Skip to Main Content


Classification of Disorders of Psychiatric Etiology


  • Dysmorphic syndrome
  • Delusions of parasitosis
  • Compulsive habits
    • Neurotic excoriations
    • Trichotillomania
  • Factitious syndromes
  • Cutaneous signs of injecting drug use


ICD-9 : 300.7 • ICD-10 : F 45.2   Image not available. Image not available.


  • Patients with dysmorphic syndrome regard their image as distorted in the eyes of the public; this becomes almost an obsession.
  • The patient with BDS does not consult a psychiatrist but a dermatologist or plastic surgeon. The typical patient with BDS is a single, female, young adult who is an anxious and unhappy person.
  • Common dermatologic complaints are facial (wrinkles, acne, scars, hypertrichosis, dry lips), scalp (incipient baldness, increased hair growth), genital [normal sebaceous glands on the penis, red scrotum (males), red vulva, vaginal odor (females)], hyperhidrosis, and bromhidrosis.
  • Management is a problem. One strategy is for the dermatologist to agree with the patient that there is a problem and thus establish rapport; in a few visits the complaint can be explored and further discussed.
  • If the patient and physician do not agree that the complaint is a vastly exaggerated skin or hair change, then the patient should be referred to a psychiatrist; this latter plan is usually not accepted, in which case the problem may persist indefinitely.


ICD-9 : 300.29 • ICD-10 : F 22.0   Image not available. Image not available.


  • This rare disorder, which occurs in adults and is present for months or years, is associated with pain or paresthesia and is characterized by the presence of numerous skin lesions, mostly excoriations, which the patient truly believes are the result of a parasitic infestation (Fig. 23-1).
  • The onset of the initial pruritus or paresthesia may be related to xerosis or, in fact, to a previously treated infestation.
  • Patients pick with their fingernails or dig into their skin with needles or tweezers to remove the “parasites” (Fig. 23-1).
  • It is important to rule out other causes of pruritus. This problem is serious; patients truly suffer and are opposed to seeking psychiatric help. Patients may sell their houses to move away from the offending parasite.
  • The patient should see a psychiatrist for at least one visit and for recommendations of drug therapy: pimozide plus an antidepressant. Treatment is difficult and usually unsuccessful.

Figure 23-1
Graphic Jump LocationGraphic Jump Location

Delusions of parasitosis A. Usually patients collect small pieces of debris from their skin by scratching with their nails or an instrument and submit them to the doctor for examination for parasites. In this case pointed tweezers were used and the result are ulcers, crusted lesions, and scars. B. Occasionally this can progress to an aggressive behavior such as depicted in this case where the patient posed to demonstrate how she collects the “parasites” from her skin on a piece of paper. In the majority of ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.