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 professionals in order to provide the knowledge base behind the specific chapters. As health professionals involved with dermatology patients, it is our responsibility to be aware of all facets of skin disease and the way that these different facets interact to create the experience of suffering that can result from skin disease. Time constraints, financial restrictions and organisational inertia mean that this broadening of knowledge to better understand the physiological, psychological and social is not always possible. If anything, it is the purpose of this book to use the shared knowledge of our different contributing experts to help to broaden our perspective as health professionals both generally and specifically in the hope that skin disease patients receive a greater level of service in whatever health context they use.
In Chapter 2, Dr Leslie Millard, a Dermatologist from the University of Nottingham, discusses the multidisciplinary relationship between the physiological, psychological and social aspects of skin disease and the way that these factors can interact to influence the course of the disease is discussed. A treatment of recent research and approaches in the field of psychoneuroimmunology and how these relate to skin disease are discussed.
The psychiatric comorbidity in dermatological disorders is often one of the most important indices of the overall disability associated with these conditions and it is well established that significant psychiatric and psychosocial comorbidity is present in at least 30% of dermatology patients. Chapter 3 looks at the psychological morbidity associated with skin disease. Dr Madhulika Gupta, a Psychiatrist from the University of Ontario with expertise in the psychosocial aspects of skin disorder, highlights the relationship between dermatological disease and psychiatric comorbidity. This chapter focuses on the results of research on the relationship between skin disease and such psychosocial constructs as depression, suicidal ideation, social anxiety and body dysmorphic disorder.
In Chapter 4, Dr Gerry Kent from the University of Sheffield focuses on the stigma associated with disfigurement and skin disease particularly. Dr Kent, a Psychologist with a particular research interest in the stigma associated with vitiligo, highlights the myths and prejudice felt by those who are visibly different. By addressing the types of stigmatisation that people encounter, the content and effects of these experiences, the reasons why stigmatisation occurs and the ways in which we might reduce stigmatisation as well as a consideration of future research possibilities, Dr Kent comprehensively addresses the different ways in which people can feel stigmatised and the responses to this stigma.
Chapter 5 elaborates on factors that impact upon the adaptation and coping process. Dr Andrew Thompson, a Clinical Psychologist from the University of Sheffield who has published widely on the topic of skin disease and coping, discusses the various behavioural and cognitive changes that may accompany the onset of a skin condition. This chapter reviews the literature pertaining to adjusting to life with a chronic dermatological condition and details the factors that play key mediating roles in explaining individual variation in coping and adjustment.
The role and significance of intimate relationships in adjusting to skin disease is a neglected area in dermatology, despite evidence that partners are usually the most important source of support when facing ill health. Previous chapters have described the emotional and psychological effects of skin disease on the individual but skin disease often has an impact on relationships and Chapter 6 considers this impact and focuses on some of the relationship contexts in which difficulties regarding the skin condition may arise. Issues covered include the impact of skin disease on relationships, appearance and physical attraction, communication problems and sexuality. This chapter is contributed by Litsa Anthis from London
Metropolitan University, a counselling psychologist with extensive clinical and research experience working with skin disease patients around the world.
Since the psychological problems associated with a child's medical condition can have long-term implications, addressing these problems could be even more crucial for children than it is for adults. Although skin disease is very common among children and young people, there is surprisingly little research on the psychological impact of skin disease in childhood. Despite this lack of research, there is widespread acknowledgement of the impact of skin disease on the psychological well-being, and quality of life of children and their families. Chapter 7 addresses the key issues in understanding the relationship between skin disorders and psychological factors for children. It describes current theoretical models of the psychological impact of physical disease on children and their families as well as reviewing intervention strategies and methods of improving the psychological outcome for the children and their families. Dr Penny Titman, a Clinical Psychologist from Great Ormond Street Hospital for Children and an expert in the psychosocial aspects of paediatric dermatology, uses this chapter to discuss these distinct challenges to this population of skin disease patients.
On a practical level, dermatology deals with an organ that can be readily seen and touched. From intrusive questions to rude comments, relationship issues to depression, cutaneous conditions can have a devastating on the life of many sufferers. Chapter 8 will examine the use of counselling in addressing the issues faced by skin disease patients and will review the most frequently used psychological treatments. Their efficacy will be critically evaluated and recommendations for treatment will be made that take into account the potential challenges faced by people with skin problems. This chapter is contributed by Dr Linda Papadopoulos, a Reader in Psychology at London Metropolitan University and Co-editor of this book. Dr Papadopoulos uses her considerable research and clinical experience to highlight the potential benefits of psychotherapy to dermatology patients.
Research technique and methodology is crucial to any academic discipline and Chapter 9 will critically focus on the techniques and methodology used to assess quality of life and outcome in the health disciplines that comprise psychoderma-tology. Dr Andrew Finlay, a leading Dermatologist from the University of Wales College of Medicine and an expert in the psychometric issues prevalent in the field of psychodermatology makes recommendations for future directions.
Dr Carl Walker, Co-editor and a Health Psychologist from University College London with wide practical and research experience in psychodermatology, uses Chapter 10 to draw together the research findings to date within a theoretical framework that emphasises our understanding the importance of the beliefs people hold about their skin disease. Real-life anecdotal illustrations of the effect that skin disease can have on sufferers are provided in order to frame some of the aforementioned theory of earlier chapters within an everyday colloquial context. This chapter also discusses the issues facing psychodermatology as a multidisci-pline and the role of psychodermatology in the future, emphasising the ways in which the implementation of psychological knowledge can benefit the health professionals that work with skin disease patients and how they can help the patients themselves.
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