12] Cullen, B. A., Samuels, J. F., Bienvenu, O. J., Grados, M., Hoehn-Saric, R., Hahn, J., et al. (2001). The relationship of pathologic skin pick- ing to obsessive-compulsive disorder. Journal of Nervous & Mental Disease, 189, 193-195.
[13] Darsow, U., Valet, M., Pfab, F., Behrendt, H., Toelle, T. R., & Ring, J. (2006). The cerebral processing of itch—An investigation with func- tional magnetic resonance Tomography. Journal of Allergy Clinical Immunology, 117, 499.
[14] Doran, A. R., Roy, A., & Wolkowitz, O. M. (1985). Self-destructive dermatoses. Psychiatry Clinical North American, 8, 291-298.
[15] Ferrão, Y. A., Miguel, E. C., & Stein, D. J. (2009). Tourette’s syndrome, trichotillomania, and obsessive-compulsive disorder: How closely are they related? Psychiatry Research, 170, 32-42.
[16] Flessner, C. A., & Woods, D. W. (2006). Phenomenological character- istics, social problems, and the economic impact associated with chronic skin picking. Behavior Modification, 30, 944-963.
[17] Flessner, C. A., Busch, A. M., Heideman, P. W., & Woods, D. W. (2008). Acceptance-enhanced behavior therapy (AEBT) for tricho- tillomania and chronic skin picking: Exploring the effects of com- ponent sequencing. Behavior Modification, 32, 579-594.
[18] Frecska, E., & Arato, M. (2002). Opiate sensitivity test in patients with stereotypic movement disorder and trichotillomania. Progress in Neuro- Psychopharmacology & Biological Psychiatry, 26, 909-912.
[19] Goodman, W. K., McDougle, C. J., Price, L. H., Riddle, M. A., Pauls, D. L., & Leckman, J. F. (1990). Beyond the serotonin hypothesis: A role for dopamine in some forms of obsessive compulsive disorder? The Journal of Clinical Psychiatry, 51, 36-43.
[20] Grant, J. E., & Odlaug, B. L. (2009a). Update on pathological skin picking. Current Psychiatry Reports, 11, 283-288.
[21] Grant, J. E., & Odlaug, B. L. (2009b).The obses-sive-compulsive spec- trum and disorders of the skin: A review. Expert Review Dermatol- ogy, 4, 523-532.
[22] Grant, J. E., Mancebo, M. C., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2006). Impulse control disorders in adults with obsessive com- pulsive disorder. Journal of Psychiatric Research, 40, 494-501.
[23] Grant, J. E., Menard, W., & Phillips, K. A. (2006). Pathological skin picking in individuals with body dysmorphic disorder. General Hos- pital Psychiatry, 28, 487-493.
[24] Grant, J. E., Odlaug, B. L., & Kim, S. W. (2007). Lamotrigine treat- ment of pathologic kin picking: An open-label study. The Journal of Clinical Psychiatry, 68, 1384-1391.
[25] Grant, J. E., Odlaug, B. L., Chamberlain, S. R., & Kim, S. W. (2010). A double-blind, placebo-controlled trial of lamotrigine for pathologic skin picking: Treatment efficacy and neurocognitive predictors of response. The Journal of Clinical Psychopharmacology, 30, 396- 403.
[26] Hayes, S. L., Storch, E. A., & Berlanga, L. (2009). Skin picking be- haviors: An examination of the prevalence and severity in a commu- nity sample. Journal of Anxiety Disorders, 23, 314-319.
[27] Jentsch, J. D., & Taylor, J. R. (1999). Impulsivity resulting from fron- tostriatal dysfunction in drug abuse: Implications for the control of behavior by reward-related stimuli. Psychopharmacology (BERL), 146, 373-390.
[28] Keuthen, N. J., Deckersbach, T., Wilhelm, S., Engelhard, I., Forker, A., O’Sullivan, R. L., et al. (2001). The skin picking impact scale: Scale development and psycho-metric ana-lyses. Psychosomatics, 42, 397- 403.
[29] Keuthen, N. J., Deckersbach, T., Wilhelm, S., Hale, E., Fraim, C., Baer, L., et al. (2000). Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin pickers. Psychoso- matics, 41, 210-215.
[30] Keuthen, N. J., Koran, L. M., Aboujaoude, E., Large, M. D., & Serpe, R. T. (2010). The prevalence of pathological skin picking in US adults. Comprehensive Psychiatry, 51, 183-186.
[31] Keuthen, N. J., Wilhelm, S., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L. , et al. (2001). The skin picking scale: scale construc- tion and psychometric analyses. Journal of Psychosomatic Research, 50, 337-341.
[32] Kondziolka, D., & Hudak, R. (2008). Management of obsessive-com- pulsive disorder-related skin picking with gamma knife radiosurgical anterior capsulotomies: A case report. The Journal of Clinical Psy- chiatry, 69, 1337-1340.
[33] LeBeau, R. T., Mischel, E. R., Simpson, H. B., Mataix-Cols, D., Phil- lips, K. A., Stein, D. J., et al. (2013). Preliminary assessment of ob- sessive-compulsive spectrum isorder scales for DSM-5. Journal of Obsessive-Compulsive and Related Disorders, 2, 114-118.
[34] Leknes, S. G., Bantick, S., Willis, C. M., Wilkinson, J. D., Wise, R. G., & Tracey, I. (2007). Itch and motivation to scratch: An investigation of the central and peripheral correlates of allergen-and histamine-in- duced itch in humans. Journal of Neurophysiology, 97, 415-422.
[35] Lienemann, J., & Walker, F. D. (1989). Reversal of self-abusive be- havior with naltrexone. The Journal of Clinical Psychopharmacol- ogy, 9, 448-449.
[36] Lochner, C., Simeon, D., Niehaus, D. J. H., & Stein, D. J. (2002). Trichotillomania and skin-picking: A phenomenological comparison. Depress and Anxiety, 15, 83-86.
[37] Neziroglu, F., Rabinowitz, D., Breytman, A., & Ja-cofsky, M. (2008). Skin picking phenomenology and severity comparison. The Primary Care Companion to the Journal of Clinical Psychiatry, 10, 306-312.
[38] O’Brien, C. P., & McKay, J. (2007). Psychopharmalogical treatments for substance use disorders. In P. E. Nathan, & J. M. Gorman (Eds.), A guide to treatments that work (pp. 148-178). New York: Oxford University Press.
[39] O’Sullivan, R. L., Phillips, K. A., Keuthen, N. J., & Wilhelm, S. (1999). Near-fatal skin picking from delusional body dysmorphic disorder responsive to fluvoxamine. Psychosomatics, 40, 79-81.
[40] Odlaug, B. L, Grant, J. E., & Chamberlain, S. R. (2010). Motor inhibi- tion and cognitive flexibility in pathological skin picking. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 34, 208- 211.
[41] Odlaug, B. L., & Grant, J. E. (2007). Childhood-onset pathologic skin picking: Clinical characteristics and psychiatric comorbidity. Com- prehensive Psychiatry, 48, 388-393.
[42] Odlaug, B. L., & Grant, J. E. (2008). Clinical characteristics and medi- cal complications of pathologic skin picking. General Hospital Psy- chiatry, 30, 61-66.
[43] Odlaug, B. L., & Grant, J. E. (2010). Pathologic skin picking. The American Journal of Drug and Alcohol Abuse, 36, 296-303.
[44] Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., et al. (1990). Comorbidity of mental disorders with al- cohol and other drug abuse. Results from the Epidemiologic Catch- ment Area (ECA) study. The Journal of the American Medical Asso- ciation, 264, 2511-2518.
[45] Schuck, K., Keijsers, G. P. J., & Rinck, M. (2011). The effects of brief cognitive-behaviour therapy for pathological skin picking: A ran-do- mized comparison to wait-list control. Behaviour Research and Therapy, 49, 11-17.
[46] Simeon, D., Stein, D. J., Gross, S., Islam, N., Schmeidler, J., & Hol- lander, E. (1997). A double-blind trial of fluoxetine in pathologic skin picking. The Journal of Clinical Psychiatry, 58, 341-347.
[47] Snorrason, I., O´lafsson, R. P., Flessner, C. A., Keuthen, N. J., Franklin, M. E. & Woods, D. W. (2012). The skin picking scale-revised: Fac- tor structure and psychometric properties. Journal of Obsessive- Compulsive and Related Disorders, 1, 133-137.
[48] Snorrason, I., Smari, J., & Olafsson, R. P. (2011). Motor inhibition, reflection impulsivity and trait impulsivity in pathological skin picking. Behavior Therapy, 42, 521-532.
[49] Stein, D. J., Chamberlain, S. R., & Fineberg, N. (2006). An A-B-C mo- del of habit disorders: Hair-pulling, skin-picking, and other stereo- typic conditions. CNS Spectrum, 11, 824-827.
[50] Stein, D. J., Grant, J. E., Franklin, M. E., Keuthen, N., Lochner, C., Singer, H. S., et al. (2010). Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety, 27, 611-626.
[51] Teng, E. J., Woods, D. W., & Twohig, M. P. (2006).Habit reversal as a treatment for chronic skin picking: A pilot investigation. Behavior Modification, 30, 411-422.
[52] Weintraub, E., Robinson, C., & Newmeyer, M. (2000). Catastrophic medical complication in psychogenic excoriation. Southern Medical Journal, 93, 1099-1101.
[53] Wilhelm, S., Keuthen, N. J., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L., et al. (1999).Self-injurious skin picking: Clinical characteristics and comorbidity. The Journal of Clinical Psychiatry, 60, 454-459.
[54] Yosipovitch, G., Ishiuji, Y., Patel, T. S., Hicks, M. I., Oshiro, Y., Kraft, P. A., et al. (2008). The brain processing of scratching. Journal of Invest Dermatol, 128, 1806-1811.