These include scarring and hyper pigmentation

**silkemeyer** · 2017-06-24, 08:19 AM

These include scarring and hyper pigmentation, which can result in substantial disfigurement [1]. Psychological Aspects Numerous psychological problems such as diminished self-esteem, social embarrassment, social withdrawal, depression and even unemployment stem from acne. However, differential diagnosis from a psychosomatic point of view indicates two serious psychological problems, which can arise from acne. These are, 1. Psychogenic excoriation and 2. Body dimorphic disorder (BDD) psychogenic excoriation also referred to as neurotic excoriation, pathological or compulsive skin picking "is characterized by excessive scratching or picking of normal skin or skin with minor irregularities" [5]. According to Niemeyer et al (2006) it is estimated to occur in 2% of dermatological patients. Patients with this disorder can also have psychiatric disorders such as mood and anxiety disorders, as well as associated disorders such as obsessive compulsive disorder, substance abuse disorder, obsessive compulsive personality disorder, compulsive buying, eating disorder, and borderline personality disorder, to mention a few [5]. Body dimorphic disorder (BDD) "is a condition characterized by an extreme level of dissatisfaction or preoccupation with a normal appearance that causes disruption in daily functioning" [3]. Niemeyer et al (2006) described it as "a syndrome characterized by distress, secondary to imagined or minor defects in one's appearance." The onset of BDD is usually during adolescence, and it occurs equally in both male and female. Common areas of concern include the skin, hair and nose, with acne being one of the most common concerns with BDD patients [3]. According to the Diagnostic and Statistics Manual of Mental Disorders (2000), BDD has three diagnostic criteria, 1. A preoccupation with an imagined defect in appearance; where a slight physical anomaly is present, the person's concern is markedly excessive, 2.