The psychological impact of skin disease

It has been suggested that people whose appearance deviates from the norm have a more acute sense of awareness of their own bodies and the associated pressure to comply with social standards. This pressure has personal and social implications such as affecting relationships and hobbies (Porter et al., 1987), quality of life and expectations (Lanigan & Cotterill, 1989), and career aspirations (Goldberg et al., 1975).

Research into the manifestations of psychocutaneous disorders has led to an increasing awareness of the psychosocial effects associated with skin disease. These include depression, a decreased sense of body image and self-esteem, sexual and relationship difficulties, and a general reduction in quality of life (Dungey & Busselmeir, 1982; Obermeyer, 1985; Porter et al., 1987; Papadopoulos et al., 1999). Indeed, research has shown that people with skin disease experience higher levels of psychological and social distress (Root et al., 1994), poorer body image and lower self-esteem than the general population (Papadopoulos et al., 1999) and higher avoidance of situations where their skin may be exposed (Rubinow et al., 1987). Leary and colleagues (1998) suggest that the degree of social anxiety depends on a person's confidence regarding their ability to successfully manage the impression they make and it has been shown that social anxiety is a mediating factor between the severity of a disfiguring condition and an individual's emotional reactions.

An eclectic group of skin disease outpatients reported that their lives had been affected by skin disease in many ways (Jowett & Ryan, 1985). They reported difficulties in their relationships and poorer employment opportunities due to their skin disease, not to mention the damage that they felt their skin disease had afflicted on their self-esteem. Furthermore, functional and interpersonal problems in the workplace, increased anxiety and lack of confidence were also cited. Many patients feel that their sexual relationships and ability to find a partner have also suffered due to their skin condition (Porter et al., 1990). Furthermore, a British survey of acne patients showed unemployment levels in acne participants to be significantly higher than control participants (Cunliffe, 1986).

There is also evidence for cross-cultural stigmatisation due to skin disease. A striking example of this is the case of onchocercal skin disease (OSD), a disfiguring skin disease mostly found in Africa and associated with river blindness (onchocerciasis). Through a series of interviews with OSD sufferers in five different African sites, it was concluded that attitudes towards stigmatising illnesses showed strong similarity over the geographical and cultural areas specified in the study (Vlassoff et al., 2000).

Perhaps one of the crucial myths that permeates the lay discourse on skin disease is that of the severity of the condition being in some way related to a fixed psychosocial morbidity as experienced by the sufferer. This myth can help to form a barrier between the patient and friends, family and health professionals when outsiders automatically assume that a small or invisible lesion of dermatitis should not affect the psychological health of the sufferer. Thompson and Kent (2001) note that there is considerable evidence to suggest that self-perceived appearance, the view from the inside, is actually limited in its relationship with the social reality of appearance (Ben-Tovim & Walker, 1995; Robinson et al., 1996; Kleve et al., 2002).

Getting to Know Anxiety

Getting to Know Anxiety

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