Psychology and Skin

Question 1

What are the five main areas for potential impact of a skin disease?

Answer 1

Physical comfort and functioning
Acceptability of self and others
Emotional well-being/self-esteem
Social/Behavioural functioning
Confidence in the nature and management of the condition (self-mastery)

Question 2

What are the most important factors in how a disease will affect someone’s state of mind?

Answer 2

Their experience, thoughts, feelings and behaviour

Question 3

Where are some high risk sites for skin diseases?

Answer 3

Aesthetic areas (e.g face), large areas

Question 4

What influence someone’s coping ability?

Answer 4

Risk and resilience factors

Question 5

What are some pre-morbid psychiatric disorders that could impact how someone will cope?

Answer 5

Anxiety, depression

Question 6

How can you screen patients for distress?

Answer 6

Measure pulse, blood pressure, respiratory rate, O2 sats, temperature, tenderness/pain (blood glucose), triages by level of distress (low-high)

Question 7

What falls under the psychosomatic medicine framework?

Answer 7

Assessment of psychological factors affecting individual vulnerability, course and outcome of any disease
Holistic consideration of patient care in clinical practice
Integration of psychological therapies in the prevention, treatment and rehabilitation of medical disease

Question 8

What are some categories of psychosomatic skin diseases?

Answer 8

Primary skin disease precipitated or exacerbated by emotional factors
Secondary psychiatric illness arising from or exacerbated by primary skin disease
Primary psychiatric disorder which is manifesting via skin lesions

Question 9

When should you adopt a psychosomatic approach?

Answer 9

When signs of emotional distress
When medical route alone is not effective
Psychiatric disorder but do not wish to see psychiatrist
When symptoms not compatible with signs
When clinical and pathological features don’t correlate

Question 10

What aspect of the skin does stigma relate to?

Answer 10

The visual aspect

Question 11

What are some different coping mechanisms?

Answer 11

Acceptance, denial, active coping, planning, positive reinterpretation and growth, practical/emotional social support, venting emotions, restraint coping, suppression of competing activities, mental/behavioural disengagement, humour, religion, alcohol/drug use

Question 12

What other conditions is the quality of life impact of skin disease comparable to?

Answer 12

IHD, diabetes, depression, cancer

Question 13

What are some management options?

Answer 13

Basic psychodermatological care
Engage patient, generate rapport, active listening
Non-judgemental, genuineness, treat seriously, empathise
Generate trust, hope and respect
Explore patient’s perspective of their illness (ICE)

Question 14

What are some psychological variables that affect vulnerability to illness?

Answer 14

Presence of abuse at some point in life
Live events and grief reactions
Perception of an environment as exceeding personal resources
Interpersonal relationships providing a buffering role for stress
Psychological assets and well-being

Question 15

What does the Dermatology Life Quality Index (DLQI) measure?

Answer 15

Emotional and behavioural reactions to skin disease:
2-5 = slight
6-10 = some
11-20 = substantial
21-30 = severe

Question 16

What are wider aspects that can be impacted by a skin disease in a patient’s life?

Answer 16

Emotional distress, burden of care, effect of household, social life and holidays, financial aspect, physical well-being, job/study and leisure activities, sleep, food/drink, restriction of liked activities, need for support, people’s attitude, effect on sex life, dissatisfaction with medical care, role of religious faith