A Case of Atopic Dermatitis with Concomitant Body Dysmorphic Disorder : Outpatient Morita Therapy for "Obsession" with Skin Symptoms

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  • アトピー性皮膚炎に身体醜形障害を併存する1例をめぐる考察 : 皮膚症状への"とらわれ"に対する外来森田療法
  • 症例研究 アトピー性皮膚炎に身体醜形障害を併存する1例をめぐる考察 : 皮膚症状への"とらわれ"に対する外来森田療法
  • ショウレイ ケンキュウ アトピーセイ ヒフエン ニ シンタイ シュウケイ ショウガイ オ ヘイソン スル 1レイ オ メグル コウサツ : ヒフ ショウジョウ エ ノ"トラワレ"ニ タイスル ガイライ モリタ リョウホウ

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Objectives : To investigate a case of atopic dermatitis with concomitant body dysmorphic disorder. Subjects : A woman with atopic dermatitis with concomitant body dysmorphic disorder. For protection of privacy, the description of this case was modified within the extent that the overall content remained unaffected. Consent to publication of this case report was obtained from the patient. Methods : A description and discussion of the course of treatment in a woman who underwent outpatient Morita therapy. Results : A woman in her 40s presented with atopic dermatitis with concomitant body dysmorphic disorder. A psychopathological structure of obsession (psychic interaction, conflict between ideal and real) based on a nervous personality was observed, and treatment using outpatient Morita therapy was initiated. The treatment objective of "changing the attitude toward rash" was clearly shared between the therapist and patient. The therapist listened attentively to the patient's "stories on chronic illness", treated her in a supportive manner, and cultivated the "desire to live fully" (existential interaction). As a result, the attitude of the patient gradually changed from the existing attitude of eliminating anxiety (a feeling-centered attitude in which the patient asked her husband or primary physician for confirmation of whether she was "okay") to an attitude in which she gradually took constructive action while leaving anxiety as is(purpose-centered). Conclusion : Outpatient Morita therapy appears useful for patients with atopic dermatitis based on a nervous personality who have a "psychopathological structure of obsession" toward skin symptoms. In the present case, even though the patient had been told by her dermatologist that "skin symptoms on the face are improving", she indicated that "I personally do not think my symptoms are improving. I am not convinced". This demonstrated "a disagreement between the objective judgment of the dermatologist and the subjective judgment of the patient". This form of cognition is derived from body dysmorphic disorder, and is called "delusional disposition" or "obsession toward deficiencies in appearance". We pointed out that this form of cognition had led the patient to engage in doctor shopping.

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