The modified curriculum was built around six one-hour lectures in the residency program’s core didactics. Three postgraduate year-four resident lecturers worked with the investigators to retain the original emphasis on differential diagnosis, risk assessment and psychopharmacological management while adding a dedicated psychotherapy segment to each session. That segment introduced a psychological model for the illness category, techniques associated with that model and a sample dialogue intended to demonstrate how the concepts might appear in conversation. The design deliberately placed psychotherapy within an established course, reflecting a broader problem in residency education: early trainees may have little time for separate instruction, even though acute inpatient work is an important setting for developing relational and psychological skills.

For psychotic disorders, residents were introduced to the aberrant salience model of psychosis and cognitive behavioral therapy for psychosis. The model links delusions and hallucinations to altered attention and salience, offering a framework for examining the evidence a patient uses to sustain a belief. Instruction emphasized an inquisitive, nonjudgmental stance, careful inquiry into perceptual experiences, alliance building and assessment of safety. For depression, the curriculum combined cognitive therapy with behavioral activation: residents learned to identify automatic thoughts involving hopelessness, unworthiness or self-inefficacy, use Socratic questioning to examine them and encourage engagement in physical and social activity. These approaches give junior clinicians a way to discuss psychological patterns while preserving the central psychiatric tasks of diagnosis, safety assessment and medical management.

The anxiety lecture used the same cognitive framework to address catastrophic thinking and exaggerated estimates of risk, alongside distress-tolerance techniques for somatic anxiety. For substance use disorders, residents were taught motivational interviewing rather than a confrontational model of change. They learned to recognize ambivalence as a normal feature of substance use, ask rather than dictate, elicit the patient’s own arguments for change and use those “change talk” to strengthen motivation. This orientation is particularly relevant in acute care, where patients may be medically unstable, ambivalent or asked to engage in treatment before they are ready to commit. Rather than treating resistance as a character defect, the method gives clinicians a way to explore what matters to the patient and connect that perspective with possible change.

Other sessions tackled interpersonal and personality dimensions of acute illness. A psychodynamic model of mania was used to explain how an acutely manic patient may exploit another person’s vulnerabilities to support grandiosity, test limits and shift responsibility onto the clinician. Residents were also taught to monitor countertransference and set boundaries. For borderline personality disorder, the curriculum presented both Marsha Linehan’s biosocial model and a brief introduction to Otto Kernberg’s object relations account of borderline personality organization. Dialectical behavior therapy skills included distress tolerance and emotion regulation, while transference-focused psychotherapy concepts included countertransference monitoring, gentle clarification and confrontation. Clinical vignettes from acute settings were used to make the more abstract concepts clinically legible, including the dynamics of splitting and projective identification.

Ten postgraduate year-one residents took part in the course. Because residents missed some sessions while covering vacation, night float or other duties, the investigators distributed optional, anonymous surveys before and after individual lectures, producing 90 survey sets. A five-point Likert scale measured confidence in understanding psychological features, comfort using psychotherapeutic interventions, likelihood of applying those interventions and the perceived helpfulness of the lectures. Six patient vignettes with multiple-choice questions assessed competency. The researchers used one-tailed Welch’s t-tests to compare average pre- and post-lecture ratings and a Fisher exact test for competency. The institutional review board determined that the curriculum evaluation did not constitute human-subjects research, while the dataset was made available from the corresponding author on request.

After the lectures, residents reported substantially greater comfort with the psychological features of psychiatric conditions, rising from a mean of 3.57 to 4.33 on the five-point scale. Comfort using psychotherapeutic techniques increased from 2.82 to 4.17, and the reported likelihood of using those techniques rose from 3.09 to 4.48. Each change was statistically significant at p less than 0.001. Participants also generally rated the lectures as very to extremely helpful for improving their psychotherapeutic technique. These findings are consistent with a familiar challenge in medical education: a short, structured intervention can increase learners’ confidence and intention to apply a skill, even when a small test cannot demonstrate that their actual performance has improved. The particularly large shift in reported willingness to intervene may be practically important, because a technique a resident does not feel able or willing to use cannot affect patient care.

Objective competency results did not improve significantly. Residents answered 92 percent of the multiple-choice questions correctly before the sessions and 96 percent afterward, a difference that the investigators did not regard as statistically significant. The authors noted that the near-ceiling baseline score suggested the test lacked discriminatory power. The result also illustrates why validated performance assessments are needed: vignettes may test recognition of concepts, but they do not necessarily show whether a resident can conduct an alliance-building interview, regulate countertransference or apply motivational interviewing with a real patient. The pilot therefore establishes feasibility and a promising signal of engagement, not proof that the curriculum changes long-term clinical competence or patient outcomes.

The teaching approach also suggests that psychotherapeutic expertise need not be concentrated entirely in experienced faculty. The course was delivered by several senior residents who were not described as psychotherapy experts, using prepared material, clinical examples and established models. Its success may reflect the accessibility of structured techniques that can be linked directly to a psychiatric condition: cognitive methods for depression and anxiety, motivational interviewing for substance use, alliance-focused CBTp for psychosis, and interpersonal or attachment-related frameworks for mania and borderline personality disorder. Future studies should test the curriculum across multiple residency programs, use larger and more diverse cohorts, track whether the changes persist after the lectures and measure performance with more demanding assessments. Even so, the pilot makes a clear case for a simple proposition: psychotherapy is not confined to outpatient clinics or the final stage of training, and acute care can become a deliberate classroom for learning how to understand and respond to the mind in distress.

Subject of Research: Pilot psychotherapy education for first-year psychiatry residents in acute psychiatric settings

Article Title: A Pilot Psychotherapy Curriculum for Early Psychiatry Residents in Acute Settings

Article References: Greenberg, N. R., Levit, J., & Gorun, A. (2026). A Pilot Psychotherapy Curriculum for Early Psychiatry Residents in Acute Settings. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02458-x

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02458-x

Keywords: psychiatry residency, psychotherapy training, acute mental health, medical education, cognitive behavioral therapy, motivational interviewing, psychodynamic therapy, resident education, clinical competence, Pilot, Psychotherapy, Curriculum

The clinical presentation of dermatitis artefacta is often strikingly atypical. Lesions may appear bizarre, geometric, or linear, and they rarely follow the patterns expected of known dermatoses. Excoriations, ulcers, blisters, burns, contact dermatitis, hematomas, and hyperpigmentation have all been described, and the variety of appearances can be so creative that the condition has been called a great imitator of ordinary skin disease. One of the most useful diagnostic clues is anatomic: lesions cluster on easily accessible body areas such as the face, neck, upper limbs, and trunk, often within reach of the dominant hand. Another hallmark is what the literature calls a hollow history, in which mature-appearing lesions are present at first assessment without any documented progression or evolutionary change, suggesting they did not arise through a typical disease process.

Diagnosis is frequently delayed, and the reasons are structural as much as clinical. Because patients conceal the self-inflicted nature of their injuries and may fear being named and shamed, dermatologists often order repeated investigations and trials of treatment before the factitious origin is even considered. The true prevalence of the condition remains unknown, since non-disclosure and clinical variability make population estimates nearly impossible. Cases have been reported across all ages, genders, and backgrounds, but the disorder is most frequently observed in adolescent and adult females, with estimated female-to-male ratios ranging from 4:1 to as high as 20:1. The review cautions that this skew likely reflects small retrospective case series, differing diagnostic criteria, referral bias, and underrecognition in certain populations rather than a settled epidemiologic picture.

What is increasingly clear is that dermatitis artefacta rarely occurs in psychological isolation. The condition arises from multifactorial causes, often rooted in psychiatric comorbidity and emotional distress, and the self-inflicted lesions frequently function as a maladaptive coping mechanism for internal pain, unresolved trauma, or unmet emotional needs that the patient may only dimly perceive. Some individuals injure themselves during dissociative episodes, while others act more deliberately yet still deny awareness or responsibility. Substance use is more common among affected patients and may amplify impulsivity and emotional dysregulation. In a retrospective review of 28 patients managed in a multidisciplinary psychodermatology clinic cited in the new paper, 46 percent had a concomitant mental health disorder at presentation, with anxiety, depression, and personality disorders representing the most frequently identified diagnoses.

Borderline personality disorder deserves particular attention in this context. It has been reported in patients with dermatitis artefacta and may contribute to the emotional dysregulation and impulsivity that complicate clinical management, although the review stresses that its specific prevalence remains uncertain and that it should be considered one of several possible comorbidities rather than a defining feature of the disorder. Complex life histories, including early trauma and chronic stress, are common antecedents, and coexisting chronic dermatologic or medical conditions can further obscure the diagnosis, especially when wounds heal slowly or psychiatric symptoms are subtle. For such patients, the authors argue, multidisciplinary care is not optional but essential to address both the physical lesions and the psychological distress driving them.

Distinguishing dermatitis artefacta from its psychiatric and dermatologic mimics is a technical exercise with real therapeutic consequences. Neurotic excoriations involve compulsive skin picking, often secondary to obsessive-compulsive disorder or anxiety, but unlike dermatitis artefacta patients typically acknowledge their behavior. Delusional parasitosis produces similar self-inflicted lesions, sometimes accompanied by the so-called matchbox sign in which patients present fragments of skin or debris as evidence of infestation, yet the driver is a fixed delusional belief rather than a voluntary behavior aimed at assuming the sick role. Malingering involves self-injury for clear external incentives such as financial gain, whereas Munchausen syndrome, the severe form of factitious disorder, involves intentional symptom production across multiple organ systems rather than the purely cutaneous manifestations of dermatitis artefacta. Body dysmorphic disorder, meanwhile, drives excessive grooming and picking through preoccupation with perceived appearance flaws. Because dermatitis artefacta can imitate eczema, psoriasis, and acne, thorough clinical evaluation and detailed history-taking remain indispensable.

The management philosophy that emerges from the review is unambiguous: dermatologic treatment alone is rarely successful, and confrontation about the origin of lesions tends to backfire. Open confrontation may provoke anger, shame, or outright disengagement from care, and patients who feel accused often simply move on to another provider, fragmenting their treatment and restarting the diagnostic cycle. Instead, the authors advocate a non-confrontational, patient-centered approach grounded in empathy, trust-building, and consistency, framed within a biopsychosocial model in which dermatologists, psychiatrists, and psychologists collaborate. Shame, self-stigma, and fear of social rejection are common across psychocutaneous disorders and contribute to avoidance behaviors and diminished quality of life, which makes the tone of the first clinical encounter disproportionately important to long-term outcomes.

Once rapport is established, structured psychiatric screening gives dermatologists an accessible entry point into mental health assessment. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item scale are validated, brief tools for identifying depressive and anxiety symptoms, while the Dissociative Experiences Scale provides a quantified measure for patients with trauma histories or dissociative features. When a formal psychiatric referral is warranted, the way it is introduced matters enormously, because patients may interpret it as dismissive of their physical complaints. The review suggests framing the referral around the well-documented overlap between chronic inflammatory skin disease and mental health disorders, positioning psychiatric care as a strategy to improve both skin and mind rather than as a verdict that the problem is all in the patient’s head.

Treatment itself must be individualized, and the review is candid about the limits of the evidence base: recommendations rest primarily on case reports, case series, and expert opinion, because controlled clinical trials in dermatitis artefacta are scarce. Cognitive behavioral therapy may help address mood and anxiety disorders and reduce maladaptive coping mechanisms such as skin manipulation. Acceptance-enhanced behavior therapy may suit patients with mood dysregulation, with reports of reduced self-initiated cutaneous injuries and improved psychological functioning. For those with trauma histories or dissociative symptoms, eye movement desensitization and reprocessing has been associated with sustained dermatologic improvement and emotional resolution of trauma-induced distress. Psychodynamic therapy may benefit patients whose depression, trauma, or anxiety is prominent, and case reports describe its usefulness in adjacent body-focused repetitive behaviors such as trichotillomania and nail biting. When psychotherapy alone is insufficient and psychiatric comorbidity causes significant morbidity, pharmacologic options come into play: selective serotonin reuptake inhibitors are favored for their efficacy in depression and anxiety and their favorable side effect profile, while case reports suggest mood stabilizers may reduce dissociative episodes and self-harm in patients with underlying affective or personality disorders.

The review closes with a sober assessment of what the field still lacks. No controlled trials exist, standardized diagnostic approaches are missing, and heterogeneous presentations continue to delay recognition, so the authors call for prospective multicenter studies, better characterization of psychiatric comorbidities, and formal evaluation of multidisciplinary psychodermatology care models. In the meantime, the practical message for clinicians is that effective management extends well beyond the resolution of skin lesions. Long-term follow-up should monitor psychiatric symptoms, psychosocial stressors, treatment adherence, and recurrence, with timely adjustment of therapy as circumstances change. Relapse is common, and the single most protective factor appears to be a sustained, trust-based therapeutic relationship that accommodates patients through the fluctuating course of this psychologically driven condition. Recognizing dermatitis artefacta as fundamentally psychocutaneous, and integrating dermatologic and psychiatric care from the first suspicion through years of follow-up, may be the difference between a patient lost to repeated referrals and one who finally begins to heal.

Subject of Research: Psychiatric comorbidities and treatment strategies in dermatitis artefacta, a factitious psychodermatologic disorder

Article Title: Psychiatric comorbidities and treatment strategies in dermatitis artefacta: a narrative review

Article References: Park, I., Bayrouti, A., MacIntyre, D., Awad, C., & Nguyen, M. O. (2026). Psychiatric comorbidities and treatment strategies in dermatitis artefacta: a narrative review. Archives of Dermatological Research, 318(1), Article 479. https://doi.org/10.1007/s00403-026-04973-1

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04973-1

Keywords: dermatitis artefacta, psychodermatology, factitious disorder, psychiatric comorbidities, self-inflicted skin lesions, cognitive behavioral therapy, SSRIs, EMDR, borderline personality disorder, mood stabilizers, psychodynamic therapy, multidisciplinary care