Appearance attraction and shame

Romantic couples spend exclusive time together, they share social and leisure experiences, and allow themselves to be mutually vulnerable in ways they rarely do with others. Consequently, the feelings and perceptions romantic partners have about one another and the feedback they give on each other's appearance could substantially impact on how each will feel about themselves, their bodies and their relationship (Tantleff-Dunn & Gokee, 2002). Sixteen per cent of dermatology patients...

Contents

Skin disease and psychology a multitude of links 2 Self-schema(s) and body image 5 The psychological impact of skin disease 6 Management Theoretical models and psychodermatology 8 The diatheses-stress paradigm 8 Cytokines in depression and anxiety 21 3 Psychiatric comorbidity in dermatologic disorders 29 Obsessive-compulsive disorder 34 Social phobia (social anxiety disorder) 35 Post-traumatic stress disorder 35 BDD and other body image pathologies 36 Delusional disorder and other psychotic...

Identity

Variables that identify the presence or absence of the illness Skin diseases can be identified by symptoms such as pain and itching, concretely by signs like sores or bleeding and by the use of abstract labels such as eczema or psoriasis. Identity is important because the meaning and interpretation of a symptom can influence the way the person addresses the symptom. Should a patient erroneously apply the label of skin cancer to a white lesion on their skin, this could precipitate a different...

Efferent pathway

The functional response, that is the degree to which the stimulus is recognised as a stress, is determined by the individual perceptions of the magnitude and importance of the challenge. The degree of the effector response is determined by factors, which may suppress or magnify this reaction. Thus patient reactions to a bee sting can be demonstrably different. In the truly venom-allergic patient this may lead to an immediate dramatic immune-mediated anaphylaxis. Secondly, in the bee-phobic...

The neuroendocrine pathway

Whatever the recognised stressor, the response is to trigger the neuroendocrine pathway via the hypothalamic-pituitary-adrenal (HPA) axis (Chrousos, 1995). The hypothalamic paraventricular nuclei stimulate the secretion of corticotrophin releasing hormone (CRH) and in addition, vasopressin. These travel down the hypophyseal-pituitary portal system to the anterior pituitary and release adreno-corticotropic hormone (ACTH). The adrenal cortex responds by secreting cortisone into the circulation...

Atopic eczema

The psychosocial stressors implicated in atopic dermatitis are summarised in Table 2.3. Table 2.3. Psychosocial stress in atopic eczema Sleep disturbance Withdrawal of touching 'allergic object relationship' Diet modification stresses Disfigurement reactions, such as rejection, secrecy and aggression Underachievement Psychosexual difficulties Parental distress The influence of these factors, with regard to physical atopic disease, depends on both generic and specific individual features....

Major depressive disorder

Major depressive disorder (American Psychiatric Association, 1994) is one of the most commonly encountered psychiatric disorders in dermatology (Gupta & Gupta, 1996 Woodruff et al., 1997). Major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)) (American Psychiatric Association, 1994) is characterised by one or more major depressive episodes. Depression is a recurrent disorder and 50-60 of patients who have experienced one major depressive...

Difficulties in communication

Secrecy and self-disclosure are two opposite forms of communication that can alter couple functioning by shaping what issues couples' feel able to discuss with one another and how needs for closeness and separateness are managed (Feeney & Noller, 1996). Secrecy in skin disease involves safety behaviours such as making excuses to avoid activities involving exposure of the skin and concealing affected areas through the use of clothes or cosmetics. In existing relationships, even if a skin...

Cognitive factors personality characteristics and core beliefs

Predisposing developmental factors are clearly linked to the development of several personality characteristics that are emerging as having predictive power in explaining some of the variability in adjustment. Whilst disrupted attachments in childhood have been discussed as having the potential to lead to stable attachment styles in adulthood, few studies have actually explored the role of attachment, and those that have, were unable to relate this directly back to early experiences. Picardi et...

Body image and sexual intimacy

Another important area in a couple's relationship is that of sexual intimacy. The association between body image and sexual functioning is a good illustration of the reciprocal nature of interpersonal influences in skin disease (Weiderman, 2002). Common sense dictates that good sex is about confidence, feeling good about yourself and your body. Yet, many dermatology patients struggle with physical intimacy and often have sex lives that are fraught with difficulties. Avoidant Attachment Style...

The impact of skin disease on the psychological wellbeing of the child and family

There are a large number of studies that have shown that any form of physical illness during childhood increases the risk of psychological difficulties for the child (Lavigne & Faier-Routman, 1992 Wallander & Varni, 1998). There is also evidence from a few studies about the specific impact of a skin disorder on childhood psychological problems. For example, Absolon et al. (1997) found that children with eczema had higher rates of behavioural problems than healthy children. Rates of...

References

Albrecht, G.L., Walker, V., & Levy, J. (1982). Social distance from the stigmatized. A test of two theories. Social Science and Medicine, 16, 1319-1327. Bandura, A. (1977). Social Learning Theory, Englewood Cliffs, NJ Prentice-Hall. Baumeister, R., & Tice, D. (1990). Anxiety and social exclusion. Journal of Social and Clinical Psychology, 9, 165-195. Baumeister, R.F., Twenge, J.M., & Nuss, C.K. (2002). Effects of social exclusion on cognitive processes anticipated aloneness reduces...

The impact of skin conditions on selfesteem

It is hard for a child to grow up with a skin condition and for this not to have some impact on their self-esteem. However, the variation in the impact on self-esteem cannot be entirely attributed to the severity of the child's condition, because it is very dependent on psychological factors and the child's beliefs about their condition. It is possible for a child with very damaged skin to report high levels of self-esteem and vice versa for a young person with very trivial skin blemishes to...

Timeline

This attribute concerns the perceived time frame for the development of the condition or threat. Time frames run through all aspects of illness representations and can be crucial with respect to the way that patients label and conceptualise the illness. A patient with newly diagnosed psoriasis may assume from the knowledge that they have gained that the condition is episodic and hence should remit in the near future. This could prompt a set of short-term avoidance behaviours designed to conceal...

Psychology and treatment

As touched upon above, attention has increasingly been given to the therapeutic benefits that might derive from psychological interventions. As discussed in Chapter 8, the research literature has documented psychological interventions for a number of cutaneous conditions (Van Moffaert, 1992 Papadopoulos & Bor, 1999), and an array of techniques and approaches have been adopted within this context. These include psychoanalysis and hypnosis (Gray & Lawlis, 1982) behavioural techniques...

Psychosocial impact of skin diseases

Within the psychodermatological literature, there is a great degree of consensus that skin disorders have a negative impact upon the psychological and emotional functioning of some patients. Indeed, research has provided evidence that such appearance-altering diseases can have profound behavioural, emotional and cognitive impact upon sufferers (Griffiths & Richards, 2001 Thompson & Kent, 2001). A brief overview of the most commonly researched psychological implications is thus provided....

Conclusion About Skin Diseases

This chapter has explored the impact skin disease has on couples and how attachment styles can influence the process of adjustment. It is evident that altered appearance, difficulties in communication, shifts in social networks and decreased sexual intimacy are triggers for acute and chronic stress that can threaten relationship functioning. Despite the aforementioned difficulties, the process of adjustment also provides couples with opportunities to discover untapped potential in their...

Obsessivecompulsive disorder

OCD (American Psychiatric Association, 1994) is characterised by recurrent obsessions or compulsions severe enough to be time consuming or cause marked distress or significant impairment. OCD is an anxiety disorder, and some of the compulsive behaviours of OCD may in fact further exacerbate skin disorders that are associated with or exacerbated by anxiety such as atopic dermatitis. Some of the compulsions involve repetitive behaviours such as hand washing, hair plucking, trichotillomania,...

Skin disease and psychotherapy an example of how psychology can help

The importance of the way that an illness is represented cognitively has been shown to be important in a number of aspects of living with a skin disease. Thus if we assume that illness schemata are implied in behavioural and coping strategies then faulty schemata may result in dysfunctional responses. Illness schemata represent learned patterns of perception and cognition, and can be extremely resistant to change. To alter maladaptive illness and or personal representations and to change...

Stress and dermatology

As far back as the 19th century, Hillier (1865), in working with eczema, implicated mental excitement, nervous debility and anxiety as the cause of these skin diseases. In 1982, Teshima and colleagues found that emotional stress had the capacity to influence the immune system to a great extent and that this would often manifest in cutaneous illness. They found that the tension in patients could lead to an enhancement of allergic reactions and these allergic patients were shown to improve with...

Skin disease and body image

To understand the social and psychological experience of living with a skin disease, it is essential for health professionals to understand patients' cognitions and the ways in which they represent their illness and their sense of self (Weinman et al., 2000). Body image can be hypothesised as the 'inside view' that pertains to our own highly personalised experiences of our looks. For many people in society, body experiences are fraught with discontent, unhappiness and self-conscious...

A theoretical framework for skin disease what do patients know about their own skin disorder

The psychology of the dermatology patient is a relatively under-researched area and so suffers from a relative lack of clarity. We have substantially covered the psychosocial effect that skin disease can have upon an individual and their social system but, just as important, is the way that the patient represents their illness. Understanding these dermatological illness representations might play a fundamental role in understanding treatment compliance, behavioural adaptation, impact upon...

In sickness and in health

When selecting a romantic partner, a personal choice is made based on reasons for wanting to be with a particular person. Some of these reasons are conscious and others are not. Undeniably, individual expectations and 'ideals' on what relationships should offer will vary, but for most there is a hope that existing or new relationships will serve as a source of support and personal growth (Altschuler, 1997). In the course of being together however, couples will face various difficulties that, if...

Psoriasis

Psoriasis, like atopic eczema, is an inflammatory skin disease with a multifactorial aetiology. It is a chronic, immune-mediated disorder (Kreuger, 1989) associated with significant physical and psychological morbidity. The psychological factors have been summarised by Ginsburg and Link (1989) and instruments have been developed to measure psoriasis-related stress (Wang et al., 1990 Fortune et al., 2002). In psoriasis there is an overexpression of INF gamma and TNF alpha and a relative...

Theoretical models and psychodermatology

Contextualing a review of any discipline requires that the discipline be placed within a theoretical and historical framework, and this approach is appropriate for psychodermatology. By the 1950s, the incidence of contagious diseases had declined rapidly and non-contagious diseases were on the increase. These included diseases that are related to lifestyle variables such as lung cancer and heart disease. Improved hygiene, vaccines and general medical treatment led to longer-life expectancy and...

Penny Titman

Skin disease is very common among children and young people. For example, up to 20 of young children develop eczema and the majority of young people develop some symptoms of acne temporarily during adolescence (McHenry et al., 1995 Smithard et al., 2001). However, there is surprisingly little research on the psychological impact of skin disease in childhood and the focus of most research in paediatric psychology has been on life-threatening conditions, such as cancer. Despite the lack of...

References Of Skin Diseases

Al-Abadie, M.S., Kent, G.G., & Gawkrodger, D.J. (1994). The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. British Journal of Dermatology, 130, 199-203. Barber, T.X. (1978). Hypnosis, suggestions and psychosomatic phenomena a new look from the stand point of recent experimental studies. American Journal of Clinical Hypnosis, 21, 113-127. Beck,A. (1976). Cognitive Therapy and Emotional Disorders. New York International Universities Press....

The social and psychological impact of skin conditions

To some extent skin conditions are unique from many other diseases in so far as they are often visible to others, and as a result social factors associated with both appearance and illness are relevant to the adjustment process. There is no doubt that living with a chronic skin condition can be stigmatising (Kent, Chapter 4, this volume). As early as 1976 Jobling found that for psoriasis sufferers the greatest psychosocial impact of having the condition were interpersonal difficulties. It is...

Conclusion

The interface between psychiatry and dermatology is multidimensional and begins in early development. The skin is a vital organ of communication and the earliest social interactions between the infant and its caregivers occur via the body, especially through touch. A disruption in tactile nurturance, for example, as a result of a skin disorder during infancy or due to childhood abuse and or neglect can be associated with serious psychiatric morbidity in later life including major depressive...

The impact of skin disease on the motherchild relationship

For a very young child or baby who is dependent on his or her mother for all his or her care, there is likely to be a reciprocal relationship between the mother and child in terms of both the child's physical and psychological state. For example, if a baby is distressed or fretful because of physical discomfort, this may result in an increased need for care from his or her mother, and this increased demand on the mother's caring resources may make her feel more stressed and she may respond less...

Litsa Anthis

'I remember a few months back, when I used to see his knuckles, how they were dry, cracked and bloody, and then I noticed his arm, and when I gently inquired he would retreat and change the subject. This was also before we became close. He has slowly grown more comfortable and one night, after cuddling and holding each other for a while, he asked me if I'd like to see and I said please. He took off his shirt and I saw the extent of his condition. His entire back, arms and parts of his legs were...

What types of stigmatisation do people encounter

People with dermatological conditions often claim that their main difficulties arise from others' reactions to their disease, rather than the disease itself (e.g. Rapp, 1999). Perceptions of stigmatisation are common amongst those with a visible skin difference. For example, Gupta et al. (1998) found that 26 of their patients with psoriasis reported that they had experienced an episode when someone made an effort not to touch them because of their psoriasis. Ginsburg and Link (1989) also...

Psychodermatology

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo The Edinburgh Building, Cambridge cb2 2ru, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title www.cambridge.org 9780521542296 Cambridge University Press 2005 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the...

Compare Alexithymia And Coping Style Between People With Ms And Other People

Not just skin deep. Nursing Standard, 37,22-24. Allegranti, I., Gon, T., Magaton-Rizzi, G., & Aguglia, E. (1994). Prevalence of alexithymia characteristics in psoriatic patients. Acta Dermatologica Vererologica, 186, 146-147. All Party Parliamentary Group on Skin (2003). Report on the enquiry into the impact of skin diseases on people's lives. London HMSO. Altabe, M., & Thompson, J.K., (1996). Body image a cognitive self-schema construct. Cognitive Therapy and...

About the book

This book is intended to provide material of interest for a range of health professionals, including psychologists, psychiatrists, GPs, nurses and dermatologists as well as any other professionals who work with dermatology patients. Indeed this multidisciplinary readership is the key context behind the creation of the book. The book has been developed by academic psychologists, psychiatrists, psychotherapists and dermatologists, and it has taken the specific skills of each of these experienced...

Future research

This review suggests that there is scope for further research in a variety of areas, both personal (in terms of effects on individuals and the development of their coping skills) and social (in terms of understanding why stigmatisation occurs and how it might be reduced). A number of studies reviewed above indicate that stigmatisation due to derma-tological conditions can have far-reaching and long-term effects on individuals. However, almost all of this work has been cross-sectional. There is...

Gerry Kent

It can be argued that all research on stigma and stigmatisation is a footnote to the sociologist Erving Goffman. In a few short, elegantly written books e.g. Goffman, 1968 , he provided a wealth of ideas and insights, giving much inspiration to work on this topic. Goffman defined a 'stigma' as a mark or sign that not only sets a person apart from others but also leads to their devaluation. He distinguished between three types of stigma 'tribal identity' such as race, gender or religion...