Personality in Patients with Psoriasis

Abstract

Objectives: In psychodermatological literature, personality has been treated both as a psychological consequence of skin disease and as stable traits that might modulate the onset and course of skin diseases. The literature regarding personality traits and psoriasis is sparse. The aim of measuring personality traits in our studies was to identify potential traits of psychological vulnerability in different clinical subgroups of patients with psoriasis. To the best of our knowledge, no previous study has yet used the Swedish Universities Scales of Personality (SSP) in psoriasis research. Method(s): A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires: SSP, Spielberger State-Trait Anxiety Inventory Form-Y, and Beck Depression Inventory. Psoriasis severity was assessed by the Psoriasis Area and Severity Index. Pruritus was measured by a Visual Analogue Scale. Result(s): Three clinically relevant subgroups of patients with an increased psychological vulnerability could be identified: Early age at onset of psoriasis, but not disease duration, was significantly associated with four pessimistic personality traits, i.e,. embitterment, trait irritability, mistrust, and verbal trait aggression. Early age at onset of psoriasis was also associated with higher scores of depression and anxiety, compared with late onset psoriasis. Patients with higher levels of pruritus showed higher scores in four negative pessimistic personality traits, i.e., somatic trait anxiety, embitterment, mistrust, and physical trait aggression. Those with severe pruritus also reported significantly higher scores for both depression and anxiety. Sixty-four patients (63%) reported a subjective association between disease exacerbation and stress, and were defined as "stress reactors". Stress reactors showed a significantly more vulnerable and stress susceptible personality profile and higher scores of both depression and anxiety, compared with non-stress reactors. Conclusion(s): From a clinical perspective, our results stress the importance of increased attentiveness to psychological vulnerability when caring for patients with psoriasis, especially those with young age at onset, and/or severe pruritus, and/or patients who experience disease exacerbation during stress.