Skin on your mind - Being mindful of this connection!
Updated: May 5, 2020
In the popular TV medical show Grey’s Anatomy, there was a case of a young girl who could never have a romantic relationship, because the moment she had an attraction towards someone, her face flushed and blushed. The skin noticeably and visibly reacts to a purely emotional and mental stimulus by increasing the blood flow on our face. This is just one example of the deep connection that exists between our skin, hair, appearance and our mind. Oftentimes, this connection results in mental disturbances ranging from minimal to severe, particularly with respect to skin problems that all of us will encounter in our lives. Let’s take a closer look at this skin mind connection and how best we can deal with mental health issues arising out of skin related problems and more broadly what the skin mind connection is!
Broadly speaking, there are three kinds of associations possible between skin disorders and the mind:
Skin problems affected by stress or other emotional states: Examples of these include acne, psoriasis, eczema, atopic dermatitis, hair loss etc.
Psychological problems caused by disfiguring skin disorders: this varies from person to person but includes any skin disorder that causes social embarrassment or makes the sufferer feel bad about his or her appearance. Examples include Acne, Pigmentation disorders, facial scars, Vitiligo etc.
Psychiatric disorders that manifest themselves via the skin, such as delusional parasitosis and trichotillomania: These are primary psychiatric disorders that have skin consequences. For example, a nervous disorder may make a sufferer pull their hair known as trichotillomania.
Skin Problems worsened by emotional stress
It is only in recent times that the connection between the skin diseases and mind is being acknowledged. I have seen, so often in my practice the worsening of hair loss, new spots of acne coming up, the inflammation in psoriasis and seborrheic dermatitis worsening with a lot of new patches and itching, all as a result of psychological stress. I have seen it in response to the stress of a new job and a tough boss, in response to a recent bereavement, after a particularly difficult break up. In these cases, just treating the skin condition alone takes the condition much longer to recover and counselling, sometimes a consultation with a psychologist and the occasional anti-anxiety medication hastens the process along.
It must be remembered that these are actual pathological conditions and you need to go to a dermatologist who can treat them as well as provide you with the support you need or provide a referral.
Often, we find that the response to treatment dramatically improves once the stress is under control and the patient’s response is calmed and attenuated. It is, therefore for the doctor to ask the relevant questions and also for the patient to share in confidence, what they think the triggers the condition and how they deal with the triggers. These are the conditions where working on both aspects, the pathological and psychological gives very gratifying results.
Appearance related psychological problems
Sometimes the appearance of the skin after scarring disorders like chicken pox or melasma can cause profound psychological distress that outlasts the duration and severity of the disease. There is a condition called dysmorphophobia where the sufferer has a twisted perception of his or her appearance, leading to profound psychological distress. In these conditions, it is critical to ensure that the patient gets ongoing support and psychological counselling. Even with getting the primary condition treated, full resolution may not happen till the person undergoes complete counselling and may need hand holding for coping with these issues which may be chronic.
Primary Psychiatric disorders manifesting on the skin
There are certain psychiatric disorders which can manifest as skin tics or even serious skin disorders. An example of this is skin picking or the habit of scratching out bits of skin that people with anxiety or depressive disorders demonstrate. Another common skin disorder is trichotillomania, where hair is pulled with great force, causing broken bits of hair with circumscribed hair loss. This required both psychologic and occasionally psychiatric evaluation and may even need medications with counselling to correct this.
Psych dermatology is a new specialty that is still just being recognized as an evolving field. Dermatologists need to work with clinical psychologists to acquire the tools needed to treat patients effectively, so that emotional issues affecting the skin and vice versa can be addressed effectively to bring physical, mental and emotional relief to patients.