Psychodermatology explained

Girl examining skin

By Simon Oates, CEO at Mind & Skin

The skin is our most visible organ and unlike internal illnesses, which are not often visible, skin disease has a capacity to be highly noticeable to other people. Therefore, the pathology of the skin could have a profound impact on a dermatology patient’s mental well-being. Psychodermatology is an approach to treating skin conditions that addresses the connection between the mind and body. The paradigm also aims to uncover some of the psychological reasons that a skin condition may emerge or worsen. Treatments are designed to help coping with and treating a skin disorder, normally in conjunction with other medications.

Psychodermatology is an approach to treating skin conditions that addresses the connection between the mind and body

Research reveals that dermatological patients are more likely to experience psychological stress and develop depression, anxiety and especially social anxiety. Dermatological improvement does not guarantee a “cure” for the patient. Even though the skin condition can be reduced or treated, the psychological “scars” can remain.

One particular issue for health professionals is that there is no objective-severity of a skin condition correlating with the psychological impact. For example, a patient with mild psoriasis might be relatively contented emotionally; whereas a patient with a small area of rosacea could be emotionally distraught. The potential psychosocial impact can also be devastating to a person’s mental health. I often encounter and hear from dermatology patients who have fewer friendships, romantic encounters and exercise less due to their skin condition.

Bullying at work

A common topic I hear is that dermatological patients are surprised and caught “off guard” when dealing with the public’s level of curiosity about their body. They have to manage intrusive comments and stares and this can result in them feeling sad, angered, embarrassed and shameful. This, combined with the social anxiety of worrying of what people may think, feel and say can lead to increased levels of stress.

Body Image & technology

The term self-schema relates to the way one feels and views oneself. What may develop is a larger discrepancy between the “ideal body” and the “perceived body”. These bodily ideals can be affected by social stereotypes such the need to have “normal” skin. Skin that is clear of blemishes spots and scars for example. When patients are suffering from a skin disorder, they may feel that they do not meet the social “norm” and therefore are “abnormal” and “undesirable”. These negative self-schemas can have a devastating impact on the patient’s mental well-being and daily psychosocial functioning. According to Grossbart, our ideals of bodily image account for about one-quarter to one-third of our self-esteem and our self-esteem has a significant influence on our psychological health.

An area that concerns me is the ever-increasing role of technology in our daily lives. We are now undoubtedly the “selfie” generation and young people are more digitally connected than ever before. As a way to connect with each other, selfies are used to share experiences and express feelings, emotions and behavior at any given time. Young people are still developing their sense of self or identity. As, we have all done, we experiment with different looks and styles whilst figuring out where we may sit in social circles, if any at all.

Selfie

In recent years we have seen the development of “body enhancing” mobile phone applications. These include software programs that alter one’s own skin to remove blemishes, reduce wrinkles and blend skin tone. In addition, there are apps that alter one’s physical appearance. I am referring to apps that can achieve instant weight loss, greater height and whiter teeth. These apps can also change the physical structure of the face by changing the shape of the nose and jawline. These are done by plastic surgery “enhancement” apps.

What are the psychological implications?

Every time a person modifies their physical appearance digitally, they are re-enforcing negative self-schemas about their bodily ideals. Whilst the user may not consciously be aware of present emotions and thoughts, this behavior can manifest on a deeper and severe subconscious level. When we see other people’s photographs and the attention that they receive, we may end up comparing ourselves physically. Over a period of time, this behavior may become an obsession, which can lead to a greater pressure to maintain a “beautiful” appearance, leading people to attribute greater importance to the way they look.

Dr David Veale, a consultant psychiatrist at the South London and Maudsley NHS Trust and The Priory Hospital, states:

"Two out of three of all the patients who come to see me with Body Dysmorphia, since the rise of camera phones, have a compulsion to repeatedly take and post selfies on social media sites"

Recently, a young male in the UK tried to commit suicide as he would spend around 10 hours a day taking up to 200 selfies a day trying to “perfect” his physical looks. Similarly, Dr Rosen says:

There is a large amount of anxiety about connecting with people online. They are the critical ones that seem to be linked with things going wrong. The use of social networking sites tends to show signs and symptoms of many psychiatric disorders when compared with people who don’t do it as much

Young people may compare themselves to the images from celebrities and their peers and feel it is their fault that their bodies compare poorly. By altering their appearance digitally, they can attempt to get positive feedback and social validation where they seek social approval. Therefore, this makes them vulnerable to the responses of the wider world, whether it is positive or negative in feedback. This issue of feedback has become more central to those taking selfies and to quote Andrea Letamendi, a doctor of psychology,

"Now that we can interact with hundreds - no, thousands - of people simultaneously, we've strengthened the impact that others have on our self-value"

For those of you who might be struggling with body related issues and selfies, Dr Routledge articles Get Over Selfie Shame and Selfie Use: Abuse or Balance provide some good helpful advice.

Conclusion

In this article we have looked at how a skin condition can have a negative effect on a patient’s mental well-being and the role of technology with “body enhancing apps”. Research into bodily ideals suggests that those who have a greater usage and dependency on “selfie” related software are more likely to suffer from negative bodily ideals from the “ideal body” and the “perceived body”.

I hope that new research can be generated to further our understanding into bodily ideals and its role with technology. We, as health practitioners, must be aware of the potential impact of negative bodily ideals. The continued act of a “selfie” could be perceived as a behavioural pattern for attention, which in truth could be an unconscious “call for help”.

To finish on an interesting fact, did you know that 93 million selfies a day are taken and uploaded by just Android users alone!

Simon Oates

Simon is a guest writer for LEO Pharma and is CEO of psychodermatology charity Mind & Skin.

This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.

UK/IE MAT-04710. Date of Prep: September 2016

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