Original Article
Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study
Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto
S.E. Marrona,b,
, T. Gracia-Cazañab,c, A. Miranda-Sivelod, S. Lamas-Diaze, L. Tomas-Aragonesb,f
Autor para correspondencia
a Dermatology Department, Royo Villanova Hospital, Zaragoza, Spain
b Aragon Psychodermatology Research Group, Zaragoza, Spain
c Dermatology Department, Barbastro Hospital, Barbastro, Spain
d Psychiatry Department, Segovia Hospital, Segovia, Spain
e Department of Statistic, San Jorge University, Zaragoza, Spain
f Department of Psychology, University of Zaragoza, Zaragoza, Spain
Leído
5534
Vecesse ha leído el artículo
1995
Total PDF
3539
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219018303809" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.001" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2048" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:28-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 92 "formatos" => array:2 [ "HTML" => 89 "PDF" => 3 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018303958" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.08.001" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2048" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:28-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 278 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 98 "PDF" => 178 ] ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "28" "paginaFinal" => "32" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 893 "Tamanyo" => 124763 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.E. Marron, T. Gracia-Cazaña, A. Miranda-Sivelo, S. Lamas-Diaz, L. Tomas-Aragones" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S.E." "apellidos" => "Marron" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Gracia-Cazaña" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Miranda-Sivelo" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Lamas-Diaz" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Tomas-Aragones" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0005"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018303809" "doi" => "10.1016/j.adengl.2018.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303809?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303958?idApp=UINPBA000044" "url" => "/00017310/0000011000000001/v1_201901030610/S0001731018303958/v1_201901030610/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018304104" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.012" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2049" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2019;110:33-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "The Super Shaving Technique to Correct the Trapdoor Effect in Nasal Flaps" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "33" "paginaFinal" => "37" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afeitado profundo <span class="elsevierStyleItalic">(super shaving)</span> para la corrección del efecto en trampilla de colgajos nasales" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3747 "Ancho" => 1500 "Tamanyo" => 396215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Postoperative outcomes of super shaving. A, D, G, J, M, P, S, V, We can see the trapdoor defect prior to surgery. B, E, H, K, N, Q,T, W, The intraoperative outcome of the technique is shown. C, F, L, O, R, U, X, Postoperative control at 3 months. I, Postoperative control after 1 month.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Correa, J. Magliano, I. Peres, C. Bazzano" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Correa" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magliano" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Peres" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Bazzano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101830396X" "doi" => "10.1016/j.ad.2018.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101830396X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304104?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018304104/v1_201901030631/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219018304037" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.007" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2025" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2019;110:20-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Controversies in Dermatology</span>" "titulo" => "Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "27" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La dermatología y sus aspectos médico-legales: seguridad clínica y dermatología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 958 "Ancho" => 1333 "Tamanyo" => 104077 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Arimany Manso, C. Martin Fumadó, J.M. Mascaró Ballester" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Arimany Manso" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Martin Fumadó" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró Ballester" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0020"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018303442" "doi" => "10.1016/j.ad.2018.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303442?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304037?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018304037/v1_201901030631/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "28" "paginaFinal" => "32" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S.E. Marron, T. Gracia-Cazaña, A. Miranda-Sivelo, S. Lamas-Diaz, L. Tomas-Aragones" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S.E." "apellidos" => "Marron" "email" => array:1 [ 0 => "semarron@aedv.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "T." "apellidos" => "Gracia-Cazaña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Miranda-Sivelo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Lamas-Diaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "L." "apellidos" => "Tomas-Aragones" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Dermatology Department, Royo Villanova Hospital, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Aragon Psychodermatology Research Group, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dermatology Department, Barbastro Hospital, Barbastro, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Psychiatry Department, Segovia Hospital, Segovia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Statistic, San Jorge University, Zaragoza, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Department of Psychology, University of Zaragoza, Zaragoza, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">INTRODUCTION</span><p id="par0005" class="elsevierStylePara elsevierViewall">Body dysmorphic disorder (BDD) is a mental health condition that is difficult to diagnose; it can cause a great deal of suffering, and treatment is often complex and challenging. The main symptom is a subjective feeling of ugliness or of a physical defect that the patient believes is evident to others, despite the fact their appearance is within the parameters of normality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> The DSM-IV states that diagnosis is confirmed when the patient suffers clinically significant distress or functional impairment.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Individuals with BDD worry about how they look; they feel unattractive or even hideous. The focus is usually on the face or head, but patients may be preoccupied with any part of the body, or the entire body. Appearance-related apprehension is difficult to control and people with this disorder spend many fretful hours mirror checking and attempting to hide the perceived defect or flaw. It is a chronic and distressing condition that can lead to severe social, academic and family difficulties.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">BDD is often under diagnosed because patients are too ashamed to talk about their symptoms and, if not specifically contemplated, it is easy to miss.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> The prevalence of BDD in the general population is around 2%.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Higher prevalence rates have been reported among adolescents (3.6%).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> Prevalence in dermatological clinics is between 10% and 12%.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the onset of BDD is usually during adolescence, patients are commonly diagnosed after many years of suffering. This is due to the fact that BDD is often unidentified and many youngsters seek non-psychiatric medical treatment, primarily from dermatologists and surgeons.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are several links between acne and BDD:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Developmental: the average age of onset (16 years) coincides with the appearance of acne in adolescence<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Phenomenological: body image is largely based on the skin; facial acne is the area of most frequent concern<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3)</span><p id="par0040" class="elsevierStylePara elsevierViewall">Compulsive behaviours: 93% of patients with BDD and compulsive excoriation is related to acne.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Sixty-four percent of BDD cases that include tanning behaviour are associated with acne.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">Youngsters with acne represent a risk group and should therefore be screened for BDD by a dermatologist. Appearance-specific questions are not asked in dermatological outpatient consultations and the disorder may not be detected. Psycho-education should be offered to patients, as well as the possibility to be referred to a mental health specialist.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The aim of this work was to undertake a pilot study for screening acne patients for BDD in a dermatology out-patient clinic and to observe the relationship between the possible cases of BDD and sociodemographic and clinical variables.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample</span><p id="par0055" class="elsevierStylePara elsevierViewall">Consecutive dermatology out-patients who met the inclusion criteria and gave consent to participate in study. Participants were recruited from a public urban hospital in Zaragoza and a public rural hospital in Alcañiz from February to May 2013.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Inclusion criteria were: (i) a diagnosis of acne vulgaris; (ii) signed, informed consent of voluntary participation; (iii) the absence of any language difficulties or intellectual dysfunctions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study PI13/0004 was approved by the Aragon Clinical Research Ethics Committee on 23 January of 2013 and conducted in accordance with the World Medical Association Helsinki Declaration.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design</span><p id="par0070" class="elsevierStylePara elsevierViewall">The project was based on a prospective and observational pilot study.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The dermatologist noted basic sociodemographic information (sex, age and area of residence) and collected clinical information regarding: age of acne onset; duration; severity (mild, moderate or severe, in accordance with the Cook scale); and, location of lesions (visible/non-visible, skin areas). Patients were also asked appearance-specific screening questions to identify possible BDD (Body Dysmorphic Disorder Questionnaire). Patients who gave positive answers to the screening questions were offered information about BDD and a referral to a mental health specialist.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment instruments</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cook's Acne Grading Scale</span>: In 1979, Cook <span class="elsevierStyleItalic">et al.</span>, evaluated the overall severity of acne on a 0-8 scale, based on photographic standards that illustrated grades 0, 2, 4, 6 and 8. A nine-point scale for comedones, papules and macules on the face was also utilsed.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Body Dysmorphic Disorder Questionnaire (Spanish translation):</span> The BDDQ is a short, self-administered questionnaire, derived from the DSM-IV criteria for BDD. It was developed by Phillips as a screening instrument. The BDDQ has shown good concurrent validity with a sensitivity rate of 94%, specificity of 90% and a likelihood ratio of 9.4.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,13</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Screening for BDD</span><p id="par0090" class="elsevierStylePara elsevierViewall">Possible cases of BBD were identified by means of two criteria: 1) A positive result in the BDDQ (4 positive points and a negative exclusion question); and, 2) A Cook Acne Grading Score that reflected non-noticeable/mild lesions (the most stringent criteria) or moderate lesions (least stringent criteria)</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analyses</span><p id="par0095" class="elsevierStylePara elsevierViewall">The descriptive analysis of the quantitative variables included the corresponding frequency distributions; means and standard deviations were also calculated.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The bivariate analysis used contingency tables and the Chi-squared test to identify relationships between the qualitative variables. Depending on whether they followed a normal distribution, either the Student T or Mann-Whitney U test was utilised to study possible differences between the measures of central tendencies of the compared groups. Statistical significance was 5% and SPSS<span class="elsevierStyleItalic">®</span> version 16 was the statistical support.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Clinical characteristics</span><p id="par0105" class="elsevierStylePara elsevierViewall">The study population comprised 81 patients. The age range of the patients was from 13 to 43 years old. The average age was 19 (SD:6.2), 54.3% were women and 45.7% were men. Sixty-one point seven per cent lived in the rural area covered by the Alcañiz hospital and 38.3% were from the urban area served by the University Hospital of Zaragoza.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The average age of acne onset was 14.9 (SD:4.1). Early onset (<16) occurred with 71.6% of the patients while 28.4% suffered late onset. The average time period that they had lived with the condition was 4.4 years (SD:3.6).</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ninety-two-point six percent of patients had acne lesions on the face, 58% on the neck, 19.8% in the pectoral region and 4.9% on other parts of their bodies. Sixty-six-point seven percent of the lesions were located in visible areas. Almost half of the 81 cases (48.1%) were classified as mild acne, 33.3% were moderate and 18.5% were severe.</p><p id="par0120" class="elsevierStylePara elsevierViewall">When more restrictive criteria regarding the seriousness of the condition were applied (only patients with mild acne), the BBDQ screening process resulted in a BDD prevalence rate of 8.6% (7 patients); if the criteria were less restrictive (including patients with moderate lesions), the rate was 14.8% (12 patients).</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparative analysis of patients with positive BDD screening and those with negative results</span><p id="par0130" class="elsevierStylePara elsevierViewall">No statistically significant differences were found with regards to sex, area of residence (rural or urban), or age of onset, from a quantitative or qualitative point of view (early/late onset).</p><p id="par0135" class="elsevierStylePara elsevierViewall">The time period of suffering acne was statistically significant in relation to a positive result in the BDDQ; (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.034; 6.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 years vs 4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 years). Concerning the age of the participants, there is a positive result in the screening process (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06; 22.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.4 years vs 18.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.6 years).</p><p id="par0140" class="elsevierStylePara elsevierViewall">No statistically significant relationships were found regarding the location of skin lesions: visible/not-visible; on hands, neck or back.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The location of acne on the chest was significant: 42% of those with positive BDDQ results had acne on the chest, compared to 10% of negative scores.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Patients that were BBD positive spent an average of two hours per day worrying about their appearance and this contrasts sharply with those patients that had negative screening results (30<span class="elsevierStyleHsp" style=""></span>minutes) (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005).</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The prevalence of BDD found among the acne patients who underwent our screening programme was similar to rates found in other studies with acne sufferers and general dermatological populations. Uzun <span class="elsevierStyleItalic">et al</span>.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> reported a prevalence of 9% among BDD patients with mild acne, almost the same result as that of the present study (8.6%). In another study with BDD acne patients, Bowe <span class="elsevierStyleItalic">et al.</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> found a prevalence of between 14% and 21%, depending on the degree of severity of the acne used as the criterion. Research on general dermatological patients has revealed a prevalence of BDD of between 6% and12%,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7,9</span></a> which is similar to the findings of this present work.</p><p id="par0160" class="elsevierStylePara elsevierViewall">As previously mentioned, there were statistically significant differences between BDD and non-BBD patients with the variables time period of suffering acne and age at the time of the screening (not onset of acne). It is possible that BDD can only be clinically identified after a certain period of time suffering acne, and at a certain age; it is also possible that the disorder appears in a subclinical manner and the screening test is unable to detect the problem. Although subsyndromal BDD may begin at the age of 13, the condition is significantly more prevalent between the ages of 15 to 18 than from 12 to 14, therefore, when BDD appears in relation to the preoccupation caused by acne it is probable that there is a time period before the full symptomology develops and diagnosis can be confirmed.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">This study found a significant association between BBD and having acne on the chest. All the patients who screened positive for BDD, and had acne on the chest, were women; a reflection of the importance of this area of the body for female corporal self-image. Despite the fact that no significant differences were found among the general study population regarding sex and BDD, in the case of this particular variable there seems to be no room for doubt.</p><p id="par0170" class="elsevierStylePara elsevierViewall">This research is not without its limitations: Firstly, a much larger sample population would have produced more statistical power. Secondly, when establishing which participants should be included as BDD patients in accordance with the criterion of severity it would have been better to use an acne severity scale instead of just the categories of mild, moderate or severe. These two issues will be taken into account in the development of a future project and it should be underlined that the present work was designed as an initial pilot study.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In conclusion, it is worth remembering that the patients who screened positive for BDD in our study, spend an average of 2<span class="elsevierStyleHsp" style=""></span>hours a day thinking and worrying about their appearance. This fact is a reminder of the importance of correctly diagnosing and treating BDD as the condition clearly has a serious and negative impact on the lives of those affected by it. In the words of Enrico Morselli, who first described the disorder, “The life of the dysmorphic patient is truly miserable; in the midst of their daily routines, conversations, while they are reading, eating, in any place and at any moment, they are trapped by the doubt of deformity...”.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1133080" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1065494" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1133081" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1065493" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "INTRODUCTION" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Assessment instruments" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Screening for BDD" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analyses" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Clinical characteristics" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Comparative analysis of patients with positive BDD screening and those with negative results" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-24" "fechaAceptado" => "2018-08-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1065494" "palabras" => array:3 [ 0 => "Body dysmorphic disorder" 1 => "Screening" 2 => "Acne patients" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1065493" "palabras" => array:3 [ 0 => "Trastorno dismórfico corporal" 1 => "Detección" 2 => "Pacientes con acné" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Body dysmorphic disorder (BDD) is a mental health condition that is difficult to diagnose; it can cause a great deal of suffering, and treatment is often complex and challenging.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study population comprised 81 consecutive dermatology out-patients who met the inclusion criteria for participation. Participants were treated at hospitals in both urban (Zaragoza) and rural areas (Alcañiz). The project was based on a prospective and observational pilot study. Assessment instruments used: Cook's Acne Grading Scale and Body Dysmorphic Disorder Questionnaire (BDDQ) (Spanish translation).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Possible cases of BDD were identified by means of 2 criteria: 1) A positive result in the BDDQ (4 positive points and a negative exclusion question); and, 2) A Cook's Acne Grading Score that reflected non-noticeable/mild lesions (the most stringent criteria) or moderate lesions (least stringent criteria)</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The age range of the patients was from 13 to 43 years old. The average age was 19 with a standard deviation of 6.2. Of the 81 participants, 54.3% were women. 61.7% were seen in a rural hospital (Alcañiz Hospital) and 38.3% in an urban one (University Hospital of Zaragoza). When more restrictive criteria regarding the seriousness of the condition were applied (only patients with mild acne), the BDDQ screening resulted in a positive BDD prevalence rate of 8.6% (7 patients); if the criteria were less restrictive (including patients with moderate lesions), the rate was 14.8% (12 patients).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients who screened positive for BDD reported spending an average of 2<span class="elsevierStyleHsp" style=""></span>hours a day thinking and worrying about their appearance. These results highlight the importance of screening for possible cases of BDD in order to follow up these patients and recommend they be seen by a mental health specialist to confirm the diagnose and offer treatment for the disorder. BDD has a serious and negative impact on the lives of those affected.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El trastorno dismórfico corporal (TDC) es una enfermedad mental difícil de diagnosticar; puede causar una gran cantidad de sufrimiento, y el tratamiento a menudo es complejo y desafiante.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La población de estudio comprendía 81 pacientes ambulatorios dermatológicos consecutivos que cumplían los criterios de inclusión para la participación. Fueron tratados en hospitales en zonas urbanas (Zaragoza) y rurales (Alcañiz). Es un estudio piloto prospectivo y observacional. Se utilizaron como instrumentos de evaluación: a) La escala de gradación del acné de Cook y b) El Cuestionario de Trastorno Dismórfico Corporal (Body Dysmorphic Disorder Questionnaire, BDDQ) (traducción al español). Los posibles casos de TDC se identificaron mediante 2 criterios: 1) Un resultado positivo en el BDDQ (4 puntos positivos y una pregunta de exclusión negativa); y 2) Escala de gradación del acné de Cook que reflejó lesiones no perceptibles/leves (los criterios más estrictos) o lesiones moderadas (criterios menos estrictos)</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El rango de edad de los pacientes era de 13 a 43 años. La edad promedio fue 19 con una desviación estándar de 6,2. De los 81 participantes, el 54,3% eran mujeres y el 45,7% eran hombres. El 61,7% vivía en el área rural cubierta por el hospital de Alcañiz y el 38,3% era del área urbana atendida por el Hospital Universitario de Zaragoza. Cuando se aplicaron criterios más restrictivos con respecto a la gravedad de la afección (solo los pacientes con acné leve), el proceso de detección de BDDQ resultó en una tasa de prevalencia de TDC del 8,6% (7 pacientes); si los criterios fueron menos restrictivos (incluidos los pacientes con lesiones moderadas), la tasa fue del 14,8% (12 pacientes).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Vale la pena recordar que los pacientes con TDC que participaron en este estudio pasan un promedio de 2<span class="elsevierStyleHsp" style=""></span>h al día pensando y preocupándose por su apariencia. Este hecho es un recordatorio de la importancia de diagnosticar y tratar correctamente el TDC ya que la afección claramente tiene un impacto serio y negativo en las vidas de los afectados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marron SE, Gracia-Cazaña T, Miranda-Sivelo A, Lamas-Diaz S, Tomas-Aragones L. Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto. Actas Dermosifiliogr. 2019;110:28–32.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sulla dismorfofobia e sulla tafefobia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Morselli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Boll Reale Accad Med Genova" "fecha" => "1891" "volumen" => "6" "paginaInicial" => "110" "paginaFinal" => "119" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994." ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The broken mirror: Understanding and treating body dysmorphic disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.A. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "Oxford University Press" "editorialLocalizacion" => "Nueva York" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body dysmorphic disorder: Treating an underrecognized disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.A. Phillips" 1 => "E.R. Didie" 2 => "J. Feusner" 3 => "S. Wilheim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1176/appi.ajp.2008.08040500" "Revista" => array:6 [ "tituloSerie" => "Am J Psychiatry" "fecha" => "2008" "volumen" => "165" "paginaInicial" => "1111" "paginaFinal" => "1118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18765493" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of body dysmorphic disorder: A population-based survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Rief" 1 => "U. Buhlmann" 2 => "S. Wilhelm" 3 => "A. Borkenhagen" 4 => "E. Brähler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0033291706007264" "Revista" => array:6 [ "tituloSerie" => "Psychol Med" "fecha" => "2006" "volumen" => "36" "paginaInicial" => "877" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16515733" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of body dysmorphic disorder and associated features in German adolescents: A self-report survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Möllmann" 1 => "F.A. Dietel" 2 => "A. Hunger" 3 => "U. Buhlmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.psychres.2017.04.063" "Revista" => array:6 [ "tituloSerie" => "Psychiatry Res" "fecha" => "2017" "volumen" => "254" "paginaInicial" => "263" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28482195" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of body dysmorphic disorder in plastic surgery and dermatology patients: A systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.V.E. Ribeiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aesthetic Plast Surg" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "964" "paginaFinal" => "970" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age at onset and clinical correlates in body dysmorphic disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.S. Bjornsson" 1 => "E.R. Didie" 2 => "J.E. Grant" 3 => "W. Menard" 4 => "E. Stalker" 5 => "K.A. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.comppsych.2013.03.019" "Revista" => array:6 [ "tituloSerie" => "Compr Psychiatry" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "893" "paginaFinal" => "903" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23643073" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency of body dysmorphic disorder in dermatology and cosmetic dermatology clinics: A study from Turkey" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Dogruk Kacar" 1 => "P. Ozuguz" 2 => "E. Bagcioglu" 3 => "K.S. Coskun" 4 => "H. Uzel Tas" 5 => "S. Polat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ced.12304" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2014" "volumen" => "39" "paginaInicial" => "433" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24758305" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathological skin picking in individuals with body dysmorphic disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Grant" 1 => "W. Menard" 2 => "K.A. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.genhosppsych.2006.08.009" "Revista" => array:6 [ "tituloSerie" => "Gen Hosp Psychiatry" "fecha" => "2006" "volumen" => "28" "paginaInicial" => "487" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17088164" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Taning in body dysmorphic disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.A. Phillis" 1 => "M. Conroy" 2 => "E.G. Dufresne" 3 => "W. Menard" 4 => "E.R. Didie" 5 => "J. Hunter-Yates" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11126-006-9002-2" "Revista" => array:6 [ "tituloSerie" => "Psychiatr Q" "fecha" => "2006" "volumen" => "77" "paginaInicial" => "129" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16779685" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An acne grading method using photographic standards" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.H. Cook" 1 => "R.L. Centner" 2 => "S.E. Michaels" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1979" "volumen" => "115" "paginaInicial" => "571" "paginaFinal" => "575" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/156006" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Brohede" 1 => "G. Wingren" 2 => "B. Wijma" 3 => "K. Wijma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.psychres.2013.07.019" "Revista" => array:6 [ "tituloSerie" => "Psychiatry Res" "fecha" => "2013" "volumen" => "210" "paginaInicial" => "647" "paginaFinal" => "652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23948660" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body dysmorphic disorder in patients with acne" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Uzun" 1 => "C. Basaglu" 2 => "A. Akar" 3 => "A. Cansever" 4 => "A. Ozsahin" 5 => "M. Cetin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0010-440X(03)00102-0" "Revista" => array:6 [ "tituloSerie" => "Compr Psychiatry" "fecha" => "2003" "volumen" => "44" "paginaInicial" => "415" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14505303" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body dysmorphic disorder symptoms among patients with acne vulgaris" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.P. Bowe" 1 => "J.J. Leyden" 2 => "C.E. Crerand" 3 => "D.B. Sarwer" 4 => "D.J. Margolis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.03.030" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "222" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17498840" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018303809/v1_201901030631/en/main.assets" "Apartado" => array:4 [ "identificador" => "6256" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000001/v1_201901030631/S1578219018303809/v1_201901030631/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303809?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 11 | 26 |
| 2024 Octubre | 90 | 58 | 148 |
| 2024 Septiembre | 97 | 28 | 125 |
| 2024 Agosto | 113 | 51 | 164 |
| 2024 Julio | 79 | 25 | 104 |
| 2024 Junio | 100 | 44 | 144 |
| 2024 Mayo | 105 | 31 | 136 |
| 2024 Abril | 72 | 42 | 114 |
| 2024 Marzo | 72 | 25 | 97 |
| 2024 Febrero | 75 | 40 | 115 |
| 2024 Enero | 70 | 36 | 106 |
| 2023 Diciembre | 89 | 27 | 116 |
| 2023 Noviembre | 112 | 34 | 146 |
| 2023 Octubre | 117 | 39 | 156 |
| 2023 Septiembre | 105 | 34 | 139 |
| 2023 Agosto | 69 | 19 | 88 |
| 2023 Julio | 67 | 46 | 113 |
| 2023 Junio | 86 | 31 | 117 |
| 2023 Mayo | 65 | 30 | 95 |
| 2023 Abril | 72 | 25 | 97 |
| 2023 Marzo | 123 | 25 | 148 |
| 2023 Febrero | 54 | 31 | 85 |
| 2023 Enero | 38 | 32 | 70 |
| 2022 Diciembre | 63 | 40 | 103 |
| 2022 Noviembre | 53 | 39 | 92 |
| 2022 Octubre | 46 | 21 | 67 |
| 2022 Septiembre | 21 | 37 | 58 |
| 2022 Agosto | 26 | 37 | 63 |
| 2022 Julio | 32 | 36 | 68 |
| 2022 Junio | 34 | 27 | 61 |
| 2022 Mayo | 79 | 56 | 135 |
| 2022 Abril | 66 | 30 | 96 |
| 2022 Marzo | 75 | 65 | 140 |
| 2022 Febrero | 44 | 38 | 82 |
| 2022 Enero | 65 | 38 | 103 |
| 2021 Diciembre | 44 | 43 | 87 |
| 2021 Noviembre | 54 | 38 | 92 |
| 2021 Octubre | 44 | 64 | 108 |
| 2021 Septiembre | 37 | 32 | 69 |
| 2021 Agosto | 37 | 44 | 81 |
| 2021 Julio | 26 | 36 | 62 |
| 2021 Junio | 32 | 25 | 57 |
| 2021 Mayo | 40 | 45 | 85 |
| 2021 Abril | 100 | 73 | 173 |
| 2021 Marzo | 76 | 40 | 116 |
| 2021 Febrero | 72 | 40 | 112 |
| 2021 Enero | 43 | 48 | 91 |
| 2020 Diciembre | 39 | 28 | 67 |
| 2020 Noviembre | 42 | 47 | 89 |
| 2020 Octubre | 36 | 21 | 57 |
| 2020 Septiembre | 56 | 24 | 80 |
| 2020 Agosto | 31 | 27 | 58 |
| 2020 Julio | 31 | 20 | 51 |
| 2020 Junio | 33 | 32 | 65 |
| 2020 Mayo | 35 | 15 | 50 |
| 2020 Abril | 29 | 13 | 42 |
| 2020 Marzo | 21 | 9 | 30 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Mayo | 0 | 1 | 1 |
| 2019 Marzo | 67 | 0 | 67 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 21 | 2 | 23 |
Mostrar todo
