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Diagnostics in Psychodermatology

A main problem of the psychodermatological classifications available today is that the assignment to classes is based on more or less unproven assumptions and postulations concerning pathogenesis and nosology. Another problem we are confronted with in psychodermatological classifications is the inconsistency with respect to selection criteria and definition of diagnostic classes. This unsatisfactory diagnostic situation was the incentive to develop the Vienna Diagnoses Schedule for Psychodermatological Disorders (VDS). In this classification, the disorders or problems we are confronted with in general psychodermatology wards are attributed to four main diagnostic categories: The first category includes mental disorders without dermatological symptoms, the second mental disorders and dermatological disorders combined, the third dermatological disorders without any mental disorder, and the fourth dermatological and/or psychological problems not reaching the level of a disorder. The main requirement for diagnostics is the improvement of communication in daily practice on the one hand and the clinical relevance of diagnoses with respect to treatment and prognosis on the other hand. The VDS may help to achieve the first objective. As no categorical classification of mental disorders may fulfill the second requirement, it is necessary to change the paradigm in diagnostics in order to develop more effective pathogenesis-oriented treatment strategies. A possible alternative to the classical categorical approach may be a pathogenesis- oriented, dimensional approach. According to the results of empirical studies carried out in the past decades, the pathogenesis of a psychodermatological disorder has to be considered a multidimensional process in which various mental, physical, and social factors act as predisposing, triggering, and disorder-maintaining factors. Therefore effective treatment strategies have to be based on an accurate differential-diagnosis including all these factors.