Psoriasis is an autoimmune condition that causes skin cells to build up and form scales and itchy, dry patches. It is a chronic condition that can come and go over time. While the exact cause of psoriasis is not known, it is believed to be related to genetics and environmental factors. There is growing evidence that emotional stress can trigger and exacerbate psoriasis in some people. This article will examine the emotional and psychological factors that may contribute to psoriasis flares.
Anxiety and Stress
Anxiety and stress are perhaps the most well-established emotional triggers for psoriasis. Research shows that high levels of anxiety and stressful life events often precede psoriasis flares. This may be due to the effects of stress hormones on the immune system. Stress causes the release of hormones like cortisol that can increase inflammation and skin cell turnover, worsening psoriasis symptoms.
People with psoriasis also have higher rates of anxiety disorders compared to the general population. Worrying about psoriasis symptoms and appearance can become a vicious cycle – anxiety worsens psoriasis, which in turn causes more anxiety. Learning to manage anxiety and finding healthy coping strategies are important for breaking this cycle.
Depression
Depression is another mood disorder strongly linked to psoriasis. Up to 60% of people with psoriasis may experience depressive symptoms. The social isolation, stigma, pain and discomfort of psoriasis can lead to sadness, hopelessness and loss of interest in normal activities. There also appear to be shared biological mechanisms between psoriasis and depression that involve inflammation.
Depression can make it more difficult for people to follow their psoriasis treatment plans and maintain healthy self-care habits. Getting treatment for depression, whether therapy or medication, may help improve psoriasis by enabling better disease management.
Anger
Anger and frustration are also very common reactions to having psoriasis. Dealing with uncomfortable physical symptoms 24/7, judgement from others, and the unpredictable course of psoriasis can understandably make people feel angry. Holding in this anger and letting it turn into resentment has been linked to worsening of psoriasis in some individuals.
Finding healthy ways to process anger, such as talking to a friend or therapist, exercising, or maintaining a gratitude journal may help prevent flares caused by unchecked anger. Anger management counseling can also help people better express their feelings and needs related to having psoriasis.
Loneliness and Isolation
Many people with psoriasis feel socially isolated and lonely. The visibility of skin lesions, scaling, and plaques can cause embarrassment, low self-esteem and avoidance of social situations. People may worry about judgement, rejection and stigmatization. Unfortunately, social isolation can act as a stressor that worsens psoriasis symptoms.
It is important for people with psoriasis to push past fear and embarrassment to maintain social connections. Joining a support group can help decrease feelings of loneliness and isolation. Counseling to overcome social anxiety related to psoriasis may also help people improve relationships and social functioning.
Grief and Loss
Receiving a diagnosis of a chronic illness like psoriasis can lead to feelings of grief and loss – loss of health, loss of a normal appearance, or loss of control. People may grieve the way life was before psoriasis. Significant psoriasis flares may also trigger a sense of loss. Allowing time to mourn these losses and receiving psychological help for grief can prevent getting stuck in depression. Processing and accepting these losses is important for moving forward to find meaning and purpose beyond psoriasis.
Shame and Embarrassment
Many people with psoriasis feel deep shame and embarrassment about their skin and symptoms. For some, this can lead to hiding themselves and avoiding activities they once enjoyed. Research shows that higher levels of shame in people with psoriasis are linked to lower quality of life.
While psoriasis symptoms are nothing to feel ashamed about, these feelings stem from fear of judgement and rejection. Challenging inner critical thoughts and finding compassionate support can help overcome shame and restore confidence. Therapy and support groups can provide tools to manage feelings of embarrassment.
Worry and Obsession
Some individuals with psoriasis develop obsessive worry focused on their skin. Compulsively checking the mirror, picking at skin imperfections, and constantly thinking about flares can all signal obsession. For some, psoriasis may coincide with obsessive compulsive disorder. Obsessive thoughts and compulsive behaviors divert attention and raise anxiety levels which can worsen flares.
Letting go of perfectionism and refocusing thoughts on more positive aspects of life can help manage obsessive worry about psoriasis. Cognitive behavioral therapy is effective for treating obsessive compulsive disorder and related excessive worries.
Impacts of Emotions on Psoriasis
Research suggests that difficult emotions may impact psoriasis through several mechanisms:
Inflammatory processes
Negative emotions like chronic stress and depression can activate inflammatory pathways involved in psoriasis. For example, depression increases inflammatory signaling molecules called cytokines. Stress hormones like cortisol also increase overall inflammation.
Immune system dysfunction
Emotional distress impairs proper immune system function. Anxiety and depression can reduce the activity of immune cells that help regulate inflammation. This may allow inflammatory processes to get out of control.
Unhealthy behaviors
Coping with difficult emotions often leads to behaviors like drinking, smoking, poor sleep and isolation that can worsen psoriasis. For example, alcohol consumption is linked to more severe psoriasis.
Treatment noncompliance
Negative moods like depression reduce motivation for self-care. People may stop following medication and treatment plans which allows psoriasis to flare.
Itch-scratch cycle
Stress and anxiety increase itching which leads to scratching that further damages the skin.
Neuroendocrine pathways
The hypothalamic-pituitary-adrenal axis regulates stress responses and is dysregulated in psoriasis, suggesting a mechanisms through which emotions impact flares.
Tips for Managing Emotional Triggers
If your psoriasis seems to worsen with emotional distress, here are some tips that may help:
Seek counseling and therapy
This can help develop coping strategies, manage difficult emotions, and break unhealthy patterns like isolation. Cognitive behavioral therapy in particular is effective for conditions like anxiety, depression and obsessive compulsive disorder that are linked to psoriasis flares.
Join a support group
Connecting with others facing similar challenges provides a sense of community and decreases loneliness. It can also provide motivation to stay on track with self-care.
Practice stress management
Techniques like meditation, deep breathing, yoga, and progressive muscle relaxation help deactivate the body’s stress response. This protects against anxiety-triggered flares.
Improve time management
Take time for relaxing activities and avoid overcommitting yourself. Saying no to extra responsibilities reduces daily stressors.
Build a strong support system
Having the emotional support of close family and friends helps buffer stress and makes it easier to cope with psoriasis symptoms.
Avoid triggers
Notice situations and circumstances that seem to worsen your mood and psoriasis, and limit your exposure. For example, reducing time with critical people.
Focus on self-care
Maintaining healthy lifestyle habits like a nutritious diet, exercise plan, and good sleep hygiene prevents flares. Following your treatment plan also keeps symptoms under better control.
Try journaling
Writing about stressors and negative emotions can help get them out of your head. Recording your thoughts in a journal can support healthy coping.
Use mindfulness techniques
Meditation, deep breathing and yoga help you manage distress in the moment it occurs to prevent it escalating.
See your doctor
If emotional problems are disrupting your life, discuss treatment options like therapy and medication with your healthcare provider.
Conclusion
In summary, there is strong evidence that emotional distress including anxiety, depression, anger, shame, grief and isolation can trigger flares and exacerbate psoriasis symptoms. These emotions appear to act through inflammatory pathways, immune dysfunction, unhealthy behaviors and treatment noncompliance. Being aware of your emotional health and using stress management techniques, counseling, and other coping strategies can help break the vicious cycle between difficult emotions and worsening psoriasis. While psoriasis is a physical condition, caring for your emotional well-being is just as important.