From healthcentral.com
The relationship between skin and mental health is a thorny one. Here’s how to navigate it
As if an unpredictable condition that causes you to break out in an angry rash isn’t enough to deal with, many people with psoriasis also have to face the disease’s mental health repercussions. Think: anxiety, depression, and even a higher risk of suicide than the average population. The connection between psoriasis and emotional and mental well-being is a complex one. It’s not so straightforward as “psoriasis makes you self-conscious”—though that may certainly be a big part of it. The truth is, the disease can influence your brain on multiple levels.
We spoke with dermatology and mental health experts to unpack the layers and learn what you can do to lessen the hold that psoriasis has on your emotional well-being.
How Psoriasis Affects Mental Health
Research has shown over and over again that people with psoriasis have higher rates of anxiety and depression than those without the skin condition. With that also comes higher instances of suicidal ideation and substance use disorder.
Chronic health conditions in general can really impact mental health because they're all-consuming, says Ariel Zeigler, Ph.D., a licensed clinical psychologist at Clarity Therapy in New York City. “It’s something you have to deal with every day,” she says. “You may never feel healthy or recovered, and that is what takes the biggest toll.”
But unlike a bone or joint condition, a skin disorder can be difficult (and at times, impossible) to hide. “Even if you want to go out into the world and pretend you don't have an illness, that’s out of your control,” Dr. Zeigler notes. “And anxiety thrives in the lack of control.”
Social anxiety, in particular, is huge with psoriasis, says Evan Rieder, M.D., a board-certified dermatologist and psychiatrist at Weiser Skin in New York City. “When psoriasis is severe in an area with exposed skin like the hands, face, or neck, people can have lots of fear and anxiety about being in social situations because of the public scrutiny,” he says, adding that improvements in psoriasis treatments in recent years have seemed to help a bit—”we used to hear it more before we had really amazing treatments”—but there’s still a decent amount of social stigma and ignorance that cause anxiety in people with psoriasis.
The Inflammation-Anxiety Link
While the unpredictability and visibility of psoriasis can cause enough complicated emotions, there may also be a deeper link between the disease and how you feel.
“There is some data [like this research review in Dermatologic Therapy] to suggest that some of the same inflammatory mediators that may be upregulated in depression and anxiety may be involved in flares of psoriasis as well,” Dr. Rieder says. Translation: The inflammation that causes your skin to get red and rashy may also affect your brain and make you more prone to developing things like anxiety and depression.
“We’ve seen in other autoimmune disorders that chronic inflammation in the body is correlated with more anxiety,” Dr. Zeigler says. On the other hand, research suggests that effectively treating psoriasis with biologic medications can also alleviate symptoms of anxiety and depression. Dr. Zeigler says that she sees this happening in her patients, too. “From my experience, yes, when psoriasis is treated, it helps mental health.”
The thing scientists still don’t know, though, is whether the reduction in inflammation (thanks to effective medication) directly improves mental health, or whether it’s the fact that effective treatment clears the skin, and this in turn alleviates some of the social pressure and worry.
Either way, it’s clear that managing psoriasis can substantially improve mental health, too. Still, it’s no magic bullet, Dr. Rieder notes. “When people are living with psoriasis for a long time or have a tendency towards anxiety, they may develop social anxiety or avoidant behaviours, and that’s something much more difficult to attack,” he admits.
What You Can Do to Feel Better—and When to Get Help
Beyond treating psoriasis—and staying on top of management for the long haul—there are some other things you can do to improve your mental health. Dr. Rieder tells his patients to start with focusing on four lifestyle habits: Mindfulness, exercise, sleep, and social connection.
Practice Mindfulness
Both Dr. Rieder and Dr. Zeigler emphasize the power of mindfulness. “It’s all about staying in touch with the present moment,” Dr. Rieder says. A lot of things can accomplish that, so do whatever works for you. For example, yoga, going for a walk in nature, or listening to a 10-minute guided meditation on your phone count as mindful activities. Dr. Rieder recommends other common anxiety-reducing techniques including deep abdominal breathing, progressive muscle relaxation, or using guided imagery—you can use free YouTube videos to do it. “Those are evidence-based, risk-free ways to decrease stress in the moment,” says Dr. Rieder.
“With mindfulness, practice is your best friend,” Dr. Zeigler says. You don’t have to dedicate a ton of time a day; it can be five minutes or even a 30-second breathing exercise. The more you practice, the better your body will be at going to that place automatically the next time you’re anxious and need to recentre yourself.
Exercise and Sleep
Taking care of your body can have huge benefits for your mental well-being. “We know it’s incredibly important to decrease systemic inflammation, and it’s also good for brain health and releasing endorphins,” Dr. Rieder says. He recommends at least 30 minutes of cardio three times a week. It doesn’t have to be anything intense—simply going for a walk is great. He also suggests making sure you get adequate sleep. The National Institutes of Health recommends all adults get seven to nine hours each night, depending on what makes you feel well rested.
Social Connection
“We know people with active social lives and a good support network of close friends and family generally do better health wise,” Dr. Rieder says. “People who have social contact even if they don't want to do it, do much better in terms of mental health outcomes.” If you’re having trouble getting out of the house to physically spend time with others, use technology to stay connected as best as you can. If you need a support network, tapping into certain communities (online or IRL) can really help—whether it’s for people with psoriasis or centred around a hobby of yours.
“If you’re incorporating all those things and still feel not doing well, that would be time to see a mental health provider,” Dr. Rieder says. For starters, tell your dermatologist. They can refer you to a mental health professional (like a psychiatrist or therapist) who can help you work through the complex emotions of psoriasis.
“Therapy is so effective in the reduction of anxiety,” Dr. Zeigler says. If you’re feeling anxious or depressed, or avoiding social situations you’d otherwise want to join in on, those are signs you could benefit from speaking with someone.
Group therapy can be really helpful, too, even if it’s via an online support group, Dr. Zeigler says. However, she cautions that some people may find it fuels their anxiety instead of helps. “Some people really like that experience of knowing someone else is going through something they are but it can also perpetuate anxieties, depending on the person.”
Also, know that medication is a very valid option, Dr. Zeigler says. “It has so much stigma, but medications can be so helpful.” And you don’t necessarily need to be on it forever; it can be a temporary tool to take the edge off and help you get through a particularly difficult time. Ultimately, the combination of therapy and medication can be really powerful. If you’re on treatment for psoriasis, make sure to discuss tell both your mental health provider and dermatologist all the meds you’re taking so that they can prescribe you a treatment that plays well with your other medication.
Above all else, know that you do not have to struggle alone. So many people with psoriasis feel its impact on their mental health. Whether you try some tactics on your own or seek help from a professional, you can (and deserve to!) feel good and live a joyful life.
https://www.healthcentral.com/condition/psoriasis/psoriasis-more-than-skin-deep
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