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Murshidi R, Hammouri M, Al-Ani A, Kitaneh R, Al-Soleiti M, Al Ta'ani Z, Sweis S, Halasa Z, Fashho E, Arafah M, Almaani N, Abdallat M, Al-Dar'awi F, Kittaneh E, Jaber B, Almudallal F, Smadi Z. Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study. Sci Rep 2024; 14:5993. [PMID: 38472284 PMCID: PMC10933333 DOI: 10.1038/s41598-024-56315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.
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Affiliation(s)
- Rand Murshidi
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Razi Kitaneh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | | | - Zain Al Ta'ani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sami Sweis
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zeina Halasa
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Eva Fashho
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Malak Arafah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Almaani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abdallat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Eman Kittaneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Besan Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zina Smadi
- School of Medicine, The University of Jordan, Amman, Jordan
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Ezzedine K, Shourick J, Bergqvist C, Misery L, Chuberre B, Kerob D, Halioua B, Le Fur G, Paul C, Richard MA, Taieb C. Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D): Development and validation of a dermatology-specific stigmatization assessment tool. J Eur Acad Dermatol Venereol 2023; 37:443-450. [PMID: 36201355 PMCID: PMC10092236 DOI: 10.1111/jdv.18641] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The skin plays an important role in establishing interpersonal relationships, and thus visible skin disorders, which have a significant impact on physical appearance, influence other people's behaviours and attitudes. OBJECTIVE To develop and validate a dermatologic-specific questionnaire to evaluate stigmatization in individuals with visible skin conditions. METHODS Items were generated by a verbatim report based on qualitative interviews with patients with various dermatologic conditions. Subsequently, a study was implemented for psychometric analysis. A dermatology-specific stigmatization questionnaire (PUSH-D) was refined via item reduction according to inter-question correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating Cronbach's α. Concurrent validity was determined by calculating the correlation between PUSH-D and the Dermatology Life Quality Index (DLQI) and the Rosenberg Self-Esteem Scale (RSES). RESULTS From a primary list of 22 items, PUSH-D was reduced to a 17-item questionnaire, covering two pertinent dimensions based on the exploratory factor analysis. Construct validity was demonstrated, and PUSH-D showed good internal consistency (Cronbach's α = 0.9). PUSH-D correlated strongly with the DLQI 0.72 (p < 0.001) and moderately with the RSES 0.49 (p < 0.001). CONCLUSION PUSH-D allows a comprehensive view of the degree of stigmatization in visible skin disorders, as well as the comparability of stigmatization levels across various skin conditions.
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Affiliation(s)
- Khaled Ezzedine
- EA 7379 EpidermE, Université Paris-Est Créteil (UPEC), Créteil, France.,Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Jason Shourick
- Department of Clinical Epidemiology and Public Health, CHU Toulouse, Toulouse, France
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France.,French Society of Human Skin Sciences [SFSHP], Maison de la Dermatologie, Paris, France
| | | | | | - Bruno Halioua
- French Society of Human Skin Sciences [SFSHP], Maison de la Dermatologie, Paris, France.,Private Practice, Paris, France
| | | | - Carle Paul
- Department of Dermatology, University of Toulouse, Toulouse, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Charles Taieb
- French Society of Human Skin Sciences [SFSHP], Maison de la Dermatologie, Paris, France.,Patient Priority Department, EMMA, Paris, France
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Abstract
Psoriasis is a chronic and recurrent immune-related skin disease that often causes disfigurement and disability. Due to the visibility of lesions in patients and inadequate understanding of dermatology knowledge in the general public, patients with psoriasis often suffer from stigma in their daily lives, which has adverse effects on their mental health, quality of life, and therapeutic responses. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Experience with Skin Complaints, and 6-item Stigmatization Scale have been commonly used. The relationship between sociodemographic characteristics, disease-related variables, psychiatric disorders, quality of life, and stigmatization in patients with psoriasis has been thoroughly investigated with these questionnaires. Managing the stigmatization in patients with psoriasis needs cooperation among policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients. Further studies can concentrate more on these existing topics, as well as other topics, including predictors of perceived stigmatization, stigmatization from non-patient groups, influence of biologics on stigmatization, and methods of coping with stigmatization.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuning Sun
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Luck-Sikorski C, Roßmann P, Topp J, Augustin M, Sommer R, Weinberger NA. Assessment of stigma related to visible skin diseases: a systematic review and evaluation of patient-reported outcome measures. J Eur Acad Dermatol Venereol 2021; 36:499-525. [PMID: 34817889 DOI: 10.1111/jdv.17833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Misconceptions about visible skin diseases are widespread, and patients often face discrimination and stigmatization due to their condition. The associated negative health and psychosocial consequences of stigmatization in skin diseases have prompted an increase in research activity in recent times, resulting in a wide variety of assessment measures. This study aimed at aggregating and evaluating evidence of psychometric properties and methodological quality of published measures to assess stigma in visible skin diseases. Studies assessing stigmatization in visible skin diseases were searched in four databases (Medline, PsycINFO, Web of Science and Embase) until February 2021. The review followed PRISMA guidelines. Papers regarding development and/or validation of measures were identified by two independent researchers. Inclusion criteria were defined as follows: (i) quantitative studies in (ii) populations with skin diseases using (iii) questionnaires explicitly assessing (iv) perceived or public stigmatization or discrimination available in (iv) English or German language. The COnsensus-based Standards of health Measurement INstruments (COSMIN) checklist was used to evaluate their psychometric properties and risk of bias. 35 studies using 21 instruments were identified. Twenty instruments focused on assessing the perceived reality of those affected by visible skin diseases, while public stigma was only assessed by two instruments. Twelve scales could be recommended for use, while nine instruments had the potential to be recommended after further studies have assessed their quality. Some limitations are to be noted. Only studies in English and German were included. Research on self-constructed instruments can lead to new validated instruments, but they were not included in the review at this point. Several validated instruments could be recommended for use. Future research is needed regarding the assessment of stigma across different visible skin diseases, in children and adolescents, and in the general public.
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Affiliation(s)
- C Luck-Sikorski
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - P Roßmann
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - J Topp
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - N A Weinberger
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
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Wójcik E, Reszke R, Krajewski PK, Matusiak Ł, Madziarska K, Ali FM, Finlay AY, Szepietowski JC. Major life changing decision profile: Creation of the Polish language version. Dermatol Ther 2020; 34:e14568. [PMID: 33222372 DOI: 10.1111/dth.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
Chronic diseases have long-term consequences and can affect individuals' life course. The aim of this study was to create the Polish language version of a questionnaire estimating the impact of the disease on important life decisions-the major life changing decision profile (MLCDP). The translation of the MLCDP followed international guidelines. The created Polish language version of the questionnaire was administered to 32 nephrology and dermatology ward inpatients. To assess its properties, statistical analysis of the results obtained was conducted. The Polish language version of the MLCDP demonstrated very good internal consistency with a Cronbach α coefficient of 0.84. The questionnaire presented excellent test-retest reliability, established with a coefficient ICC of 0.97. The Polish language version of MLCDP has shown high internal consistency and reproducibility, and can be used effectively to assess the cumulative impact of the disease by indicating the number of major life decisions affected by chronic disease.
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Affiliation(s)
- Ewa Wójcik
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Dimitrov D, Matusiak Ł, Szepietowski JC. Stigmatization in Arabic psoriatic patients in the United Arab Emirates - a cross sectional study. Postepy Dermatol Alergol 2019; 36:425-30. [PMID: 31616216 DOI: 10.5114/ada.2018.80271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Stigmatization is the phenomenon of labeling negatively people who differ from social norms in some aspect. It seems to be a common and important problem in dermatology. Psoriasis, being a chronic and recurrent skin disease, is frequently associated with various psychosocial consequences. Aim To evaluate the stigmatization level in an Arabic population of psoriatic individuals. Material and methods A total of 108 consecutive patients suffering from psoriasis were enrolled in the study. All recruited subjects were of Arabic origin. Severity of psoriasis was documented with the Psoriasis Area and Severity Index (PASI). Stigmatization was assessed with validated Arabic language versions of the 6-item Stigmatization Scale and the Feelings of Stigmatization Questionnaire. Moreover, all patients were asked to complete the Dermatology Life Quality Index (DLQI) questionnaire. Results The majority of patients showed feelings of stigmatization due to psoriasis. The mean level of stigmatization was 5.6 ±4.5 points assessed by the 6-item Stigmatization Scale and 98.4 ±26.4 points by the Feelings of Stigmatization Questionnaire. Positive attitudes and feeling of being flawed were the most bothersome aspects of stigmatization expressed by patients. Involvement of the face appeared to be the only independent factor influencing the stigmatization level. In the Feelings of Stigmatization Questionnaire, itching was found to be a factor responsible for feelings of stigmatization. Conclusions Our study indicated that stigmatization is common among psoriatic Arabic patients. We postulate that measurement of stigmatization level could contribute to the holistic therapeutic approach of psoriatic patients.
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