Only limited support for a role of psychosomatic factors in psoriasis. Results from a case-control study.
ABSTRACT To investigate the role of stressful events, social support, attachment security and alexithymia in triggering or exacerbating psoriasis.
Outpatients experiencing a recent onset or exacerbation of psoriasis (n=40) were compared with outpatients with skin conditions in which psychosomatic factors are regarded as negligible (n=116). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and perceived social support were assessed with the ECR questionnaire, the TAS-20 and the MSPSS, respectively.
The mean number of recently experienced life events, or of undesirable, uncontrollable or major events was not different between psoriatic patients and controls. The only stress measure that showed a slight trend towards an association with psoriasis was having experienced four or more stressful events in the preceding year. There was a statistical trend towards an association between alexithymia and psoriasis, whereas there were no significant differences between patients with psoriasis and controls with respect to perceived social support and attachment security. Subgroup analysis suggested that the role of all psychosomatic factors studied might be more important in certain clinical types, such as guttate and diffuse plaque psoriasis.
Our findings provide only limited support for a role of psychosomatic factors in psoriasis. Future studies should investigate chronic and daily stressors in addition to major life events, include measures of stress appraisal and include specifically patients with a recent onset of disease.
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ABSTRACT: To examine the effect of a brief laboratory stressor and social support before the stressor on cardiovascular and cortisol responses, and skin barrier recovery after skin disruption. Eighty-five healthy participants (mean age 22.9 +/- 4.4 years) underwent a "tape-stripping" procedure that disrupts normal skin barrier function, and were randomly assigned to a No Stress (reading task), Stress (Trier Social Stress Test), or Stress + Social Support condition (support from a confederate before the stressor). Skin barrier recovery was assessed by measuring transepidermal water loss from up to 2 hours after skin disruption. Compared with the No Stress condition, the stressor delayed skin barrier recovery by 10% at 2 hours after skin disruption (effect size, r = .29), and increased anxiety (r = .24), negative affect (r = .22), cardiovascular activity (r values from .4-.6), and among male participants, cortisol levels (r = .40). Social support did not influence psychological or physiological responses or skin barrier recovery. Larger physiological responses to the tasks did not predict slower skin barrier recovery. Instead, larger systolic blood pressure responses predicted faster skin barrier recovery (r = .26). This study replicated the effects of short-term laboratory stressors on skin barrier recovery, further establishing the relevance of skin barrier recovery for future research. The support manipulation did not influence physiological responses or skin barrier recovery, suggesting that future research on social support, physiology, and objective health outcomes should focus on naturalistic social interactions, relationships, and stressors.Psychosomatic Medicine 12/2007; 69(8):807-15. · 4.08 Impact Factor
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ABSTRACT: Objective: Problems of affective regulation are considered to contribute to the pathogenesis of psoriasis. The aim of this study was to assess the association between alexithymia and anger, and affect regulation in patients with psoriasis.Methods: One hundred and five consecutive patients with psoriasis and 109 healthy subjects who applied to Ankara Numune Education and Research Hospital, 2nd Dermatology Clinic between August 2005 and January 2006 were enrolled in the study. The subjects were evaluated by using sociodemographic data form, the Turkish version of the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anger Expression Inventory, 20-item Toronto Alexithymia Scale (TAS-20).Results: No significant statistical difference was detected between the BAI and TAS scores of the two groups.The BDI scores of the psoriatic group were significantly higher than those of the healthy control group. The trait anger and anger-in scores were higher in the patient group compared with the control group, while no difference was detected between the two groups in terms of anger-out and management of anger. Scores of TAS-A were positively correlated with trait anger, anger-in and anger-out. TAS-B and TAS-Total were correlated positively with trait anger and anger-in, and negatively with anger-control. Conclusion: The present findings suggest that patients with psoriasis are not alexithymic and anxious, but more depressive, trait anger and anger-in. Trait anger and anger management styles were detected to be related with alexithymia, especially with its emotional component. Correlation between trait anger and severity of illness suggests that anger management is important in the treatment of patients with psoriasis. Our results indicate the regulatory role of alexithymia in the management of anger in patients with psoriasis. (Archives of Neuropsychiatry 2009; 46: 169-74)Nöropsikiyatri Arşivi. 01/2009;
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ABSTRACT: The authors' aim was to investigate the role of stressful events, perceived social support, attachment security, and alexithymia in triggering exacerbations of diffuse plaque psoriasis. Inpatients experiencing a recent exacerbation of diffuse plaque psoriasis (N=33) were compared with inpatients with skin conditions believed to have a negligible psychosomatic component (N=73). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia, and perceived social support were assessed with the Experiences in Close Relationships questionnaire, the Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support, respectively. Multiple logistic regression analysis was used to control for age, gender, education, marital status, and alcohol consumption. In relation to comparison subjects, the patients with psoriasis had lower perceived social support and higher attachment-related avoidance. Also, they were more likely to have high alexithymic characteristics. There were no differences between the patients with psoriasis and the comparison subjects in scores on the Experiences in Close Relationships anxiety scale, the total number of stressful events, and the number of undesirable, uncontrollable, or major events. Although caution should be applied in generalizing these findings to outpatients, this study suggests that alexithymia, attachment-related avoidance, and poor social support might increase susceptibility to exacerbations of diffuse plaque psoriasis, possibly through impaired emotional regulation. Several physiological mechanisms involving the neuroendocrine and the immune system might mediate the interplay between stress, personality, and diffuse plaque psoriasis.Psychosomatics 01/2005; 46(6):556-64. · 1.73 Impact Factor