ABSTRACT
In the anal region, pruritus may be both idiopathic (mainly of psychological/psychiatric origin) and secondary to an underlying disorder or related to local causes (mainly of dermatologic interest). Persistent pruritus ani is, in particular, a challenging experience for the dermatologist.
Subject(s)
Pruritus Ani/diagnosis , Pruritus Ani/etiology , Pruritus Ani/psychology , Diagnosis, Differential , HumansABSTRACT
OBJECTIVE: This article presents the results of a brief hypnosis treatment of a woman with chronic, idiopathic vaginal and anal itch. METHODS: The patient was referred after 3 years of unsuccessful outcomes with standard topical and oral treatments prescribed by her family physician and three dermatologists. Treatment consisted of five sessions of self-hypnosis training in techniques of relaxation, deepening, and imagery, and home practice with an individualized instructional tape. RESULTS: After treatment, the patient reported substantial tissue healing, confirmed by her treating physician, that coincided with significant reductions in her scores of itch intensity, itch-related sleep disruption, and distress from pre- to posttreatment. These improvements continued at 4 months of follow-up, and the patient reported complete resolution of physical symptoms. CONCLUSIONS: The fact that these changes coincided with only minor improvements in general anxiety scores suggests that the resolution of the patient's itch condition was treatment-specific rather than the result of methodological artifact, participant reporting bias, or a general sense of feeling better. These findings suggest that hypnosis is a cost-effective treatment for idiopathic itch conditions, especially those that are unresponsive to standard medical treatments.
Subject(s)
Hypnosis/methods , Pruritus Ani/therapy , Pruritus Vulvae/therapy , Adult , Female , Humans , Life Change Events , Pruritus Ani/psychology , Pruritus Vulvae/psychology , Self Administration , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to compare psychological profiles in 17 patients suffering from idiopathic pruritus ani with a control group of 28 patients showing secondary pruritus ani. METHODS: The two groups completed the Mini-Mult personality test and results were compared using chi 2 test and analysis of variance. RESULTS: The mean hypomania and depression scale scores were greater and smaller respectively in the idiopathic pruritus ani group. Nevertheless, the percentage of abnormal psychological profiles was not significantly different between the two groups. CONCLUSIONS: It seems arbitrary to systematically ascribe psychogenic aetiologies to idiopathic pruritus ani even though psychological factors may be present in individual patients.
Subject(s)
Pruritus Ani/psychology , Somatoform Disorders/psychology , Adult , Aged , Female , Humans , MMPI , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Patient Care Team , Personality AssessmentABSTRACT
Although the importance of the anal zone is well known in psychoanalysis, pruritus ani has not been studied recently in the psychoanalytic literature. This paper is presented to show how bisexuality in a male patient has been analysed through pruritus ani as the main presenting symptom. After giving the case history of Fernand, pruritus ani is analysed from three main points of view: phallic, anal and oral. This is done to illustrate the connexions of the psychopathological material at the three stages and their expression through one symptom of the 'instincts and their vicissitudes'. Finally, the importance of the anal stage and its symptomatology as an attempt to diminish the affective charge brought up in the individual by the oral and phallic conflicts is discussed briefly.
Subject(s)
Bisexuality , Pruritus Ani/psychology , Psychoanalytic Theory , Adult , Conflict, Psychological , Humans , Male , Psychoanalytic Therapy , Psychosexual DevelopmentABSTRACT
The authors present two cases of idiopathic pruritus ani in the same family in which psychological factors seem to play an etiological role.
Subject(s)
Depression/complications , Pruritus Ani/psychology , Stress, Psychological/complications , Adult , Female , Humans , Middle Aged , Mood Disorders/complications , Pruritus Ani/etiologyABSTRACT
Seventy-five patients presented with the complaint of pruritus ani. The following prospective studies were employed to evaluate groups of these patients; (1) laboratory, including blood count, stool examination for ova and parasites, urinalysis, Sequential Multiple Analysis-12 serum studies, stool pH, and skin scrapings for fungi; (2) Minnesota Multiphasic Personality Inventory; (3) anal manometry; (4) elimination of dietary factors, and (5) topical ointment application. Many patients were concerned that a cancer caused the symptom. Once reassured, they tolerated the pruritus. Forty-eight to 50 per cent of these patients had poorly formed stools or incomplete stool evacuation; thus, soiling was frequent. An underlying skin problem was found in six patients with psoriasis and in one with erythrasma. Patients tended to worsen the problem by application of many medications and overzealous cleaning. Minor surgical problems of the anus should be corrected before other managements are instituted. Idiopathic pruritus ani responds to anal cleanliness, dietary discretion with avoidance of specific items by some patients, bowel habit regulation, and a mild topical hydrocortisone cream.
