CLINICAL - DERMATOLOGY
PSYCHOLOGY
SPOT
Clinical Psychologist and psychodermatology specialist, Dr Reena Shah, explains the powerful link between skin disorders and psychology
T
he skin is the largest organ of the body and is immediately on show, if not covered up. It represents an external barrier between our internal being and the outside world. Having unblemished skin is perceived by society as a sign of beauty, an idea that is arguably perpetuated by the media.
Dr Reena Shah, CPsychol Dr Reena Shah is a Clinical Psychologist with a special interest in psychodermatology. She conducted her doctoral thesis within this area and ever since she has been dedicated in working clinically and conducting research within psychodermatology.
People of all ages have reported feeling pressured by the media and society’s influence of looking ‘perfect’. Ritvo et al. (2011) showed that the first thing teenagers and adults noticed about a person with acne was their skin (65% and 75%, respectively). The study suggests that teenagers and adults alike perceive other teens with acne as generally being shy, less socially active, more likely to be bullied, and less successful in terms of finding a job. Overall, the results show that acne has a negative effect on the way people are perceived by others. Some people with skin conditions report becoming preoccupied with covering their skin and often avoid activities where it might be on display. Hence, people with skin disorders may take various steps to maintain a sense-of-self. This may be due to the belief that other people may stigmatise or reject them because of how they look. Living this way day in and day out, depending on person experiences and coping strategies, can sometimes lead to the development or exacerbation of mental health problems. Some people living with skin disorders have reported high levels of psychological distress, with some studies indicating that 30% of clients have clinically significant levels of psychological
distress (Gupta & Gupta, 2003). Interestingly, the severity of a visible difference does not correlate with the amount of psychological distress and dysfunction experienced (Rumsey et al., 2004). For example, someone with a small patch of vitiligo (depigmentary disorder of the skin which causes the occurrence of visible white patches) could feel the same way as someone who has eczema all over their body. Reasons for the psychological distress could be due to various factors, such as past experiences, relationships with others, personal beliefs and one’s upbringing. Dr Anthony Bewley, consultant dermatologist and head of the London Psychodermatology Service stated, “It is increasingly recognised that the physical and psychological aspects of a disease are very intimately linked. For example, in psoriasis, sufferers usually indicate that a stressful life event initiated the psoriasis, and that living with psoriasis is at least as bad as living with cancer or diabetes.” It is well recognised that having a skin disorder may have numerous physical (e.g. dryness, itching, scarring and pain) and psychological consequences for people of all ages. The level of psychological morbidity found in research has been supported within clinical practice. A recent survey conducted by Shah (2012) within in a general dermatology clinic in the NHS indicated that 29% of females and 24% of males scored within the clinical range for anxiety, with 47% of females and 36% of males reaching the borderline range for anxiety. Interestingly, 89% of females and 97% of males had a high degree of appearance-related concerns.
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