手の傷跡を頻回に見つめる醜形恐怖症の1例

A Case of Dysmorphophobia: frequent staring at a hand scar

　【抄録】　患者は，22歳の男性。中学3年生時，学校で同級生のある女生徒に手の凍瘡をからかわれたが，その夜，「傷にみせかけたらいい」と唐突に思いつき，凍瘡の部分を自らコンクリート壁にこすりつけた。しかし，その後患者は，傷を作ったことを非常に後悔して，傷が治癒してまったく目立たなくなった後も傷跡ばかりを見つめ，また，「傷ができたために他人から哀れに思われるのではないか」と恐れて傷跡を隠そうとする醜形恐怖症状が出現した。

　約4年間上記症状が続いたが，初めて職場の同僚に悩みを打ち明けたところ，「傷跡は気にするほどのものではない」と，一笑に付され，それを契機に他人から傷跡を見られることに対する恐れは急速に消失した。しかし，その後，傷跡を気にしたために楽しく過ごせなかった過去に対する後悔が出現し，そのために手の傷跡を頻回に見つめるという行為が持続した。

　このような，発病当初から患者に一貫して認められている手の傷跡を見つめる行為を通して，患者における傷跡の持つ意味を精神病理学的に考察した。

　A case of a 22 year-old patient: When he was in third year of junior high school, a schoolgirl in his class played a prank, hurting the chilblain on his hand. That night, he suddenly hit on the idea of changing the chilblain into an injury, so he rubbed the chilblain part against a concrete wall. Then he deeply regretted having made the wound and always stared at the injury even after the jnjury had been healed, and had become hardly visible. He also developed dismorphophobia symptoms in which he tended to hide the scar in an attempt not to be sympathized with by other people.

　These symptoms persisted for about 4 years. Finally he told his colleague in the company his concern about the scar. The colleague said with a laugh, “It is stupid to think about such a slight scar, it doesn't matter anyway”. After that, he soon lost the fear that his scar might be seen by other people. However, he again began to regret that he had been unhappy in the past because of his concern about the scar, and this new regret caused him to stare at the scar frequently, again.

　So, it can be said that he has never really quit staring at the scar on his hand since the initial development of the aberration. Because of this behavior, we discussed the psychopathological meaning of the scar in this patient, and our undestanding of the case is reported.