Certain Personality Traits in Patients With Psoriasis May Explain Social Anxiety

A Turkish study analyzing mental health and quality of life in patients with psoriasis revealed that patients are more likely to express personality traits associated with social anxiety regardless of the severity of their psoriasis.

This is the first controlled study investigating social anxiety and related factors in patients with psoriasis, the authors claimed.

Social anxiety disorder is characterized by intense fear and avoidance of others in social situations. For patients with psoriasis, open lesions and skin abnormalities can cause patients to feeling shame or embarrassment over their appearance, which can lead to poor self-esteem, social anxiety, and a lower quality of life, the authors said.

In this study, investigators recruited 50 patients from an outpatient clinic attached to a hospital between May 2012 and March 2014. The researchers also used a control group of 50 employees from the hospital, matched for age, sex, and education.

Patients were assessed with 5 tools:

• The Liebowitz Social Anxiety Scale (LSAS)
• The Hospital Anxiety and Depression Scale (HADS)
• The Multidimensional Scale of Perceived Social Support (MSPSS)
• Ways of Coping questionnaire (WCQ)
• Eysenck Personality Questionnaire Revised: abbreviated form (EPQR-A)

In addition, the severity of their disease was assessed with the Psoriasis Area and Severity Index (PASI) and patients were also asked to complete the Dermatology Life Quality Index (DLQI). Statistical methods included multiple regression and Pearson correlation analysis.

Compared with the control group, patients displayed significantly higher degrees of social anxiety (r: = 0.373; P = .008), which was closely related to impaired quality of life (r: = 0.336; P = .018).

On the personality questionnaire, regression analysis showed that extraversion and neuroticism subscale scores significantly impacted the LSAS-Social Anxiety scores, accounting for 41.5% of the variance. Having tendencies towards extraversion also significantly influenced LSAS-Social avoidance scores, accounting for 26.8% of the variance.

Patients with psoriasis had higher degrees of social anxiety, depression, distrustful approach, submissiveness and neuroticism.

In contrast with previous studies, investigators found that disease severity did not correlate with social anxiety scores, which investigators propose has to do with the location of lesions on the body, rather than disease severity, as most participants had skin lesions in visible areas.

“Since being scrutinized is a contributory factor to social anxiety disorder, the expectation is that patients with lesions on visible areas would suffer most from social anxiety, apart from disease severity,” said the researchers. They said this makes sense considering that patients with psoriasis often continue to be socially anxious and avoidant even after skin lesions have resolved.

Additionally, the study revealed that a significant percentage of patients with psoriasis perceived themselves as having less support from their social networks compared with those who do not have psoriasis.

“This finding is a critical health concern, as a vast body of research reports indicate that social support provides protection for the psychological and physical well-being of people,” investigators stressed.

Scores for using active coping skills were lower in patients with psoriasis compared with healthy participants, which aligned with previous studies. Patients with psoriasis had less active coping strategies such as planning inadequacy, lack of positive representation, and poor humor compared with controls. But the authors said the passive coping mechanisms did not appear to be a significant determinant of social anxiety.

Investigators said that the results from their study and previous ones “indicate that dermatologists should consider embodying the awareness of a negative impact of social anxiety on patients living with psoriasis welfare.”

Reference

Yildirim FE, Seremet S, Afşar FŞ, Yildiz İ, İyidoğan. Evaluation of social anxiety levels and related factors in psoriasis patients: A controlled, cross-sectional study. Arch Neuro. 2020; 57 (2):148-153. doi:10.29399/npa.24854