Podcast Summary
The Intersection of Mental Health and Skin Conditions: Psychodermatology bridges mental health and dermatology, addressing the emotional impact of skin conditions and providing comprehensive care
The connection between mental health and skin conditions is significant and often overlooked. Chloe Walker, a soon-to-be doctor with a passion for both psychiatry and dermatology, shared her personal experience of suffering from severe acne and the emotional distress it caused. This sparked her interest in the field of psychodermatology, where she could help individuals dealing with both the mental and physical aspects of skin conditions. During her clinical training, she discovered her affinity for the hands-on approach of dermatology and her ability to emotionally connect with patients. In her current role, she works with individuals dealing with medical and psychiatric issues, including those whose skin conditions lead to intense emotional distress, depression, and even suicidal thoughts. Psychodermatology, as Chloe defines it, is the marriage of psychiatry's internal focus on mental health and dermatology's external focus on physical skin conditions. By addressing the mind-skin connection, healthcare professionals can provide more comprehensive care for individuals dealing with these complex issues.
The Mind-Skin Connection: A Deep Embryological Link: The mind and skin are deeply connected, with roots in embryological development, and understanding emotional causes is crucial for treating skin diseases
There is a deep connection between the mind and skin that dates back to embryological development. The ectoderm, which gives rise to the nervous system and skin, highlights this interlink. Ancient texts, such as Hippocrates' writings, suggest that this connection has been recognized for centuries, with instances of stress-induced hair loss (trichotillomania) reported. A 2008 article by Mars et al. emphasized the importance of understanding the underlying emotional causes of skin diseases, which cannot be fully explained by biomedical understanding. This connection between the mind and skin is further evidence of the complex interplay between physical and emotional health.
Stress and poor coping mechanisms can cause physical symptoms like eczema: Expressing psychological conflicts congruently can help reduce physical symptoms associated with stress and poor coping mechanisms, as studied in the association between chronic idiopathic urticaria and PTSD
Stress and poor coping mechanisms can lead to physical symptoms, such as eczema. During the first few months of medical school, the speaker experienced extreme stress due to not knowing her diagnosis and the high workload. She also adopted unhealthy habits like poor sleep and diet. The dermatologist only mentioned the dry weather as a possible factor. However, the speaker noticed that her eczema disappeared once she became less stressed and figured out her diagnosis. A 2018 study found an association between chronic idiopathic urticaria and PTSD. The study suggested that converting traumatic emotions into physical symptoms is facilitated by escape-avoiding coping mechanisms. People who suppress their emotions are more likely to experience somatic issues. The first step in treating such patients is helping them express their psychological conflicts congruently. The speaker uses microexpression training to help identify hidden emotions and guide therapy. Microexpressions are quick, subtle facial expressions that last a fraction of a second. Anger, for instance, is indicated by a quick downward movement of the eyebrows. Understanding these microexpressions can provide valuable insights into a person's emotions and help guide therapy.
Identifying Psychocutaneous Disorders: Stress and Skin Connection: Psychocutaneous disorders are categorized as psychophysiologic, psychiatric with dermatologic symptoms, or dermatologic with psychiatric symptoms. Stress can worsen certain skin conditions like herpes simplex, acne, vitiligo, alopecia areata, psoriasis, seborrheic dermatitis, and urticaria. Asking about stress impact on skin can aid diagnosis.
There are three main categories of psychocutaneous disorders: psychophysiologic disorders, psychiatric disorders with dermatologic symptoms, and dermatologic disorders with psychiatric symptoms. Psychophysiologic disorders are those in which the skin disease is worsened by stress. Psychiatric disorders with dermatologic symptoms are those in which the primary issue is a psychiatric disorder that causes skin symptoms. Dermatologic disorders with psychiatric symptoms are those in which the primary issue is a dermatologic disorder that causes emotional problems. There are also direct and indirect associations between psychiatric disorders and dermatologic symptoms. In a direct association, the psychiatric disorder directly causes the dermatologic manifestation. In an indirect association, the psychiatric disorder causes the patient to engage in behaviors that lead to skin symptoms. Many skin issues can have a temporal relationship with stress or psychological factors, including herpes simplex infection, acne, vitiligo, alopecia areata, psoriasis, seborrheic dermatitis, and urticaria. Asking the patient if their skin seems to look or feel worse when they're stressed can be a helpful way to identify these disorders.
Impact of Psychological Factors on Skin Health: Dermatologists should consider psychiatric comorbidities when assessing patients, as insecure attachment styles and psychiatric disorders like depression and anxiety can significantly impact skin health. Utilize screening tools to help identify potential issues and be aware of parasuicidal behaviors that may indicate underlying psychological problems.
The way we perceive and cope with stress, as well as our attachment styles, can have significant impacts on our skin health. A 2017 European study revealed that individuals with insecure attachment styles reported stressful life events and had less comfort with intimacy more frequently than those with secure attachment styles. Additionally, up to 90% of individuals who commit suicide may have a psychiatric disorder, with major depressive disorder being the most common. As a dermatologist, it's crucial to be on the lookout for psychiatric comorbidities and consider using screening tools like the GAD 7 for anxiety and the PHQ 9 for depression to help identify potential issues. Furthermore, certain parasuicidal behaviors, such as dermatitis artefacta and Trichotillomania, can also be indicative of underlying psychological problems. The incidence of psychiatric disorders among dermatological patients is estimated to be as high as 60%.
Skin conditions linked to psychological distress: Studies show strong connection between acne and anxiety/depression. Dermatologists recognize psychological impact, offering psychotherapy as first line treatment.
There is a strong connection between skin conditions, particularly acne, and psychological distress, including anxiety and depression. A 2006 study found that a significant number of patients with skin conditions, specifically chronic hives (chronic urticaria), had attempted suicide due to the severity of their condition. Additionally, a 2015 study of high school students with acne found that the most prevalent psychological issue was fear that acne would never cease. These thoughts can contribute to anxiety and distress. Dermatologists are already recognizing the psychological impact of skin conditions and are looking for ways to address it, including using screening tools and referring patients to mental health professionals. Treatment modalities include both medication and psychotherapy, with the first line of treatment being psychotherapy. Dermatologists may benefit from having a therapist or psychiatrist in their office or building relationships with these professionals to better serve their patients.
Collaboration between dermatologists and mental health professionals: Effective collaboration can improve patient care for those dealing with both dermatological and psychological issues. Dermatologists can recognize emotional burden, use motivational interviewing, and provide resources for therapy or mental health services.
Effective collaboration between dermatologists and mental health professionals can significantly improve patient care for those dealing with both dermatological and psychological issues. This collaboration can begin with dermatologists recognizing the emotional burden of certain skin conditions and utilizing motivational interviewing techniques to encourage patients to engage in therapy. While therapy is the first-line treatment for managing stress, other interventions such as exercise, sleep, diet, and mindfulness can also be beneficial. For dermatologists who may not have the time or expertise to provide extensive psychological support, learning the basics of medications and developing a strong therapeutic alliance with patients can be a good starting point. By acknowledging the psychological aspects of skin conditions and providing resources or referrals for mental health services, dermatologists can contribute to better overall patient outcomes.
Achieving congruency in mental health treatment for chronic diseases: Effective mental health treatment for chronic diseases requires extensive therapy, empathetic therapists, and sometimes intensive methods like ECT, TMS, or Ketamine.
Achieving congruency between a patient's inner experience, their self-expression, and their family dynamics is crucial for effective treatment of mental health issues related to chronic diseases. This process often requires extensive therapy, potentially beyond outpatient care, and can take up to 20-30 sessions. The choice of therapy modality depends on the patient's history, tolerance to side effects, and the therapist's empathy and therapeutic alliance. Empathic therapists, regardless of modality, can yield better outcomes than less empathetic ones. For severe cases, such as suicidal patients or those resistant to multiple treatments, more intensive methods like Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), or Ketamine may be considered.
Combining medication and therapy for effective OCD treatment: Medication reduces obsessions, therapy changes brain structure and promotes long-term improvements. Holistic approach including therapy, exercise, diet, and sleep essential for managing OCD and related conditions.
Effective treatment for conditions like Obsessive-Compulsive Disorder (OCD) requires a combination of medication and psychotherapy. While medication can help decrease obsessions, therapy plays a crucial role in changing the brain's structure and promoting long-term improvements. The therapy process involves relabeling intrusive thoughts, distracting oneself, and revaluing priorities. The release of stressors triggers the HPA axis system, leading to the production of cortisol and pro-inflammatory cytokines. Chronic stressors can exhaust this system, resulting in decreased cortisol release and increased cytokine production, exacerbating inflammation. People with a history of childhood trauma may have lower cortisol levels and be more prone to inflammation-related conditions. Therefore, a holistic approach that includes medication, therapy, exercise, diet, and sleep is essential for managing and treating OCD and other related conditions.
Mental health and cortisol levels impact skin conditions: Chronic stress and trauma increase cortisol levels, contributing to skin conditions like eczema and psoriasis. Addressing psychological aspects of skin conditions and integrating mental health support into dermatology care can lead to better outcomes.
There is a strong connection between mental health, cortisol levels, and skin conditions. Chronic stress and trauma can lead to increased cortisol levels, which can contribute to conditions like eczema and psoriasis. Additionally, the body's response to trauma can result in a shift into a shutdown state, which can further impact the immune response and skin health. It's important to note that the adrenal glands never stop producing cortisol, but in some cases, steroids are prescribed to quiet down the inflammatory system. This highlights the importance of addressing the psychological aspects of skin conditions, and equipping healthcare professionals with tools to help patients engage in treatment. A key finding from the research is that patients with dermatologic issues may suppress their emotions, which can exacerbate skin conditions. Therefore, integrating mental health support into dermatology care could lead to better outcomes.
The importance of a patient and non-judgmental relationship with healthcare providers: Seeking out supportive, patient, and understanding healthcare providers leads to effective treatment and improved health outcomes.
The power of a patient and judgment-free relationship between a patient and their healthcare provider cannot be overstated. The speaker shared her experience of partnering with her dermatologist, who was patient, understanding, and non-judgmental throughout their journey to find a solution for her skin issues. This approach not only helped the speaker feel more comfortable and hopeful but also led to effective treatment. The speaker emphasized that this kind of supportive relationship is crucial, especially from an authority figure like a doctor. She concluded by encouraging listeners to seek out such relationships and engage in open communication with their healthcare providers to find the best possible solutions for their health concerns.
