Certain Response Skills May Help Address Stigma Among Patients With Skin Conditions


Although previous research has explored and documented the prevalence of stigma facing people with chronic skin conditions, less is known about how patients respond to such stigma.

Certain response skills may help alleviate the burden of stigma in people living with chronic skin conditions, suggest study findings in Frontiers in Medicine.

Although previous research has explored and documented the prevalence of stigma facing people with chronic skin conditions, less is known about how patients respond to such stigma.

“Existing research shows that stigma in various skin conditions, including acne, atopic dermatitis, vitiligo, and psoriasis, is associated with poorer quality of life and increased distress. For example, individuals with psoriasis often feel ‘different’ from others,” wrote the researchers. “Further, studies in patients living with acne show that stigma is the largest contributor in predicting poorer quality of life, over and above disease and demographic variables. These findings are concerning, highlighting that individuals with skin conditions have to deal with the diagnosis/management of the condition in addition to the potential negative effects of feeling stigmatized.”

In their study, the researchers included just over 100 patients with different chronic skin conditions, including psoriasis (n = 23), eczema (n = 16), and alopecia (n = 11). Patients provided demographics and information about their condition and completed standardized questionnaires measuring perceived stigma (Perceived Stigmatization Questionnaire), anxiety (Generalized Anxiety Disorder Assessment), depression (Patient Health Questionnaire), and quality-of-life (EuroQOL 5-Dimensions).

Patients also completed the 23-item Comprehensive Assessment of Acceptance and Commitment Therapy Processes measure assessing skills of psychological flexibility (PF), which includes 3 response style: openness to experience (open), behavioral awareness (aware), and valued actions (active).

Among these 3 PF response styles, “open” and “active” skills appeared to be most influential. Network analysis showed that being open to the experience of stigma, distancing themselves from stigmatized thoughts, and actively bringing attention to value-based committed actions contributed to less stigmatized experiences.

Excluding these PF measures, the strongest positive relationships were seen between depression and anxiety and between stigma and depression. The strongest negative relationships were seen between anxiety and perceived health and between depression and perceived health.

“The role of depression and anxiety is consistent with studies on stigma. In our study, we observed depression as the only variable associated with stigma in the network model,” explained the researchers. “Concerning stigma, depression in individuals with skin conditions might be seen as a form of avoidance and passivity behaviors. These behaviors can lead individuals with skin conditions to avoid seeking support as a result of stigma and shame. On the other hand, anxiety can be seen as a form of social anxiety related to the visible difference in appearance, further supporting some studies, showing that social anxiety is the most common form of distress for this population.”

Performing a multivariate analysis, the researchers found that 7 predictors—age, sex, condition severity, stigma, openness to experience, behavioral awareness, and value-based actions—accounted for 57% of variance in generalized anxiety, 38% of variance in depression, and 22% of variance in perceived health. Among predictors, behavioral awareness had the highest prediction for both anxiety and depression. Behavioral awareness and value-based actions were the only significant predictors of perceived health.


Vasiliou VS, Russell H, Cockayne S, de Holanda Coelho G:, Thompson AR. A network analysis of psychological flexibility, coping, and stigma in dermatology patients. Front Med. Published online May 16, 2023. doi:10.3389/fmed.2023.1075672

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