Identification of anger and self-esteem in psoriasis patients in a consultation-liaison psychiatry setting: a case control study

Abstract

Objective: Psoriasis is one of the most common chronic skin diseases, which has a negative impact on the interpersonal relationship and psychosocial well-being. Therefore, psoriasis may lead to a decrease in the self-esteem of the patients. Increased level of anger often accompanies patients with psoriasis. Our aim is to investigate the relationship of anger, anger expression style and level of self-esteem in patients with psoriasis and to determine whether duration and severity of disease affects anger, anger expression style and level of self-esteem. In addition, we aimed to compare the level of self-esteem in patients with early and late onset of psoriasis. Methods: Eighty-five patients with psoriasis and 86 healthy controls were included in the study. Severity of disease was calculated with Psoriasis Area and Severity Index (PASI). The patients were classified as early-onset (age < 20 years) and late-onset psoriasis (age ≥ 20 years). Duration of disease and socio-demographic characteristics were recorded. State-Trait Expression Inventory for Anger (STAXI) and Roserberg Self-esteem Scale (RSES) were used for determining anger, anger expression style and self-esteem. Results: Trait anger, state anger and anger-in scores were statistically significantly higher in patients with psoriasis (p < .05). Anger-out and anger-control scores were similar in both groups. RSES scores were statistically significantly higher in the psoriasis group (p < .05). There was a negative weak statistically significant correlation between RSES and angercontrol scores (r = −0.246, p = .027). A positive, weak, statistically significant correlation was found between RSES scores and anger-out scores (r = 0.224, p = .045). A positive, mild, statistically significant correlation between duration of the disease and anger-in scores (r = 0.277, p = .027) was detected in patients with psoriasis whereas no statistically significant correlation between the other parameters and duration and severity of the disease was detected. No significant difference was detected when patients with early-and late-onset psoriasis were compared in terms of self-esteem (p = .722). A positive, mild, statistically significant correlation between duration of the disease and anger-in scores (r = 0.277, p = .027) was detected in patients with psoriasis whereas no statistically significant correlation between the other parameters and duration and severity of the disease was detected. Conclusion: Reduced self-esteem and increased anger levels are remarkable in psoriasis patients. While evaluating and arranging treatment of psoriasis patients, it should be considered that psoriasis is not only a dermatological disease, but also a disease resulting in reduced self-esteem and increased anger level; therefore dermatologic and psychiatric approaches should be taken with the patients. ARTICLE HISTORY

Emotions, Alexithymia, and Emotion Regulation in Patients With Psoriasis

“…From our review, it is apparent that emotional reactivity, alexithymia, and emotion regulation have a profound impact on the management of psoriasis symptoms. On the one hand, emotional reactivity in patients with psoriasis seems to be characterized by negative emotions such as anger (Matussek et al, 1985;Sampogna et al, 2012;Aydin et al, 2017), shame (Sampogna et al, 2012;Shah and Bewley, 2014;Lahousen et al, 2016), disgust (Lahousen et al, 2016), and feelings like social exclusion (Vardy et al, 2002;Schmid-Ott et al, 2007;Lahousen et al, 2016;van Beugen et al, 2017;Łakuta et al, 2017) and also by psychopathological disorders such as anxiety (Pujol et al, 2013;Cepuch et al, 2014;Fleming et al, 2017) and depression (Jensen et al, 2016). This emotional pattern seems to affect slightly more women (Sampogna et al, 2012;Pujol et al, 2013;Talamonti et al, 2017) than men and to be a risk factor for a wide range of negative outcomes spanning from lower quality of life (Vardy et al, 2002;O'Leary et al, 2004;Vari et al, 2013) to suicide (Pompili et al, 2016).…”

“…In psoriasis, anger (subclinical condition) frequency correlates with severity and length of the disease, and it is higher in patients with a low level of education (Sampogna et al, 2012). Psoriasis patients are characterized by a higher level of trait anger respect to controls; moreover, when they have low self-esteem, they show more anger toward people or objects and have enhanced difficulties in anger control (Aydin et al, 2017); conversely, they score very low in autoaggression (Matussek et al, 1985). Notably, however, one study reported that psoriasis patients exhibited fewer verbal aggression responses after anger-inducing procedures (Niemeier et al, 1999).…”

Relationship between self-esteem and stigmatization in psoriasis patients

“…demonstrated that psoriasis patients had lower self-esteem than healthy persons, but did not find a link between duration of the disease and self-esteem scores. According to those authors, management of psoriasis patients should also be adjusted for their self-esteem or quality of life as only such attitude may increase the likelihood of better treatment outcome [ 22 ].…”

Negative Emotions in Skin Disorders: A Systematic Review

“…20 years State-Trait Anger Expression Index and the Mini International Neuropsychiatric Interview (M.I.N.I) Pruritus duration was correlated with anger trait and anger-in subscale scores in all patients. Aydin et al (2017) Turkey Psoriasis Eighty-five patients with psoriasis and 86 healthy controls State-Trait Expression Inventory for Anger (STAXI) and Roserberg Self-esteem Scale (RSES) Reduced self-esteem and increased anger levels are remarkable in psoriasis patients. ( Coneo, Thompson, & Lavda, 2017 ) England Dermathology patients ninety-one participant Optimism (LOT-R), perceptions of social support (SFSSQ) social acceptance, fear of negative Evaluation (FNE), appearance concern (CARVAL/ CARSAL), appearance discrepancy PADQ), social comparison (INCOMM) and wellbeing (HADS) on aggression levels (RAQ) Anxiety was also found to have a significant positive relationship with aggression (β = 0 .…”