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: Stress is considered as a major contributor to the development and exacerbation of psoriasis by a significant proportion of patients and dermatologists. As both stressor and its effects are subject-dependent, thus extremely difficult to measure, our understanding of the exact role of stress in disease development was limited for a long time. In the past decade several new studies were carried out which expanded our knowledge on the pathophysiologic processes linking stress to psoriasis via with their objective measurements and the applied new techniques. The authors review the current literature of both psychological (alexithymia, personality, affect) and biological (cortisol, epinephrine, neurogenic inflammation) factors influencing stress perception and response in psoriasis. Results of recent investigations support previous reports about the interaction between stress and psoriasis with objective evidence. Knowing how effective stress-reducing psychopharmacologic and psychotherapeutic interventions are in the treatment of psoriasis the authors hope that this review contributes to a wider acceptance of the psychosomatic attitude in everyday dermatologic practice. Orv. Hetil., 2014, 155(24), 939-948.Orvosi Hetilap 06/2014; 155(24):939-948. DOI:10.1556/OH.2014.29897
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ABSTRACT: Alexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. One hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients' psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI). Psoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well. The alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.Annals of General Psychiatry 12/2014; 13(1):38. DOI:10.1186/s12991-014-0038-7 · 1.53 Impact Factor
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ABSTRACT: The purpose of this prospective study was to identify predictors of "adversarial growth" or the ability of patients to construe benefits from negative events, in adaptation to the chronic, disfiguring, skin condition, psoriasis. Patients with a dermatologist confirmed diagnosis of psoriasis were assessed at induction to the study and again at between 4 and 6 months follow-up subsequent to active medical treatment. Patients completed assessments of adversarial growth, illness perceptions, alexithymia, anxiety, and depression. Patients who were classified according to clinical significance standards as demonstrating significant increases in adversarial growth at follow-up (18% of the sample), were characterized by a younger age at onset of psoriasis, less alexithymia, and, paradoxically, stronger beliefs in chronicity of their condition. Distress, illness identity, beliefs about severity of consequences, cure or control, and beliefs about emotional or physical causes and clinical severity of psoriasis at induction or at follow-up did not account for significant increases in growth. Results suggest that adversarial growth is related to greater psychological mindedness, awareness of the reality of disease course, and being younger at onset of the condition. Further work is required to investigate predictors of benefit finding and adversarial growth in patients with conditions that hold the possibility of being recurrent forms of trauma.Psychology Health and Medicine 02/2005; 10(1):44-56. DOI:10.1080/13548500512331315352 · 1.53 Impact Factor