Understanding the PsO Mind-Body Connection
The path to clear skin starts by getting a grip on your mental health.
Living with a visible skin condition like psoriasis—particularly on areas of the skin that are exposed for all the world to see—takes a daily kind of courage. Yes, there are some people in the world (who probably have a chronic condition of their own), who are thoughtful enough not to stare at your plaques or act like you have the plague. Others? Let’s just say they could use a lesson in good manners—or any manners. “We have an almost innate response to something that we suspect might be contagious,” says Ari Tuckman, Psy.D., a psychologist in West Chester, PA. “But perhaps, even more significant, the person with the visible condition may be self-conscious and have negative feelings about it, creating a self-fulfilling prophecy where the person comes across as uncomfortable or anxious and causes other people to treat them differently.” All of this becomes even more intense during a flare. It can be a vicious cycle.
The Psoriasis-Stress Connection
The fact that your skin issues mess with your self-esteem is bad enough. But get this: Stress created by your plaques can turn around and—yep—make your PsO even worse. (How’s that for irony?) “Psoriasis is a psychophysiological disorder which is exacerbated by stress,” says Mohammad Jafferany, M.D., FAPA, a clinical professor of psychodermatology and psychiatry at Central Michigan University and executive director for the Association for Psychocutaneous Medicine of North America (APMNA). “Due to its chronic and visible nature, and because it affects exposed parts of the body, it exerts a huge psychological trauma.” Patients with psoriasis can suffer from impaired quality of life, low self-confidence, poor treatment adherence, higher rates of sexual dysfunction, sleep disturbances, increased incidence of depression, anxiety, and stigmatization, and even suicidal ideations and behaviors, adds Dr. Jafferany.
Once those feelings of emotional stress pile up, it causes a boomerang effect. In fact, research shows stress is directly related to flareups, Dr. Jafferany says. “Stress and psoriasis are closely linked. There are more flareups when a patient is stressed, and psoriasis can increase your stress levels, so it is a vicious cycle,” he says. The reason for the link? People with psoriasis have an impaired hypothalamic-pituitary-adrenal (HPA) axis, the system that controls their body’s reaction to stress. They also have lower levels of the stress hormone cortisol, which normally helps decrease inflammation. “Inflammation kicks in when people are under stress, and since psoriasis is an inflammatory disease, stress causes the condition to flare up,” Dr. Jafferany says.
Depression and Anxiety Risks
Along with stress, research shows anxiety and depression rates rise in association with PsO. “Higher rates of depression, anxiety, and suicidality are reported by patients with psoriasis,” Dr. Jafferany says. “Rates of depression in psoriasis patients are higher than many other dermatological conditions and depression risk increases with greater disease burden.” Depression and anxiety disorders are particularly common in PsO patients who are younger, female, and early on in their diagnosis. The more visibly the condition, the more likely someone is to be depressed as well. (Mental health issues extend beyond just PsO: Studies show 25% of all patients with skin diseases also struggle with depression and anxiety.)
The challenge with PsO is clear: Insecurity about the appearance of plaques causes someone with psoriasis to avoid social contact or going out in public; in turn, lack of social connection and a deterioration of personal relationships leads to more insecurity, anxiety, and stress—which then increase the odds of flares and more severe appearance of plaques. “People with visible skin conditions are more likely to have social anxiety, anxiety in general, and depression,” Dr. Tuckman says. “This is especially true if they feel powerless to change the course of their skin condition and feel that their social life or mood overall hangs in the balance of what is happening with their skin condition. Feeling powerless, whether real or exaggerated, is a big contributor to anxiety and depression.”
Taking Control of Your Skin—and Brain
Of course, you want to be diligent about managing your psoriasis well. “Figure out what makes your flares more or less likely (and what doesn’t have much effect),” Dr. Tuckman says. Also, “take your treatment as prescribed, and follow up when you’re supposed to. Maintaining a regular course of treatment can help you minimize flares.”
Now that you know stress has a major effect on your psoriasis flares, it is important to try to reduce stress as much as possible. “Various therapeutic modalities such as yoga and meditation practices have shown great success in relieving stress associated with psoriasis,” says Dr. Jafferany. “Talking with a therapist on regular basis to learn coping skills to manage the level of anxiety and stress is highly beneficial in conjunction with the use of traditional antidepressant and antianxiety medications.” Consider looking for a psychodermatologist who studies the link between the mind and the skin and can work mental health treatment techniques into your skin care. Many doctors practicing this form of medicine have dual degrees in dermatology and psychiatry.
And remember, your psoriasis does not define you. “Psoriasis is something to be lived with; it’s self-consciousness that can limit your life,” Dr. Tuckman says. “The key is to separate psoriasis from self-consciousness. One of them you don’t have enough control over, but the other one is much more possible to manage.”
To find a Psychodermatologist in your area, visit APMNA.com.
Psychological Effects of Skin Disorders: Canadian Family Physician. (2002). “Psychosocial effect of common skin diseases.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214020/
Skin Diseases & Stress: Journal of the German Society of Dermatology. (2020). “Skin and Psychosomatics – Psychodermatology today.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756276/
Psoriasis & Stress: International Journal of Dermatology. (2011). “Stress and quality of life in psoriasis: an update.” https://pubmed.ncbi.nlm.nih.gov/21699511/