Psychodermatology is a currently developing field that, by exploring the connections between mental state and dermatological conditions, helps to find the source of problems and solutions. Skin diseases can be both a cause and a consequence of psychological conditions. However, any of these, regardless of the underlying cause, can have tragic consequences in the form of suicidal thoughts and even attempts to bargain for one's life.
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There are many links and connections between the medical disciplines of dermatology and psychiatry. Most of the psychological problems, in dermatological patients, are associated with secondary sequelae of conditions related to skin problems. However, there are also situations where the opposite is true, namely when there are problems of a psychological nature manifesting themselves in skin symptoms. Adequate time and accurate diagnosis, both psychiatric and dermatological, is crucial for both the improvement of the psychological condition and the skin condition.
Psychodermatology
The medical field of psychodermatology itself is a relatively young science, the birth of which was driven by an interest in the links that exist between psychological conditions and skin diseases. Nevertheless, it is worth noting that already in ancient times there were references to the connection between the state of our skin and our mental state, for example by pulling out our hair as a result of strong emotions, as Hippocrates himself wrote. In 1857, there is a reference to so-called skin neuroses, described by the surgeon and dermatologist William James Erasmus Wilson in his publication on skin diseases.
Underlying the interest in the links between the two fields of medicine is the fact that mental processes have a significant impact on biological treatment. The skin, is the part of our body that is 'most on top', or is most visible to those around us. In times of the cult of beauty and the ideal body, any blemish on the skin, especially in the most visible areas, can be misperceived by society and lead to stigmatisation. Moreover, the skin is one of the tools of interpersonal communication. Firstly, this is due to the fact that it is on the skin that we can best see our emotions or fatigue, it is an element of our self-esteem and thus becomes part of our self-esteem and image-building. In addition, it is the "organ of feeling" and sensing various external stimuli and also allows us to feel sensitivity or even sexuality.
From this perspective, it is simply possible to find a bi-directional influence - both the state of our skin on our psychological state and the psychological state on the state of our skin.
Psychodermatoses
The most common division used in the context of talking about psychiatric disorders reflected on the skin is that between psychophysiological disorders, psychiatric disorders that are secondary to dermatological disorders and primary psychiatric disorders that manifest with dermatological symptoms.
Psycho-physiological disorders are referred to when skin problems or an increase in dermatological symptoms occur when severe stress is experienced. The basis for this phenomenon is psychoneuroimmunology, i.e. the specific connections between the nervous, immune, skin and endocrine systems. Although the interrelationships between these systems are still being researched and investigated, there is no doubt that they influence the inflammatory processes in the skin.
Dermatological diseases are often associated with impaired social functioning, especially if we are talking about their acute or chronic phase. When dealing with acne, psoriasis or alopecia, there can be significant stigmatisation or partial elimination from social functioning. This often has a formative effect on self-image, causing lowered self-esteem and psychological or mental disorders such as frustration, anger, depression and even in extreme cases leading to suicidal thoughts and acts. Dermatological disorders are therefore primary to disorders of a psychological nature.
Patients who are affected by a psychiatric disorder and experience its manifestation in the skin are in a slightly different situation. Cases of this type are much less studied, as the main focus of the specialist diagnosis is precisely on skin problems, while the psychological sphere remains overlooked. Lesions associated with self-injury are the most frequently noted and are significantly suggestive of the reason for the skin lesions.
Another example of dermatological lesions resulting from a psychiatric illness are those associated with parasitic lunacy, which is characterised by the patient's delusions as if they were suffering from such an illness. Usually, however, in psychiatric disorders, there are skin symptoms in the form of itching, burning, paresthesias or simply tactile hallucinations.
Mental disorders, photo: shutterstock
Another disorder in this group is dysmorphophobia, which is the belief that one's own body is flawed and imperfect. It is a disorder that has been in the literature for a long time, and relates these beliefs to a neurotic background, manifested in the form of intrusive thoughts, as well as to a psychotic background, where we are dealing with delusions. The prevalence of this disorder is around 1% of the population and its development begins in adolescence, when, on the basis of created patterns, we build up an image of ourselves and see to what extent we deviate from it. Approximately 12% of dermatological patients are convinced of the imperfections of their own body and, moreover, this is a group that is particularly at risk of developing co-morbid social phobias, mood disorders or obsessive-compulsive disorders.
Onychophagia, i.e. experiencing a compulsion to bite one's nails that is impossible to overcome, is also included in this group of disorders. The substrate of nail biting can be seen in the striving for perfection, i.e. the desire to remove any bumps, imperfections visible on the nails. On the other hand, the very act of biting may bring relief and a kind of release of tension, but it does not lead to positive aesthetic effects. In addition, an unsightly appearance alone is not the only consequence of nail biting, as various bacterial infections may occur and, what is more, we may feel psychologically ashamed of our ugly hands and, consequently, avoid social contact.
A separate diagnostic category, which has recently become part of the DS-V classification, is NSIS. A person suffering from NSIS, tends to perform minor, non-deep self-harm, without suicidal intentions, just to the extent of provoking bleeding, pain or bruising. It is a form of action that provides psychological relief, a release from negative psychological states and self-related difficulties.
Risk of suicide
Dermatological conditions are inextricably linked to the human psyche, whether they are the consequence of a disorder or the cause of it. However, it is important to accurately assess the risk of a suicide attempt by the patient in question. Experts have identified four groups of dermatological patients at highest risk.
The first group, which is most at risk, includes people who suffer from dysmorphophobia.
The second group includes adolescent patients with severe acne.
The third group is made up of patients with skin conditions that interfere with normal functioning, i.e. patients with psoriasis or atopic dermatitis.
The last, and highest risk group, are those diagnosed with affective disorders. [1]
