The skin and the psyche
Most people accept that there are strong links between skin disease and the emotions, but only a few skin disorders, such as dermatitis artefacta, have emotional factors as their direct cause. The relation-ships between the mind and the skin are usually subtler and more complex than this. Nevertheless, patients with skin disorders do have a higher pre-valence of psychiatric abnormalities than the general population, although specific personality profiles and disorders can seldom be tied to specific skin diseases. Similarly, it is still not clear how, or even how often, psychological factors trigger, worsen or per-petuate such everyday problems as atopic eczema or psoriasis.
Each school of psychiatry has its own theories on the subject, but their explanations do not satisfy everyone. Do people really damage their skin to satisfy guilt feelings? Does their skin ‘weep’ because they have themselves suppressed weeping? Until more is known, it may be wise to adopt a simpler and more pragmatic approach, in which interactions between the skin and psyche are divided into two broad groups:
• emotional reactions to the presence of skin disease, real or imagined; and
• the effects of emotions on skin disease (Fig. 20.1).