The psychiatric significance of the localisation of cutaneous artefacts
The psychiatric significance of dermatitis artefacta (self-inflicted skin lesions that are presented by the patient as an authentic dermatosis) varies with the localisation. Cutaneous artefacts in the region of the head and neck, on the limbs, on the genitals and all over the body are preceded by different life-events and they have different underlying psychiatric diagnoses. The localisation of artefacts has predictive value for the evolution of the skin lesions and for the prognosis of other expressions of disturbed illness-behaviour (i.a. invalidism, medical shopping, and such types of self-destructive behaviour as alcohol- and sedative abuse, suicide attempt, and pathomimicry relating to non-dermatological organs). The localisation of self-inflicted skin lesions co-determines the effectivity of the psychotherapeutic and/or psychopharmacological treatment. The clinical fact of the localisation possesses a psychodynamic dimension as well.