personality disorders; It is a continuous pattern of internal experiences and behaviors that deviate significantly from what is expected according to one’s own culture. It begins in adolescence or young adulthood, persists over time, and causes distress or impairment. In order for personality traits, which can be seen in various forms in everyone, to be considered as personality disorders, they must be inflexible and maladaptive, causing significant impairment in functionality or personal distress. These unchanging attitudes and behavior patterns manifest themselves in the following areas: (1) Differences in thought (in the way the person interprets himself, others and events); (2) In affective differences (range, intensity, variability and relevance of emotional responses); (3) In the difficulties experienced in interpersonal relations; (4) Difficulty controlling impulses.
Narcissistic Personality Disorder
Narcissism and narcissistic personality organization and disorder are one of the central concepts of psychoanalysis. In its pathological sense, narcissism manifests as impaired ability to relate, emotional investment in one’s own self, hypersensitivity to others’ thoughts about them, and a lack of empathy towards relationship objects. Its main feature is grandiosity in behavior or fantasy, the need to be admired, and an inability to understand the feelings of others. Its incidence in the general population is 2-6%. Narcissists are often thought to be people who love themselves too much and who are overconfident. However, the real situation is exactly the opposite. Since the narcissist cannot love and respect himself without doing something, he constantly needs to do something in order to be able to love and respect himself. Mental activity is narcissistic to the extent that it seeks to sustain the structural integrity, temporal continuity, and positive emotional coloring of the self-design. In summary, we characterize activities aimed at gaining and maintaining self-esteem as narcissistic. We can talk about the weight of narcissistic pathology in proportion to the necessity and frequency of the need for such activities. They feel that they are very important (for example, they exaggerate their achievements and abilities, expect to be recognized as superior without adequate achievement). They try to get others to think so too, in order to convince themselves that they are someone moist and special. The more he can influence the other, the more he can convince himself that he is not worthless. They ponder fantasies of unlimited success, power, intelligence, beauty, or perfect love. Efforts to feel valued by influencing others give way to fantasies in the absence of people. If there are no positive reflections from the outside, this will be replaced by dreams. They have various dreams of doing things that will impress all people, gain the admiration of all, and make them well-known and adored. They imagine themselves as Nobel prize winners, chosen as the smartest, most handsome man in the world, and performing a heroic act that will save the world. They believe in these dreams as if they are real and they get rid of feeling worthless. They believe that they are special and unique and that only other special or socially privileged people (or institutions) can understand them or befriend them. They want to be liked very much. However, because they can respect themselves when they feel that others like them, they constantly strive to win the admiration of others. They are not really interested in anything, they are busy with many different activities in order to be liked more. They want to know about everything, to show it to others. Has a sense of entitlement: expectations that he or she will receive a form of treatment that is particularly favored, or conforming to these expectations. While waiting in lines and not getting special treatment makes them feel worthless, they expect a favored approach and treatment when someone is doing their job in easier ways. They make an effort to get special or privileged treatment, get angry when their expectations are not met, or insult people who do not give them special treatment. Uses interpersonal relationships for his own benefit; They use the weaknesses of others to achieve their own ends. They use the people they interact with for their own needs and purposes, especially to make them behave in a way that makes them feel good. If the people they are in contact with don’t meet these needs or they don’t need them, they move away and find other people. Unable to empathize: They are reluctant to recognize and describe the feelings and needs of others. One of the biggest challenges in human relationships is their lack of empathy. In their interpersonal relationships, they are egocentric, self-centered, and exploitative of others. Their greatest, uniqueness, and dependence on the attention, love and admiration of others gives a contradictory appearance.6 Belief in their uniqueness inhibits their ability to get close to, identify with, and empathize with others. They create a sense of inaccessibility in the objects they relate to. They do not care about their problems, troubles, needs. They are only interested in the feelings of the people they are in a relationship with about how they feel towards them. They are often jealous of others and believe that others are also jealous of them. Conscious or unconscious envy is prominent enough to draw attention. Another person’s being good and successful creates discomfort because it triggers their own feelings of inadequacy. They feel uneasy when something good is said about someone. The fear here is the fear of being left behind, being forgotten and losing its importance. They immediately attempt to belittle those who are praised and appreciated. They try to catch and expose the vulnerabilities of the people in question with various opportunities. Shows arrogant, smug behavior and attitudes. Arrogance, aloofness, coldness are common as a defense against narcissistic injuries. They make it clear from the start that they don’t care about the opinions of others, as a defense against criticism from others. They act arrogantly and distantly when they can be criticized.
Borderline Personality Disorder
Borderline disorder was considered at the border of schizophrenic disorders at the beginning of the psychiatric perspective; later conceptualized as a transition zone between neuroses and schizophrenia. This is especially true in psychoanalysis. Their main characteristics are inconsistencies in interpersonal relationships, sense of identity, and affect, and difficulty controlling their impulses. While their incidence is 2-3% in the community, they constitute 30-60% of personality disorder cases in psychiatry clinics. It is 3 times more common in women than men. They make frantic efforts to avoid a real or imagined abandonment. They live in fear of abandonment. They fear their lover or spouse or close friend will abandon them, and they make frantic efforts to avoid being abandoned, including by making suicide threats or attempts. They try to keep people under control, such as by inducing guilt, exploiting feelings, or leaving them in debt. They have tense and inconsistent interpersonal relationships, oscillating between extremes of over-magnification and disgrace. They praise people who treat them well and are very close, they get close very quickly, but they also become very distant and angry after a disappointment. They change friends and lovers frequently, often because of their tendency to move away quickly, although sometimes a breakup or a period of anger can take the glory of the same person again. There is a markedly and persistently inconsistent sense of self or self that is defined as identity confusion. Their feelings and thoughts about who they are, what they like, what they care about, their plans for the future, what kind of people they want to be friends with, how they want to live, change frequently and easily. In a very short time, they may have opposing desires, desires, beliefs and thoughts. They show impulsivity (eg, spending money, sex, substance abuse, reckless driving, binge eating) in at least two areas that are likely to be self-harming. They show uncontrolled and impulsive behaviors in various areas such as driving fast, shopping randomly and having difficulty paying, engaging in random, risky sexual relationships, not being able to control eating or drinking, gambling, using alcohol or drugs. They show repetitive, suicidal behaviors, attempts, intimidation, or self-mutilation. They inflict physical harm on themselves in various ways, such as cutting off their arms and chest with a razor blade, or putting out a cigarette on them. These behaviors are mostly done against intense boredom, exacerbated and unmanageable emptiness. On the other hand, it is common to self-harm, threaten to commit suicide, or attempt suicide in order to get others to behave as they want, or to punish them for upsetting them. There is affective instability (affective instability) due to a marked reactivity in mood. Depending on minor events, their affect shows dramatic changes. They may suddenly fall into a great depression, intense distress, or become angry. They often do not describe their emotions well and are unaware of what makes them feel that way. They often experience anger and distress at the same time, and in such situations they display behaviors that are harmful to themselves or others. They constantly feel empty. This situation, due to the lack of identity integrity and long-term goals, becomes especially evident in the absence of people and environments that can make them feel good. 8 Feeling inappropriate, intense anger, or unable to control their anger. They have difficulty controlling their anger, as well as other impulses. The ego, covered with anger, cannot control or prevent destructive, damaging behaviors. They show temporary paranoid thoughts or severe dissociative symptoms related to stress. There may be delusions and dissociative symptoms that arise with stress, especially in situations where they feel abandoned, object loss, or excluded, usually that they will be treated badly or hostile. These symptoms improve with understanding of the cause or with short-term, low-dose drug administration.
Today, psychosomatic dermatology is an important and indispensable component of dermatology. Skin (skin) is the mirror of the soul. There are dozens of idioms in our language that convey our feelings about the skin: “I got goosebumps”, “I got itchy”, “thick skin (no face)” etc. Skin and brain arise from the same germ sheet, the ectoderm, in the embryo. The effects of these two organs on each other in various ways in the later stages of life have been the subject of many studies and many studies have been conducted on this subject. These researches can be grouped under three groups: 1- stress studies, 2- analytical and dynamic studies in skin diseases, 3- clinical evaluation and treatment of psychosomatic dermatological researches. In some countries that have realized the importance of the subject in recent years, psychiatry, dermatology doctors and psychologists work together in the psychodermatology departments where these two scientific disciplines work together, and the diagnosis and treatment plans of the patients are organized jointly. In fact, it is now accepted that this joint work of psychiatry and dermatology is a necessity in many cases. While such a collaboration aims to increase the chances of success in treatment and to provide psychiatric support to the patients who apply to dermatology and refuse to apply directly to psychiatry despite their primary condition being psychiatric, on the other hand, providing psychiatric treatment support in addition to dermatological treatment in patients whose primary problem is dermatological and who develop psychiatric problems secondarily. It also brings a more satisfying and holistic approach for the physician and the patient.
Grouping of Dermatological Diagnoses
In the most commonly used classification, diseases are divided into three groups:
1. Psychosomatic Skin Diseases:Neurodermitis, Psoriasis vulgaris, Contactdermatitis (Periorale Dermatitis), acne, urticaria
2. Psychiatric Skin Diseases:
2 a. Somatoform Disorders
2.a.1. Conversion disorders: Local genital or anal pruritus, Erythema e pudore
2.a.2. Undifferentiated somatoform disorders: Common Pruritus (sine materia) and Glossodynie
2.a.3. Bodily Dysmorphic Disorders
2.a.4 Social Phobias: Erythrophobia
2.b. Chronic Manipulative Disorders
2.b.1 Artifact: Dermatkitis artifact
2.b.2 Simulations: Münchausen Syndrome
2.b.3 Paraartefacte (Impulse Control disorders): Neurotic Exkoriationen, itching attacks, acne excorie, trichotillomania, onychophagie, onychotilomania, morcicatio buccarum, cheliditis factitia (eczema), balinitis simplex
2.b.4 Delirium syndrome: Dermatous delirium
3. Somatopsychic dermatous disorders
3.a Psychological/psychic changes in skin cancer (Melanoma)
In this study, besides the SKID 2 and SCL-90 scales, a questionnaire containing socio-demographic information will be applied to the participants.
SKID-2 will be used to select people with Narcissistic and Borderline Personality organization. It consists of 117 questions. 16 to measure the narcissistic dimension; There are 14 questions to measure the borderline dimension. The answers are “yes” or “no”. Not only the answers of the applied subject, but also the observations of the tester are decisive and important. The tester, according to his own impression, may tick “yes” instead of the administered subject, because in the diagnostic category, “yes” answers are decisive. The application takes an average of 75 minutes. The international working group gave its final shape to SKID 2 in 1996.
It is a measurement tool used to determine the psychological symptoms that may exist in the individual and the level of these symptoms. It consists of 9 subtests and 1 additional scale, a total of 10 subtests. It can be applied to individuals aged 17 and over. It is a scale that can be applied individually or as a group. The individual is given a 90-item, 5-point Likert-type question form and is asked to follow the instructions in the form. It can be applied by psychiatrists and graduates of psychology, psychological counseling and guidance departments of universities. The practitioner must receive special training to administer the SCL-90 Symptom Screening test.
120 female and 120 male adults (18 years and older) selected from the patients who applied to Okan University Medical Faculty Dermatology Clinic and diagnosed with narcissistic and borderline personality organization from SKID-2 and SCL-90 applications will participate in the study. Subjects with this narcissistic and borderline personality organization should also be included in one of the psychosomatic, psychiatric and somatopsychic dermatology diagnostic groups. It was aimed to include 40 female and 40 male subjects in each dermatology diagnosis group. Education and other sociodemographic characteristics are not intended to be evenly distributed.
Pen-and-paper (question and answer) test will be applied by interviewing the subjects face to face. 120 minutes are planned for each application. In addition to SKID 2 and SCL 90, family and biography-based information will also be obtained during the interviews. Identity information will not be requested and a voluntary participation certificate will be signed.
The structural equation model is the statistical analysis model of this research. In structural equation model studies, the researcher has a theoretical model in his hands – the model to explain the relationship between narcissistic and borderline personality organizations and the dermatological 3 diagnostic groups – but this time the main function of the model is to clarify the cause and effect relationships between a number of theoretical structures – narcissistic and borderline personality organizations They constitute one of the causes of the 3 dermatological diagnosis groups. However, in such studies, the researcher has to test the measurement model(s) created by the variables in question before investigating the relationships between the variables. In other words, just as in confirmatory factor analysis, after testing whether the measurement model of each variable is confirmed by the data, an answer is sought to the question of whether the relationships between these variables are as predicted theoretically. In the literature, in addition to testing the measurement models of all variables separately, it is seen that the measurement models of all variables are tested within a single model.
N (Narcissistic Person. Org.) Psychosomatic Dermatological Comfort.
B (Borderline Cor. Org.) Psychiatric Dermatological Comfort.
Somatopsychic Derm. Comfortable.
In this study,
1. It is assumed that patients with narcissistic personality organization will have more intense psychosomatic dermatological diagnoses than patients with borderline personality organization, and narcissistic personality organization is significantly (r=0.05) associated with psychosomatic dermatology diagnoses. In summary, narcissistic personality organization is claimed to be one of the causes of psychosomatic dermatological disorders.
2. It is assumed that patients with borderline personality organization will have more intense psychiatric dermatological diagnoses than patients with narcissistic personality organization, and borderline personality organization is significantly (r=0.05) associated with psychiatric dermatology diagnoses. In summary, it is claimed that borderline personality disorders are one of the causes of psychiatric dermatological disorders.
3. It is assumed that having a narcissistic or borderline personality organization is not determinant in somatopsychic dermatous disorders and that both personality groups will have a significant relationship (r=0.05) with somatopsychic dermatology.