Helplessness as Predictor of Perceived Stigmatization in Patients with Psoriasis and Atopic Dermatitis

Abstract

Background: The experience of stigmatization is a problem frequently recognized in chronic skin diseases such as psoriasis and atopic dermatitis. The purpose of the study was to investigate a broad spectrum of physical, psychological and social predictors for perceived stigmatization in patients with psoriasis and atopic dermatitis. Patients and Methods: Stigmatization experience, demographic variables, age of onset, clinical status, physical symptoms of itch and fatigue, the impact of the disease on daily life, illness cognitions of helplessness and acceptance, and social support were recorded using self-report instruments in 131 patients with psoriasis and in 139 patients with atopic dermatitis. Results: For both skin diseases, lower age, not being married, a worse clinical status, physical symptoms of itch and fatigue, the impact of the disease on daily life, heightened helplessness and less acceptance as well as less social support were all significantly related to the experience of stigmatization. In patients with psoriasis, stigmatization was also related to lower education and earlier age of onset. However, when comparing the predictors in multiple regression analyses, perceived helplessness proved the strongest predictor of the experience of stigmatization in both patients groups. Conclusion: Our results indicate that perceived helplessness acts as a common major predictor of stigmatization in both skin diseases, suggesting that helplessness should be the focus in the study and treatment of stigmatization in patients with psoriasis and atopic dermatitis.

Predictors of perceived stigmatization in patients with psoriasis

“…In order to aid intervention development, a broad understanding of associated risk factors is needed, to be able to identify risk populations and focus points for interventions. The literature suggests several potential sociodemographic predictors of perceived stigmatization in psoriasis, such as lower age, 7 being female 5 and lower education. 7 Secondly, disease-related variables such as higher disease severity, longer disease duration, greater cosmetic involvement and greater impact of the condition on daily life may be relevant.…”

“…The literature suggests several potential sociodemographic predictors of perceived stigmatization in psoriasis, such as lower age, 7 being female 5 and lower education. 7 Secondly, disease-related variables such as higher disease severity, longer disease duration, greater cosmetic involvement and greater impact of the condition on daily life may be relevant. [7][8][9]13,21,22 General ways in which patients deal with a chronic condition, such as heightened helplessness regarding the disease and its consequences, and lower disease acceptance have also been found to be predictive.…”

“…7 Additionally, social support and a large social network may serve a protective function against experiences of stigmatization. 7 While several studies have examined the above-mentioned variables as predictors, the role of personality has hardly been studied. 7,9 A possibly relevant personality construct is type D, which is defined as a tendency to inhibit the expression of emotions or behaviour to avoid negative reactions of others (social inhibition; SI), in combination with the stable tendency to experience negative affect (negative affectivity; NA).…”

“…7 While several studies have examined the above-mentioned variables as predictors, the role of personality has hardly been studied. 7,9 A possibly relevant personality construct is type D, which is defined as a tendency to inhibit the expression of emotions or behaviour to avoid negative reactions of others (social inhibition; SI), in combination with the stable tendency to experience negative affect (negative affectivity; NA). 23 Type D personality has been associated with increased risk of cardiovascular morbidity and mortality 24 and impaired health behaviour, 25 which are both frequently reported in psoriasis.…”

Psychological Treatments for Dermatological Conditions

“…However, the proportion of patients that suffer from 'the experience of stigmatization' is far greater. Indeed, Lu et al [13] found that about 80 percent of patients with psoriasis and atopic eczema felt stigmatized by others because of their skin disease at least once, 30 percent of which severely. The experience of stigmatization is one of the strongest determinants of perceived restrictions in everyday life [14,15] and can lead to decreased self-confidence and feelings of shame.…”