ABSTRACT
La tendencia instintiva a manipular la piel y sus pequeñas imperfecciones forma parte normal de las conductas repetitivas centradas en el cuerpo. Cuando esta conducta se incrementa sin control y causa daños somáticos y psíquicos al individuo, estamos ante un caso de Trastorno Excoriativo (TE), patología que ha sido incluida en la Clasificación Internacional de Enfermedades (CIE-11), y que, en la Clasificación Norteamericana de Trastornos Mentales, forma parte de los trastornos relacionados con el trastorno obsesivo compulsivo. La prevalencia de vida del TE en adultos oscila entre 3 y 5% y presenta elevadas comorbilidades con problemas afectivos, de consumo de sustancias y rasgos mórbidos de personalidad. Aunque no es aparentemente una patología severa, acarrea importante discapacidad y requiere ser tamizada sistemáticamente por su frecuente soslayamiento, tanto por el paciente afectado como por los profesionales de salud.
The instinctive tendency to manipulate the skin and its small imperfections is a normal part of body-focused repetitive behaviors. When this behavior increases without control and causes somatic and psychic damage to the individual, we are dealing with a case of Excoriative Disorder (ET), a pathology that has been included in the International Classification of Diseases (ICD-11), and that, in the Classification American Mental Disorders, is part of the disorders related to the obsessive-compulsive disorder. In adults, the lifetime prevalence of ET ranges between 3 and 5% and presents high comorbidities with affective problems, substance use and morbid personality traits. Although it is not apparently a severe pathology, it causes significant disability and requires systematic screening due to its frequent avoidance by both the affected patient and health professionals.
ABSTRACT
Presentamos 3 casos de pacientes que necesitaron cirugía a causa de un bezoar secundario a la ingesta de cabellos y otras sustancias no nutritivas (cerdas de cepillos) en el contexto de un trastorno de control de impulsos, en el que suele haber ansiedad previa a la ingesta, la misma que disminuye con el acto de ingerir estos elementos. Se revisa el concepto de impulsos irresistibles sistemáticos, la neurobiología y tratamiento de la impulsividad, y la relación de ésta con los denominados trastornos del espectro obsesivo-compulsivo. Por último, se resalta el papel del entorno familiar y social en el desarrollo y pronóstico del cuadro clínico de las pacientes.
We present 3 cases of patients who had to undergo surgery due to a bezoar that was secondary to the ingestion of hair and other non-nutritive substances (brush bristles) in the context of an impulse-control disorder, where there is often anxiety prior to intake that decreases with the act of eating these elements. We reviewed the concept of irresistible systematic impulses, the neurobiology and treatment of impulsivity, and the relation of this syndrome with the so-called obsessive-compulsive spectrum disorders. Finally, the role of the family and the social environment are highlighted in the development and prognosis of the patientsÆ clinical syndrome.
Subject(s)
Humans , Female , Child , Adolescent , Bezoars , Impulsive Behavior , Obsessive-Compulsive DisorderABSTRACT
INTRODUÇÃO: A insatisfação com a imagem corporal é uma das características mais proeminentes do transtorno dismórfico corporal (TDC) e dos transtornos alimentares (TA). Esses dois grupos de transtornos apresentam semelhanças em suas características psicopatológicas e epidemiológicas e na resposta ao tratamento. Apesar de ambos serem considerados transtornos do espectro obsessivo-compulsivo, pouco se sabe em relação à comorbidade entre esses dois grupos de transtornos. OBJETIVO: Avaliar a produção bibliográfica atual sobre a comorbidade entre TDC e TA. MÉTODO: Foi realizada uma revisão sistemática nos bancos de dados PubMed e ISI Web of Science dos artigos referentes à comorbidade entre TDC e TA. RESULTADOS: Oito artigos foram selecionados. As amostras de portadores de TA apresentavam comorbidade com TDC em 6 por cento a 39 por cento dos casos. Dos pacientes com TDC, 10 por cento a 32,5 por cento, por sua vez, podem apresentar comorbidade com TA. O TDC frequentemente precedia o TA, e os pacientes com comorbidade apresentavam quadro clínico mais grave que os com apenas um dos transtornos. CONCLUSÃO: Estudos recentes demonstram que as taxas de comorbidade entre esses dois transtornos são elevadas. Apesar disso, o TDC raramente é diagnosticado em portadores de TA, mesmo quando é o transtorno que causa mais incômodo.
BACKGROUND: Body image dissatisfaction is one of the most prominent psychopathological features of body dysmorphic disorder (BDD) and eating disorders (ED). These groups of disorders present similarities in psychopathological and epidemiological features and also in response to treatment. Although these disorders are included in the obsessive-compulsive spectrum, little is known about the comorbidity between the two groups of disorders. OBJECTIVE: To evaluate the current bibliographic production on the comorbidity of BDD and ED. METHOD: A systematic review has been conducted on the PubMed and ISI Web of Science databases. RESULTS: Eight articles have been selected. These articles report that patients with ED may present comorbidity with BDD in 6 percent to 39 percent of the cases. 10 percent to 32.5 percent of the patients with BDD might present comorbidity with a TA. BDD preceded ED in the majority of the patients with comorbidity and patients with both disorders had more severe presentations than patients with either disorder alone. CONCLUSION: Recent studies have shown that comorbidity ratios between these disorders are high. However, BDD is seldom diagnosed in patients with ED, even when it is the most severe disorder.
Subject(s)
Body Image , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/epidemiology , Body Dysmorphic Disorders/diagnosis , Body Dysmorphic Disorders/epidemiology , Brazil , Comorbidity , Feeding Behavior , PrevalenceABSTRACT
Los trastornos del espectro obsesivo-compulsivo son un conjunto de entidades relacionadas con el trastorno obsesivo-compulsivo con similitudes a éste y diferencias propias de cada trastorno. Actualmente se encuentran ubicados en diferentes apartados de los manuales diagnósticos. A lo largo del espectro se encuentran distribuidos las distintas entidades que lo componen, desde el polo impulsivo al polo compulsivo. El objetivo del siguiente artículo es analizar las características clínicas, epidemiológicas y el manejo terapéutico de los tres trastornos más importantes del polo impulsivo: el juego patológico, la tricotilomanía y las conductas autolesivas.
The Obsessive-Compulsive Spectrum Disorders are a group of entities related to the Obsessive-Compulsive Disorder having similarities with it and also differences that are characteristic of each disorder. Nowadays, they are published in different chapters of current diagnosis manuals. On the one hand, entities of the impulsive spectrum can be found, and on the other hand, entities of the compulsive pole can also be found. However, these entities will soon be included in the same chapter for a better analysis and debate. The present article aims at analyzing the clinical and epidemiological characteristics and the therapeutic management of the three most important disorders of the impulsive spectrum: the pathological gambling, the trichotillomania and the self-injury behaviour.
Subject(s)
Humans , Self-Injurious Behavior/psychology , Gambling/psychology , Obsessive-Compulsive Disorder , Trichotillomania/psychology , Psychotherapy , Disruptive, Impulse Control, and Conduct DisordersABSTRACT
Triple X syndrome is a relatively rare sex chromosomal anomaly, and its association with psychopathology is not well understood. The authors report one case of obsessive-compulsive disorder(OCD)with karyotype-confirmed triple X syndrome, 47,XXX. She had incomplete sexual development, seconddary amenorrhea and multiple obsessive-compulsive symptoms. Magnetic resonance imaging of the brain revealed left occipital white matter hyperintensity lesion. The patient's multiple obsessive-compulsive symptoms were responded partially with fluoxetine and adjunctive buspirone treatment, however, her overall psychological functions were much improved. With the literature reviews, the authors suggest the possibility that a certain type of sex chromosome aneuploidy might be susceptible to obsessive-compulsive spectrum disorders(OCSDs)or OCD.