Psychosomatic Aspects of Prurigo nodularis – Psychodynamics of Two Cases

Abstract

Based on a psychodynamic interpretation of two case reports, prurigo nodularis is defined as multicausal skin disorder of the elderly. We consider this disease a semi-artifact. Specific neurotic conflicts, generally with depressive symptomatology, center on an altruistic conception of life. From a psychoeconomic perspective this entails self-sacrifice, insufficient self-actualization, and repression and inhibition of aggressive impulses. Psychotherapeutic exploration frequently does not occur until decades after the onset of the illness. Our discussion addresses ‘specificity’ in psychosomatic medicine. We encourage dermatologists interested in psychosomatic phenomena to pay attention specifically to early experiences of loss and separation, as well as strain and excessive demands in the life of patients suffering from prurigo nodularis. Such experiences tend to be minimized due to the altruistic orientation of these patients. The primary manifestation and the actual conflict can be utilized to reconfigure the history of neurotic conflicts.

Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study

“…‘Alexithymia’ is a similar construct which could be associated with chronic itch: it describes persons who have difficulty identifying and describing their feelings, a concrete and reality‐based cognitive style and impoverished inner emotional and fantasy lives 5,6 . However, the studies on psychological factors in PN were usually based on single case reports 7–9 . Whether these findings are valid for a larger sample or perhaps even the majority of patients with PN has as yet not been investigated.…”

Psychological factors involved in prurigo nodularis: A pilot study

“…The psychological aspects involved in the etiology of diseases such as PN have been studied in single case reports (18,19) or by comparing PN patients to those with psoriasis vulgaris, for whom psychosomatic factors have also been demonstrated to trigger the disease and influence its course (4,20,21). Findings do not allow definition of any specific psychological problem area for PN.…”

“…The BDI-II is designed to provide a single overall score that can range from 0 to 63. Categorial depression ratings are suggested for patients diagnosed with major depression: 'minimal' (0-13), 'mild' (14)(15)(16)(17)(18)(19), 'moderate' (20-28) and 'severe' (29-63). A cut-off of 17, investigated in a study presented in the BDI-II manual (12), reported convergent validity with the Hamilton Psychiatric Rating Scale for Depression (HAM-D) (14) and excellent internal consistency among psychiatric outpatients (a = 0.91) and among undergraduate students (a = 0.93).…”