Psycho-dermatology

Question 1

How can psychological stress trigger or worsen a skin condition?

Answer 1

The skin is associated with the peripheral sensory, autonomous and central nerve systems

Various stressors activate the hypothalamus within the CNS, resulting in the release of neuromediators such as CRH, MSH or PACAP. They may stimulate either the release of norepinephrine and cortisol from the adrenal glands, or directly stimulate leukocytes in the blood system, therefore modulating immunity and inflammation.

Norepinephrine and cortisol effect several immune cells, which release cytokines, chemokines and neuropeptides which modulate inflammatory responses in the skin

Upon stimulation, sensory nerve release neuromediators

Question 2

What is meant by a psychosomatic disorder?

Answer 2

A condition caused by a combination of both organic and psychological pathology

Question 3

What is meant by a psychogenic disorder?

Answer 3

A condition that is completely caused by emotional stress or psychological factors

Question 4

What are some examples of non-dermatological psychosomatic disorders?

Answer 4

• Back pain/Sciatica
• Pinched nerve
• Carpel tunnel syndrome
• Migraines
• IBS
• Pain
• Low energy
• Insomnia

Question 5

What are some psychosomatic dermatological conditions?

Answer 5

• Urticaria
• Psoriasis
• Atopic dermatitis
• Pruritus (localised)

Question 6

What is an example of a psychogenic condition?

Answer 6

Delusions of infestation

Question 7

What is meant by a stressogenic condition?

Answer 7

A condition that is caused by an external, non-specific stressor

Question 8

What is meant by a conflictogenic condition?

Answer 8

A condition that is caused by an internal clash of opposing specific forces causing conflict

Question 9

What is meant by a human given?

Answer 9

A thing that all humans desire and need

Question 10

What are the 10 human givens?

Answer 10

• Security
• Autonomy
• Control
• Attention (Friendship, loving relationships, intimacy)
• Connection to the wider community
• Status
• Privacy
• Sense of own competence
• Fun
• Meaning

Question 11

What are the risks of unmet human givens?

Answer 11

Emotional malnourishment, causing crying out or rage

Question 12

What are vulnerability factors?

Answer 12

Vulnerability factors are cases in which the human givens may not be met, leading to this malnourishment

Question 13

What are some examples of vulnerability factors?

Answer 13

Social isolation
Unemployment
Recreational drug misuse
Psychological trauma
Dysfunctional upbringing

Question 14

What are some effects of visible skin differences?

Answer 14

Effects on social acceptance
Effects on self image
Effects on self esteem
Sense of lack of control

Question 15

What is an example of an effect of a physical difference in skin conditions?

Answer 15

Over-secretion of sweat, especially in the palms may stigmatise people and decrease a person employability

Question 16

What are some changes to the skin that may be perceived as a skin condition by the person?

Answer 16

• Male pattern alopecia
• Body Dysmorphic Disease
• Erythrophobia (Fear of blushing)
• “Life-sucks” syndrome

Question 17

What are some common causes of blushing?

Answer 17

• Embarrassment
• Exercise
• Anxiety and phobia (Including erythrophobia)
• Frustration
• Sadness
• Happiness and laughter
• Menopause
• Hot and spicy foods
• Alcohol

Question 18

What are factitious disorders?

Answer 18

These are pretend or fiegned diseases, in which there is the falsification of physical signs

This is often explained by another mental disorder such as psychosis

Question 19

What is dermatitis artefacta?

Answer 19

This is a skin-specific form of factitious disorder in which the patient self-inflects a skin condition or disorder onto themselves as a coping mechanism or strategy to receive care

This may include skin picking and self-harm