More Than Skin Deep—Psoriasis and Mental Health

Imagine living with painful, inflamed, red, itchy lesions covering 70 percent of your body—awful. Now, imagine being shunned by others who are repelled or scared of your skin—that may be even worse.

For some people with psoriasis, this is a daily reality—one that inevitably takes its toll on their mental health. Psoriasis' strong link to anxiety, depression and other mood disorders make it crucial for patients to think about taking care of their psyche, as well as their skin. 

What is Psoriasis?

Psoriasis affects a million Canadians and around 140 million people worldwide according to the Canadian Association of Psoriasis Patients, but its severity and symptoms can vary. For some people it's a bothersome rash. For others it's a debilitating condition that affects every part of their life. At its worst, the disease covers the body with painful, itchy, red plaques that are impossible to disguise and flare up when stressed or rundown.

When psoriasis strikes, the immune system becomes hyper-stimulated and white blood cells kick into high gear causing inflammation in the skin cells. It can be diagnosed at any stage of life and there are a few different forms. 

Plaque psoriasis is the most common, and can show up anywhere—the knees, elbows, scalp, chest, back and even genitals. Aside from the unsightly plaques, it can bring a whole host of other symptoms unrelated to the skin, like joint pain (psoriatic arthritis), fatigue, nail discolouration or crumbling, and mental health disruptions.

Psoriasis and Mental Health

When Kim Kardashian revealed she had psoriasis in 2011, many health advocates hailed it as an important step forward in breaking the stigma of the disease. Putting psoriasis front and centre in the media in this way gave hope to many similarly-afflicted young people struggling with their self-image.

Young people are particularly at risk of social isolation, as they are more likely to experience bullying, and end up being avoided in general due to the widespread misconception that psoriasis is contagious. When the people around you are afraid to touch you, life can become hell. One of our most basic needs, human contact, is a necessity for mental wellness. 

Being accepted by your peers is important, but it's also crucial to be accepted by yourself. Young people are bombarded with images of 'body perfection' and encouraged to achieve unhealthy standards of ‘attractiveness’ on social media.

Adults also have a hard time. People with the disease are at much higher risk of depression, anxiety and suicidal thoughts according to one study. Further research revealed that 67 percent of people with psoriasis reported depression, compared to just 12 percent of those without.

Individual Therapy for Better Mental Health Support

As with any body confidence issue, therapy can help. Peer support therapist Sharon Blady has worked with young people struggling with chronic illness and body image. She says it's often helpful to put their difficulty into context by urging them to find their inner superhero—

“Sometimes with body image issues that can occur with conditions like psoriasis someone can feel more Hulk than Spider-Man in what they feel they are managing. I support clients to recognize that they are not their condition—to acknowledge it as an on-going self-care and self-management issue, but with the additional reframing that each superhero usually has some limiting condition or aspect of themselves that is part of their powers. When we see ourselves in this light we can be more compassionate to ourselves.”

Group Therapy

Individual therapy can help, but group therapy is also an option, giving people the chance to meet others with the disease, and share their experiences and advice. Counsellor Magdalena Eid says support groups can also provide that much-needed human connection.

“It is not easy being looked at as if you come from outer space with a contagious disease, and should be avoided at all cost. If you see that others are dealing with that same thing, you can get advice and at least know that you are not alone in your condition, which is very important, because we are all social beings and need each other to survive and thrive.”

Hypnotherapy

Eid is also a certified hypnotherapist and says this type of treatment can stimulate the body's self-healing mechanisms, and help people with psoriasis control their stress—

“Hypnosis can be used to lower pain levels, strengthen the immune system’s response, alter blood pressure, and speed up the body’s healing process. The condition can easily turn into a vicious cycle – the more stress you have, the more flare-ups you have; and the more flare-ups you have, the more stress you have. That's why we look at lowering anxiety and stress levels first and foremost, and that’s why psoriasis responds well to hypnotic intervention.”

Eid guides clients through a metaphor known as the Quilt Factory, which she learned from hypnotherapy legend Maureen Pisani. The metaphor describes seven storeys in the factory, relating to the seven layers of skin. The first layer (the top storey) deals with the first stages of putting together a quilt—choosing a good quality fabric for the foundation etc. Clients go through the various stages of production, floor by floor, until reaching the final layer (at the ground floor) where they discover the end product of the perfect 'quilt' i.e. unblemished, healthy skin.

Eid says, “Hypnotherapy taps into the subconscious mind and uses its powers to induce healing. When clients manufacture all those ‘clean layers’ as a metaphor for the seven clean skin layers during the deep trance hypnosis, the skin cells are triggered to renew themselves.”

Eid advises clients to look at hypnotherapy as complementary care, and suggests trying it  alongside other medical treatments and therapies, such as diet.

Eating for Body and Mind

Diet plays a large role in managing psoriasis symptoms. Food can reduce the physical effects, but also help ward off mental crises.

How? By eating brain-friendly foods.

A 2016 study discovered that people following the Mediterranean diet (mostly plant-based, healthy fats and fish) had a 50 percent lower risk of developing depression, while another revealed that Omega-3 fatty acids reduced anxiety symptoms by 20 percent. 

It's not just a question of what to add to the diet, but also what to remove. Evidence suggests that cutting sugar can significantly reduce depression and anxiety, as well as avoiding processed foods which often contain hidden, harmful, additives.

“There is a huge link between diet and mental health. A lot of times, when people have psoriasis flare ups, what their eating is also giving them mental health issues,” says nutritionist Kyra Follis who advises her clients to follow a whole food diet, and focuses on improving their gut health in particular— 

“Any kind of health issue will show up on the skin last, so if you are seeing it there, there's something deeper going on. For people with psoriasis, the focus is the gut and to reduce the inflammation that is going on there.”

She recommends healthy fats like avocado, flaxseeds and fish, as well as plenty of fibre, colourful antioxidants like berries, and leafy green vegetables. She's also a fan of using adaptogens like rhodiola to mitigate stress.

Staying Positive

Follis started to show symptoms of psoriasis as a teenager, and says she suffered with anxiety and stress until learning to manage it through diet, and alternative treatments such as acupuncture. She encourages fellow psoriasis patients not to give up, saying—

“You can't change your DNA but you can manage your symptoms. You can still experience everything in life, but you have to put the work in. I never thought it would ever end for me, but it did, and that’s the best feeling. Seeing the look on people's faces and hearing how excited they are when their flare ups go away is my favourite part of what I do.”

It's easy to become depressed when you’re living with an incurable chronic disease, but the best antidote to despair is hope. Psoriasis is incurable, but it's also manageable. Eid says reaching out to other sufferers can be a key part of a patient's holistic treatment plan—offering a glimpse at a symptom-free future.

“When you see other people with the same condition it means a lot because they know what you have been through. You can see how they were empowered to deal with the condition, and how they have recovered. You can see that there is hope for you too, and that is key.”

If you’re dealing with mental health challenges as a result of a chronic, incurable condition, Which Doctor can help. Browse our network of therapists, counsellors, and health coaches to take that first step towards better mental health.

Catherine Morris

Writer

Catherine Morris is an award-winning journalist with a bad case of wanderlust and a passion for all things health and wellness. Originally from Northern Ireland, she worked as a news and feature writer for media outlets in the UK, South Africa, France and the Caribbean before settling in Canada. Catherine now lives in Alberta with her husband and rescue mutt and spends her time happily exploring the great outdoors with both.