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 investigated by Hughes et al. (1983) reported that their skin condition affected their married life; Lannigan and Coterill (1989) found that a small proportion of women (9%) would not reveal their birthmarks, even to their husbands, and according to Koo (1996), many patients with psoriasis claim that their disease is a major obstacle in forming and sustaining intimate relationships. This demonstrates that, in both established and new relationships, disfigurement can be profoundly shaming if skin disease creates insecurities over how attractive and desirable individuals feel they are to their partners.
Kellet (2002) describes patients' responses to disfigurement as reflecting a specific form of body shame, namely dermatological shame, where focus is on the appearance of the skin and its relative attractiveness. Dermatological shame may be 'specific' to the disease or 'generalised' in relation to self-schemas (beliefs about the self). In specific dermatological shame, the focus is on the disease itself. Other aspects of the self remain unaffected and the individual is able to function effectively in various spheres of life. Individuals with a secure attachment style, being confident with their identity, are more likely to experience 'specific' shame. This would involve accepting the disease and dealing with its physical and psychosocial consequences in a contained way.
Generalised shame, as it suggests, is more pervasive. It merges with other shame schemas to create an all-encompassing inner experience of self-disgust that includes negative self-beliefs, social stigma and unfavourable comparisons with others. Such shame can have devastating effects on a couple if it leads to loss of intimacy and communication difficulties. For example, anxious-ambivalent adults naturally worry about abandonment, thus generalized shame may confirm that they are unattractive and ultimately rejectable. Fear of losing the relationship may then trigger coping, such as heightened displays of distress possibly to elicit a response from their partner or solicitous behaviour to gain acceptance. Avoidant adults are more likely to react by hiding their shame and by minimising displays of emotional distress over appearance.
In some couples, unaffected partners can deepen psychological distress in their loved one by passing insensitive comments about their appearance. Off-the-cuff remarks such as 'what happened to your face?' or those said in the heat-of-the-moment, such as 'your skin looks awful', can lead to relationship tension. Anxious-ambivalent individuals are particularly sensitive to criticism, thus a situation of high reactivity may evoke counter-attacking arguments in which partners begin to use each other's imperfections as weapons for war. Such conflict increases the likelihood of misunderstandings and, if it escalates, relationship distress will undermine the emotional security of both partners. Conversely, partners' who show unconditional acceptance, demonstrate respect, sensitivity, use humour and make their loved one feel valued and attractive, despite the skin condition, can have a powerful effect on adjustment. Richards et al. (2004) examined illness representations in patients with chronic psoriasis and their partners. Findings showed that divergent beliefs over the emotional impact of the disease was linked with significantly higher levels of anxiety, depression and worry in patients as opposed to their partners. 'Empathic coping' is thus a special challenge to partners as it involves understanding how dermatological shame impacts on their loved one and also on the functioning of the relationship.
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Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.