Misophonia is the adverse emotional reaction to everyday sounds (e.g., chewing or pen clicking). Since atypical sensory experiences are a key feature of autism, we investigated whether autistic individuals are more liable for experiencing misophonia symptoms. In addition, we explore the contribution of sensory sensitivity to misophonia symptoms in autism. Autistic adults (N = 1050) filled out the Amsterdam Misophonia Scale-Revised (AMISOS-R), the Autism Spectrum Quotient (AQ-28), and the Sensory Processing Questionnaire (SPQ). Chi-square tests were applied to compare proportion of moderate or higher AMISOS-R scores over 20 to previously reported values in the extant literature. Next we modelled the quantitative level of AMISOS-R scores as function of AQ-28 with age, sex, and co-occurring disorders. Finally, we ran a mediation model adding SPQ as a mediator. Autistic people reported moderate to extreme levels of AMISOS-R in higher proportion than the general population. In particular autistic females and those with co-occurring disorders scored higher. In quantitative models, we found that autistic traits strongly predicted misophonia symptoms after correcting for multiple covariates. Both the hearing and vision subscales of the SPQ significantly mediated the effect. The increased level of misophonia symptoms in autism and the mediation analyses suggest that autistic traits and sensory sensitivity are factors to consider for a subset of misophonia sufferers, with possible consequences for their clinical interventions.

BACKGROUND:Anxiety, depression and suicidal ideation are frequent in patients with chronic prurigo (CPG). OBJECTIVE:To analyze perceived stress, stigmatization, body dysmorphia, anxiety, depression and itch-related quality of life in CPG patients and compare them to controls, and then to identify variables/predictors of them. METHODS:This study is part of a cross-sectional multicenter study in 17 European countries including 5487 consecutive patients and 2808 controls. RESULTS:One hundred twenty-seven individuals with prurigo were included in the analyses. They reported higher levels of stress, stigmatization, and body dysmorphia than controls. In the patient group, stigmatization was associated with higher stress and having a severe disease, stress with younger age and lower income, depression and anxiety with lower income and higher itch intensity, body dysmorphia with younger age, and dissatisfaction with appearance. LIMITATIONS:CPG patients were older than controls and had significantly more comorbidities. However, multivariate analysis allowed controlling for these differences by including them as a covariate. CONCLUSION:CPG patients have high levels of perceived stress, perceived stigmatization and body dysmorphic, which are partly related to sociodemographic factors like younger age or lower income as well as to other psychological and disease-related factors.

Background:Skin diseases are symptomatic, visible, and stigmatizing and it is acknowledged that they can be associated with stress. However, large studies comparing disease-specific stress are scarce. Objectives:To investigate stress in a large, diverse sample of patients with different skin conditions and identify predictors of stress. Methods:A cross-sectional, multicenter study was conducted in 22 dermatology clinics across 17 European countries (response rate 82.4%). The study included 5487 patients diagnosed with various dermatological conditions and 2808 skin-healthy controls. The Perceived Stress Scale, 10 items was used to measure stress. Results:Patients reported significantly higher stress levels, more stressful life events during the last 6 months, and more economic difficulties than controls. Patients with psychodermatological conditions, hyperhidrosis, hidradenitis suppurativa, atopic dermatitis, acne, and urticaria experienced the highest stress levels. 44% of the variance of perceived stress in patients with skin conditions could be predicted by sociodemographic data and disease-related and psychological variables (depression, anxiety, stigmatization, and body dysmorphic concerns). Limitations:As with all cross-sectional studies, causality and directionality cannot be inferred. Conclusion:Stress poses a significant psychosocial burden to dermatological patients, especially to vulnerable subgroups. Health interventions targeting stress may be essential to improve clinical outcomes.

Initial treatment for obsessive-compulsive disorder (OCD) consists of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) and/or psychological treatment with cognitive behavioral therapy (CBT). The assumption is that both treatments have different neural working mechanisms, but empirical evidence is lacking. We investigated whether these treatments induce similar or different functional neural changes in OCD. We conducted a longitudinal nonrandomized controlled trial in which thirty-four OCD patients were treated with sixteen weeks of CBT or SSRIs. Functional magnetic resonance imaging was performed before and after treatment during emotional processing (emotional face matching and symptom provocation tasks) and response inhibition (stop signal task). Twenty matched healthy controls were scanned twice with a similar time interval. Both CBT and SSRIs were successful in reducing OCD symptoms. Compared to healthy controls, treatment led to a reduction of insula activity in OCD patients during symptom provocation. The comparison between treatment groups revealed widespread divergent brain changes in the cerebellum, posterior insula, caudate nucleus, hippocampus, and occipital and prefrontal cortex during all tasks, explained by relative increases of activity following CBT compared to relative decreases of activity following SSRIs. Pharmacological and psychological treatment primarily lead to opposite changes in brain function, with a common reduction of insula activity during symptom provocation. These findings provide insight into common and specific neural mechanisms underlying treatment response, suggesting that CBT and SSRIs support recovery from OCD along partly distinct pathways. This trial is registered with NTR6575.

The evidence on the techniques, targets, and clinical results of deep brain stimulation (DBS) in obsessive-compulsive disorder (OCD) is constantly evolving. The aim of this chapter is to provide an overview of the latest updates on clinical results of DBS in OCD, predictors of response, and the mechanisms of action. Overall, studies have shown a significant mean improvement in Yale-Brown Obsessive Compulsive Scale of approximately 47% (95% CI 40%–53%) across treatment-refractory OCD patients. Furthermore, the quality of life improved in the physical and psychological domains at all targets. Surgery-related serious adverse events (SAEs) are relatively rare (7.9%) and mostly transient. These include infection and intracranial hemorrhage. In order to improve implementation of DBS in clinical practice for treatment of OCD and psychiatric disorders in general, it is important to educate future clinicians about the effectiveness of DBS in OCD.

Misophonia is a recently identified disorder of decreased sound tolerance that often originates in childhood. Currently, there is a lack of validated questionnaires for screening and assessing misophonia severity in children/adolescents. This paper presents an iterative validation process of two innovative (parallel child-/parent-reported) questionnaires: the Misophonia Screening List—Child and Youth for screening, and the Amsterdam Misophonia Scale—Youth (AMISOS-Y) for assessing misophonia severity in youth. After instrument refinement, we performed ROC curve, reliability, and principal component analyses, and assessed concurrent, convergent and divergent validity, on a combined sample (aged 8–18; clinical sample N = 94 youth, 95 parents; control group screening N = 197 youth, 56 parents; control group AMISOS-Y N = 192 youth, 55 parents). Both questionnaires were unidimensional and displayed excellent psychometric properties (α = 0.95–0.96). Future replication studies are needed in community and clinical samples to contribute to a unified diagnostic framework. Trial registered 09/2021: NL-OMON20775.

BackgroundItch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses.Results3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes.ConclusionThis study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.

INTRODUCTION:Hidradenitis suppurativa (HS) can severely affect the quality of life (QoL) and is linked to psychological distress, including anxiety, depression, and reduced self-esteem. Stigmatization due to physical appearance may significantly contribute to the psychological burden and impact on QoL for HS patients. This study investigates the association between stigmatization, depression, anxiety, and health- and disease-related variables among HS patients in Europe. PATIENTS AND METHODS:This observational cross-sectional multicenter study was conducted across 22 dermatological outpatient clinics in 17 European countries. Data collected included sociodemographic variables, general health variables, disease-related variables, perceived stigmatization (PSQ), and mental health (PHQ-2, GAD-2). RESULTS:Of the 5487 dermatological patients, 142 (2.6%) were diagnosed with HS, and data from 135 patients (70.1% women, mean age 38.2 years) who completed the PSQ questionnaire were analyzed. Scores on the stigmatization measure indicated that significant stigmatization levels were present in the sample. Linear regression models revealed a significant relationship between stigmatization and both the duration of HS and the presence of itch. Similar findings were noted for the PSQ "confused/staring behavior" scale with depression. The PSQ "absence of friendly behavior" scale was inversely associated with general health status, whereas the "hostile behavior" scale was positively linked to depression. CONCLUSION:HS patients experience significant stigmatization linked to disease duration, itch, and depression. Comprehensive management, including screening for psychosocial co-morbidity, is essential, as is providing access to psychological interventions that support patients to both manage internal distress and the potential reactions of others.

BackgroundDysmorphic concern is an overconcern with an imagined or slight defect in physical appearance that can be a symptom of body dysmorphic disorder (BDD). Appearance-related concerns are frequently reported by people with dermatological conditions. However, relatively little remains known about the relationship between dysmorphic concern and other variables within persons with different skin conditions.ObjectivesThe aim of this multicentre, cross-sectional study was to investigate gender differences regarding dysmorphic concern and the prevalence of BDD in a large sample of patients with skin conditions, in relation to sociodemographic, clinical and psychological variables.MethodsParticipants aged >= 18 years with skin conditions were consecutively enrolled in dermatological clinics of 22 European centres. Dysmorphic concern and the possible presence of BDD were measured using the Dysmorphic Concern Questionnaire (DCQ) and compared between men and women in relation to sociodemographic, clinical and psychological variables, and separately for each skin condition.ResultsThe DCQ questionnaire was completed by 5290 dermatological patients. In all categories, mean scores were significantly higher in women than in men. Mean DCQ scores were also higher in women for most skin conditions, with the highest effect size in vitiligo. The percentage of patients who screened positive for BDD on the DCQ was 10.5%, 7.7% of men and 12.7% of women. The prevalence of BDD positive was 6.9% in patients with mild clinical severity, 11.1% for moderate and 19.1% for severe condition. In the multivariate model in patients with mild skin condition, the presence of BDD was positively associated with stress and stigma both in men and in women.ConclusionsDysmorphic concern and BDD were more frequent in women than in men with skin conditions. Both received and actual stigmatization might have an impact on body-related concerns, in particular in women, who may be more at risk for sociocultural reasons. image

Morgellons disease (MD) is a rare and contentious health condition characterized by dermatological symptoms including slow-healing skin lesions 'attributed' to fibres emerging from or under the skin. Patients also report sensations of crawling, biting and infestation with inanimate objects. This review examines the aetiology, patient characteristics, epidemiology, historical context, correlation with Lyme disease, role of internet, impact on quality of life and treatment approaches for MD. Despite ongoing debate, MD is not officially recognized in medical classifications, with differing views on its aetiology. Some link MD to Lyme disease, while others view it as a variant of delusional infestation. The literature suggests both psychiatric and environmental factors may contribute. The manuscript explores the association with substance abuse, psychiatric comorbidities, infectious agents and the role of internet communities in shaping perceptions. MD's impact on quality of life is significant, yet often overlooked. Treatment approaches are varied due to limited evidence, with low-dose antipsychotics being considered effective, but patient beliefs may influence adherence. A patient-centred, multidisciplinary approach is emphasized, considering both the physical and psychological dimensions of MD. Addressing the controversies surrounding MD while focusing on patient well-being remains a critical challenge for healthcare professionals.

Existential concerns, such as autonomy and identity, are often overlooked although they play an important role in psychopathology and clinical practice. The aims of this study are to investigate how existential concerns relate to psychopathological symptoms and to identify important existential concerns. This study used a cross-sectional quantitative design with a transdiagnostic sample. A mixed graphical model of 4 existential and 3 symptom domains with 4 covariates was estimated in a sample of 996 individuals with various psychiatric disorders. Symptom nodes were derived from questionnaires on psychopathological symptoms and existential nodes from questionnaires on transdiagnostic psychiatric dimensions and self-esteem. The centrality metric, expected influence, was calculated to determine nodes’ cumulative influence in the network. Existential concerns were related to worse psychopathology overall, but most strongly to depressive and anxiety symptoms. The strongest cross-domain relationship was between anxiety and recognition of psychiatric disorder. Of the existential concerns, autonomy and identity were the most central nodes in the network. Our results advocate the need to address existential concerns in clinical practice and research. Conveying individual responses to experiencing psychopathology, such as recognition of disorder, and supporting autonomy or positive identity formation may be areas for intervention.

Objective: To examine whether patients with obsessive-compulsive disorder (OCD) are adequately treated with pharmacotherapy before referral to a specialized center for OCD. Methods: We performed a retrospective chart review of patients with OCD who were seen for intake at an academic outpatient center in The Netherlands between 2016 and 2023. We collected data on age, gender, illness severity using the Yale-Brown Obsessive-Compulsive Scale, duration of illness, comorbidity and past pharmacotherapy and psychotherapy. Following the international treatment guidelines, we calculated percentages of patients treated with one SSRI, two or more SSRIs, clomipramine and/or antipsychotic augmentation treatments. Using multiple regression, we analyzed if patient and illness characteristics influenced the adequacy of treatment. Results: We included 673 patients with an average YBOCS score of 27. 76 % had taken at least one SSRI, and 35 % at least two SSRIs before admission. Only 29 % received a high SSRI-dose and 4 % had taken at least two SSRIs in high dose. Clomipramine and antipsychotics augmentation had been taken by less than one-third of patients. Only 3 % of referred patients followed all guideline-recommended treatment steps. Although the vast majority of patients had received some form of psychotherapy, a minority had received exposure and response prevention treatment. Multiple regression showed that illness duration and having received psychotherapy were independent moderators of the adequacy of pharmacological treatment. Conclusion: Patients with OCD are not being treated adequately according to the pharmacological guidelines. Poor pharmacological treatment may lead to increased duration of illness, suboptimal recovery and unnecessary societal costs. Further research could clarify barriers for patients and caregivers, and facilitate improvement of pharmacological treatment for OCS.

Psychodermatology is a subspecialty of dermatology that is of increasing interest to dermatologists and patients. The case for the provision of at least regional psychodermatology services across Europe is robust. Psychodermatology services have been shown to have better, quicker and more cost-efficient clinical outcomes for patients with psychodermatological conditions. Despite this, psychodermatology services are not uniformly available across Europe. In fact many countries have yet to establish dedicated psychodermatology services. In other countries psychodermatology services are in development. Even in countries where psychodermatolgy units have been established, the services are not available across the whole country. This is especially true for the provision of paediatric psychodermatology services. Also whilst most states across Europe are keen to develop psychodermatology services, the rate at which this development is being implemented is very slow. Our paper maps the current provision of psychodermatology services across Europe and indicates that there is still very much more work to be done in order to develop the comprehensive psychodermatology services across Europe, which are so crucial for our patients.

Background: Misophonia is a recently identified disorder in which individuals experience intense, uncontrollable and disproportional irritation, anger or disgust when confronted with specific sounds or stimuli associated with these sounds. Prevalence rates in children and adolescents are currently still to be investigated. The reported average age of onset is around 13 years, in clinical practice children from 8 years old are referred. Misophonia is associated with avoidance and anticipation anxiety, possibly leading to serious educational and social consequences for children and families. Worldwide, no evidence-based treatment exists specifically for children and adolescents with misophonia. This article presents the design of a randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) combined with psychomotor therapy (PMT) for misophonia in children and adolescents (aged 8-18).Methods: In total, 82 patients will be randomly assigned to a treatment condition or waiting list condition of 3 months (WCG). Treatment consists of 7 weekly group therapy sessions (1.5 h CBT plus 1.5 h PMT) and a follow-up after 3 weeks. Pre and post treatment assessments will be conducted during a baseline assessment, after 3 and 6 months. The primary outcome will be assessed by the Amsterdam Misophonia Scale - Youth (AMISOS-Y) and secondary outcomes (e.g. quality of life) and putative predictors (e.g. parenting burden) will be studied.Conclusion: This trial is the first study worldwide testing the effectiveness of a combined CBT plus PMT protocol for misophonia in children and adolescents. If proven effective, this protocol provides an innovation to improve care for youth with misophonia.

Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.

Objective . Deep brain stimulation is a treatment option for patients with refractory obsessive-compulsive disorder. A new generation of stimulators hold promise for closed loop stimulation, with adaptive stimulation in response to biologic signals. Here we aimed to discover a suitable biomarker in the ventral striatum in patients with obsessive compulsive disorder using local field potentials. Approach. We induced obsessions and compulsions in 11 patients undergoing deep brain stimulation treatment using a symptom provocation task. Then we trained machine learning models to predict symptoms using the recorded intracranial signal from the deep brain stimulation electrodes. Main results. Average areas under the receiver operating characteristics curve were 62.1% for obsessions and 78.2% for compulsions for patient specific models. For obsessions it reached over 85% in one patient, whereas performance was near chance level when the model was trained across patients. Optimal performances for obsessions and compulsions was obtained at different recording sites. Significance . The results from this study suggest that closed loop stimulation may be a viable option for obsessive-compulsive disorder, but that intracranial biomarkers are patient and not disorder specific. Clinical Trial: Netherlands trial registry NL7486.

Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.

Abstract Objectives In body dysmorphic disorder (BDD), anxiety for judgement of appearance plays a major role and is especially difficult in contact with others. In sexual engagement this is unavoidable. It is also known that sexuality is an essential part of quality of life and that for both healthcare providers and patients it is still a difficult topic to address. To date, there is no clear insight in how BDD interacts with sexuality. The aim of this study is to get a better understanding on how patients with BDD experience sexuality. Methods In the outpatient setting of the psychiatry department of the Amsterdam University Medical Center 15 patients (of mixed gender and sexual preference) underwent a semi-structured interview conducted by two researchers. The analyses took place by open coding and the results were discussed by all researchers involved. Results Sexuality is strongly influenced by the presence of BDD. During intercourse patients are trying to navigate on a vulnerable tension field that is created by opposite motives and feelings (such as avoidance versus willingness to engage or arousal versus disgust). Their sexuality is surrounded by rituals where there is little room for spontaneity. The success of the sexual experience depends mainly on the pleasure of the other person and can be immediately interrupted by a tactile or visual confrontation with the respective BDD focus. In the continuous stream of negative thoughts, there is either little contact with the body or it rather serves as a functional instrument that is used to get out of their head. All patients agree that discussing sexuality and using bodily exercises are important. Conclusions In this first qualitative study on sexuality in a diverse group of BDD patients, it became clear that sexuality is a topic full of tension. Sexuality should have a part in the treatment of patients with BDD. Conflicts of Interest There are no conflicts of interest.