Understanding the Link Between Psoriasis and Social Anxiety
Medically reviewed by Michael MacIntyre, MD
Psoriasis is a chronic inflammatory skin condition that can have a significant impact on your quality of life and body image, all of which can lead to social anxiety. In turn, social stress and anxiety can also worsen psoriasis.
The condition causes areas of skin to become inflamed, flushed, and flaky, and the appearance of psoriatic lesions may lead you to feel anxious, depressed, and self-conscious. However, there are many resources to help people with psoriasis manage these feelings.
This article explains the connection between psoriasis and social anxiety and provides tips on maintaining a positive body image.
Olga Kalacheva / Getty Images
The Link Between Psoriasis and Social Anxiety
Research has found that psoriasis causes social anxiety, leading to a lower quality of life. One review found that approximately 15% of people with psoriasis have social anxiety disorder.
Social anxiety is a type of anxiety triggered by social situations in which a person fears they may be judged or rejected based on how they act, behave, or appear.
Those with psoriasis may feel social stigma based on their appearance and worry about how they are perceived based on their psoriasis lesions, contributing to social anxiety.
Body Image and Feelings of Self-Worth
Psoriasis can cause red, gray, white, or brown scaly patches on your skin that may itch, flake, ooze, or crack. In short, psoriasis can significantly affect your appearance and body image and contribute to social anxiety.
One study found that psoriasis lesions on the head and neck were associated with the highest levels of social anxiety. This is likely because those are the most visible areas of your body in social interactions.
Appearance plays a large role in many people's self-worth; therefore, when psoriasis alters their appearance, their self-worth is negatively impacted. Additionally, many people with psoriasis report feeling stigmatized by their condition, adversely affecting them in work and social settings.
What Does Social Anxiety Look Like?
Social anxiety looks different than general anxiety, and it's more than just "shyness." It is brought on specifically by social situations, from an upcoming performance or big presentation at work to simply meeting up with a friend or small talk in an elevator.
Social anxiety can look different from person to person, but here are some examples of how it may manifest:
Feeling self-conscious in everyday social interactions
Dread or deep fear around all levels of social interaction
Persistent fear that other people are negatively judging or evaluating you
Overthinking how you had appeared, spoke, or behaved in social situations or "playing them over" in your head
Avoiding social interactions, especially meeting new people or novel social situations
Difficulty eating or going to the restroom in public, attending work or school functions, or with public speaking
Physically feeling sick, rigid, rapid heartbeat, sweating, trembling, or blushing
Who Is More Likely to Experience Social Anxiety With Psoriasis?
Not everyone with psoriasis has social anxiety. Scientists have investigated what factors predispose a person with psoriasis to social anxiety. These include:
Gender: Women with psoriasis are more likely than men to have social anxiety and other psychological disorders.
Personality: Personality traits are linked to social anxiety among people with psoriasis. People with psoriasis and social anxiety are more likely to have neuroses (symptoms of stress, such as depression, anxiety, and hypochondria) and are less likely to be extroverted.
Disease severity: There is mixed research on the relationship between psoriasis severity and social anxiety. One study found that higher disease severity was linked to higher levels of social anxiety, but only among those people whose psoriasis started before adulthood. Another study found no relationship between disease severity and social anxiety.
Lesion location: The location of the psoriasis lesions may be a better predictor of social anxiety than the severity of the disease. Lesions on the head and neck are linked to higher levels of social anxiety.
Social support: A lack of perceived social support may play a role in whether a person with psoriasis is likely to have social anxiety or not.
Psoriasis and Stress Triggers
Stress is one of the most common triggers for psoriasis flares, creating a challenging situation if you find social interactions stressful.
For one, you don't want the stress of interaction to worsen your psoriasis, and as well, you don't want to isolate yourself from friends, family, and work.
Relaxation techniques, stress management tools, psychotherapy, and other methods can all help lessen stress's impact on psoriasis.
Can Psoriasis Cause Anxiety?
Psoriasis can cause anxiety. One systematic review, the highest level of research, found that between 7% and 48% of people with psoriasis had high levels of anxiety, which was significantly higher than the healthy individuals without psoriasis.
Researchers believe that this is due to social and biological factors. People with psoriasis report feeling stigmatized and judged due to their lesions, which can contribute to anxiety. Biologically, there are similarities in the inflammatory processes involved in both anxiety and psoriasis, which could also contribute to the link.
Can Stress and Anxiety Cause Psoriasis?
Psoriasis and anxiety have a bidirectional relationship, meaning that just as psoriasis can cause anxiety, so can stress and anxiety cause or worsen psoriasis. It is an ongoing area of study.
The field of study that examines the connection between skin conditions and mental health conditions is called psychodermatology. The connection between anxiety and psoriasis is complex, but the shared inflammatory process is key.
There is evidence that treating mental health conditions with psychotherapy can improve psoriasis lesion severity and the total surface area affected.
Related: Psoriasis Treatment: How Therapy Can Help
How to Deal With Psoriasis and Social Anxiety
It's important first to acknowledge that having psoriasis and social anxiety is difficult. You may feel torn between wanting to socialize and connect with others and fearing how you will be perceived or judged.
Managing stress is crucial for keeping social anxiety and psoriasis under control. Start by identifying your stressors so you can work to manage them.
Some ways to manage stress and live well with psoriasis include:
Getting regular exercise
Trying relaxation techniques like mindfulness, meditation, hypnosis, biofeedback, or yoga
Seeking support from a psychotherapist
Eating a healthy and balanced diet
Finding clothing and fabrics that make you feel confident
Keeping your skin moisturized
Having open conversations with friends, family, and colleagues about psoriasis
Understanding Negative Self-Talk
You may not realize you're engaging in negative self-talk until you take a step back, analyze your thoughts, and become aware of how you think or speak about yourself. When you notice a negative thought about your psoriasis, challenge it with self-compassion.
Self-compassion is how you treat yourself when you feel inadequate or as though you've failed. It involves accepting your struggle, understanding that you're not alone in these feelings, and supporting yourself in these challenging moments.
Focusing on the positives in your personality, environment, relationships, or skills can all help build resilience and lessen the negative internal self-talk.
Achieving Self-Love and Acceptance
Achieving self-love and acceptance with psoriasis is much easier said than done. This is a lifelong process, and your relationship with yourself changes over time, just as your psoriasis does.
Self-esteem and acceptance are vital components of living well with psoriasis. According to one study in which all participants had the same level of psoriasis, those with higher self-esteem were:
Less likely to think of themselves as unattractive
Less frequently believed that other people gazed at their lesions
Less frequently avoided other people because of their psoriasis
Remember that if someone comments negatively about your skin, this reflects poorly on them, not you. Try not to internalize those comments or generalize them to everyone else.
Consider Support Groups and Professional Help
If social anxiety and psoriasis are negatively impacting your life, consider attending a support group. Connecting with other people who share your autoimmune condition and can relate to the stressors that accompany it can help you feel empowered and confident. You may find that this is a stepping stone to feeling less social anxiety in other settings.
You may also want to consider getting professional help from a licensed therapist. Therapy is an evidence-based treatment option for both anxiety and psoriasis. Talk to a healthcare provider for recommendations or contact a therapist directly; you don't need a referral.
Summary
Psoriasis is an autoimmune skin condition that can cause lesions anywhere on the body. It can be painful and itchy and is linked to mental health conditions such as social anxiety. People with psoriasis may feel stigmatized or judged because of their lesions, but there are also biological processes that connect social anxiety and psoriasis.
Read the original article on Verywell Health.
