Systematic Review of Psychodermatologic Assessment Tools: Diagnostic Accuracy and Clinical Utility.

Abstract

Primary psychodermatologic disorders such as body dysmorphic disorder, trichotillomania, and excoriation disorder present significant challenges in dermatological and psychiatric assessment due to their complex psychological and dermatological symptoms. Reliable and valid screening tools are essential for effective diagnosis and management, yet there is a lack of consensus on the most appropriate instruments. A systematic review was conducted, identifying 81 studies that employed 45 different psychodermatologic tools, of which 13 studies provided empirical data on their diagnostic accuracy. Tools were assessed for their psychometric properties, including sensitivity, specificity, reliability, and validity. The Body Dysmorphic Disorder Questionnaire (BDDQ) and its variants demonstrated high diagnostic accuracy, with the BDDQ showing a sensitivity of 0.97 [95% CI: 0.82-1.00] and specificity of 0.91 [95% CI: 0.86-0.95]. The Skin Picking Scale-Revised showed high diagnostic accuracy for excoriation disorder, with a sensitivity of 0.89 [95% CI: 0.84-0.94] and specificity of 0.95 [95% CI: 0.93-0.96]. Similarly, the Massachusetts General Hospital Hairpulling Scale, frequently utilized for trichotillomania, exhibited strong psychometric properties, with a sensitivity of 0.90 [95% CI: 0.81-0.96] and specificity of 0.72 [95% CI: 0.63-0.80]. Despite their frequent use, many tools lack a comprehensive assessment of the full range of symptoms, including social impairment and behavioural nuances. The review highlights the importance of developing standardized, multidimensional assessment tools that are valid, reliable, and easy to implement in daily practice. Further research is needed to establish the practical utility of these tools in routine dermatology settings, addressing gaps in effectiveness, referral and intervention limitations, and patient acceptability.