Only limited support for a role of psychosomatic factors in psoriasis - Results from a case-control study

Sapienza University of Rome, Roma, Latium, Italy
Journal of Psychosomatic Research (Impact Factor: 2.74). 10/2003; 55(3):189-96. DOI: 10.1016/S0022-3999(02)00574-3
Source: PubMed


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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    • "High sympathetic activity, high heart rate, high electrodermal activity, and low oxygen consumption were reported in alexithymic individuals (Guilbaud et al., 2003; Kauhanen et al., 1994). In a study by Picardi et al. (2003) in patients with alopecia areata, more alexithymic features, inadequate social support, and less close relationship have been reported. The majority of patients with alopecia areata who did not respond to treatment were shown to be alexithymic (Panconesi and Hautmann, 1996). "
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    • "Among dermatologic diseases psoriasis is the most common disease that researchers were interested in exploring the relationship between alexithymia. The association of alexithymia and psoriasis was revealed in many studies4,22-24 whereas other studies failed to demonstrate a significant difference in alexithymic scores between patients with psoriasis and healthy controls.3,14,25 "
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    • "The association between onset and exacerbation of psoriasis with stress is much debated and previous studies point in different directions. A recent study comprising 40 patients with mixed psoriasis phenotypes showed no evidence for an influence of stressful life events on psoriasis symptoms (Picardi et al, 2003), whereas other studies suggest a link between psycho-social stress and both onset and exacerbation of psoriasis (Naldi et al, 2001; Fortune et al, 2003). Obviously, more epidemiological and experimental research is needed to understand this potentially key issue in expression of psoriasis phenotype. "
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