A rapid heartbeat, headache, stiff neck, backache, rapid breathing, sweating and upset stomach are a few of the everyday physical symptoms of stress, anxiety or depression. There is a growing medical consensus of opinion that many skin diseases are strongly associated with psychological stress and illness. The relationship of stress, anxiety, depression, not to mention feelings of stigma, shame, embarrassment, and low self-esteem all impact upon a person who is suffering from psoriasis. 1, 2
The interplay between stress and multiple biologic systems in our bodies can trigger the onset of psoriasis. For many anxiety or depression is a symptom after the event, especially if the condition is chronic and especially visual and/or painful.
Regardless of how stress is defined, studies conducted show a consistent relationship between stress and psoriasis. The majority of psoriasis sufferers, themselves, also consider stress to be the main cause for or exacerbation of their psoriasis, ranking it above infections, trauma, medications, diet, or weather.
Studies have defined stress into three general categories:
1) Major stressful life events (e.g., employment or financial problems,
death of a spouse, major personal illness),
2) Psychological or personality difficulties, and
3) Lack of social support.
In one study patients were questioned as to what types of stressful life events that had occurred in the previous 12 months, that could have triggered their skin condition.
Stressful life events were seen in 26% of the psoriasis patients, the most common stressful life event seen was financial loss or problems (8%), death of close family member (4%), sexual problems (4%), family conflict (2%), major personal illness or injury (2%), change in working conditions (2%), failure in examinations (2%), family member unemployed (2%), illness of family member (2%), getting married or engaged (2%) and miscellaneous (2%). 5
It is important to recognize that psoriasis is a lifelong disease that affects patients not only physically but also socially and emotionally. As seen from the patients’ perspective, the most severe negative effects of their skin condition do not result from physical symptoms alone, but rather from the interaction of their physical symptoms and their mental/emotional state. Researchers have found that the stress of having psoriasis, in itself can initiate or exacerbate depression in depression-prone individuals.
The challenge for sufferers of skin conditions is, with the aim of improving their quality of life, to help themselves to find, together with their practitioner, the best personal treatment plan and then sticking to it. The main challenges in the effective management of skin conditions, comes down to patient adherence to the treatment plan and their emotional resilience.
- Biljan D. et al.: Psoriasis, Mental Disorders and Stress, Coll. Antropol. 33 (2009) 3: 889–892
- Buske KIrschbaum Hellhammer et al.,; Endocrine and immune responses to stress in chronic inflammatory skin disorders; 992. 231-240 (2003)
- Gerhard Schmid-Ott et al.,; Patient considerations in the management of mental stress in psoriasis; Patient Intelligence 2012:4 41–50; 2012 publisher and licensee Dove Medical Press Ltd.
- Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria.; Indian J Dermatol Venereol Leprol 2008;74:594-9.
- Madhulika A. Gupta. Et al.; A Psychocutaneous Profile of Psoriasis Patients, Who Are Stress Reactors, A Study of 127 Patients; Gen Hosp Psychiatry;11, 166-173, 1989
- Jafferany M. Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders.Primary Care Companion to The Journal of Clinical Psychiatry. 2007;9(3):203-213.