The below has been listed from inputs shared by Dr Sudipta Roy, MA, M Philb (NIMHANS), Ph D Consultant Clinical Psychologist, Director, Psy Lens Centre, and Dr Swapna Bondade, Professor & HOD, Department of Psychiatry, The Oxford Medical College Hospital & Research Center, and Consultant, Narayana Multispecialty Hospital, and Apollo Clinic, HSR, Bengaluru.

• Body Dysmorphic Disorder (BDD): Body Dysmorphic Disorder (BDD) is a painful psychological condition where individuals have a distorted view of their appearance, fixating on minor flaws they perceive as major imperfections. This obsession leads to significant distress, social isolation, and compulsive behaviours such as excessive mirror checking, grooming rituals, and seeking reassurance. The individual may go to great lengths to hide or correct these perceived imperfections, often seeking cosmetologic and aesthetic consultations, procedures, and even painful surgeries. However, the results of such interventions may be discounted or considered unsatisfactory, perpetuating the cycle of preoccupation, distress, and further consultations.

At the heart of BDD lies the societal and cultural standards of beauty, which exacerbate the individual’s distress. The challenge for dermatologists is not only to address the physical aspects but also to help the client manage their distress, develop a realistic body image, and avoid potentially damaging interventions. This holistic approach is essential in improving the individual’s overall well-being and quality of life.

• Skin picking disorders: Also known as Excoriation disorders, these are characterised by repetitive picking, scratching, or digging at the skin, often leading to wounds and scarring. These behaviours can be driven by various factors such as anxiety, stress, or underlying obsessive-compulsive disorder (OCD). Individuals may exhibit compulsive and habitual tendencies to pull out skin, particularly at single or multiple sites, with the most common area being the scalp. They may also engage in elaborate rituals to maintain the affected areas. Psychologically, individuals with this disorder may be less conscious of the pain and harm during the act, sometimes doing so unconsciously. This condition may arise in people who have difficulty expressing their feelings, particularly anger, and it takes the form of an unbreakable habit that the person cannot seem to break out of. The individual becomes entrapped in an itch-scratch cycle, further exacerbating the condition and its associated distress.

• Delusional parasitosis: In this case, individuals believe that insects or parasites are infesting their skin, experiencing a sensation of bugs, ants, or parasites moving under their skin. Despite investigations conducted without supportive evidence, the person cannot shake off this feeling. This condition may lead to feelings of irritability, worry, fear, anger, and frustration as individuals feel misunderstood and unable to rid themselves of the delusion. This is a rare manifestation of dermatological conditions and can be rooted in underlying psychiatric conditions, necessitating specialised treatment to address both the dermatological and psychological aspects of the disorder.

• Hair-pulling disorders: Also known as trichotillomania, these involve individuals experiencing an irresistible urge to pull out their hair, resulting in noticeable bald patches. This compulsive behaviour can be linked to various factors such as anxiety, stress, or obsessive-compulsive disorder (OCD). Sufferers often go to great lengths to conceal the resulting bald patches, experiencing feelings of shame, unconscious aggression, dissociation, and habit formation.