What Role Does a Patient's Personality Play in Dermatologic Conditions?

It seems odd to think of personality characteristics having an impact on disease onset and severity, although one can imagine a strong connection in chronic pain patients. The connection has also been explored and, in some cases, demonstrated for certain dermatological conditions, most notably in psoriasis and atopic dermatitis. Incorporating the information into your practice involves being at least somewhat aware of psychological factors that may contribute to these conditions.

A study in Postᶒpy has established a connection between certain personality characteristics and chronic idiopathic urticaria (CIU). Prior to this study, much of the research in this area was a bit dated. The authors believe that this study was the first to evaluate characteristics of patients with urticaria in terms of temperament and character dimensions.

CIU, defined as the occurrence of daily (or almost daily) wheals and itching for at least 6 weeks, is among the least well-understood conditions in allergy and dermatology. Recent CIU research has demonstrated that in 30% to 50% of patients, the disease is due to an autoimmune process, but there is much more that needs to be studied to get a better handle on onset, severity, and treatment. What are the other causes, and do personality traits contribute to the disease?

The Postᶒpy study tackled this question through a trial that involved patient assessments of 70 CIU patients and 60 control subjects. After examination in the dermatology clinic, patients diagnosed with CIU and who chose to participate in the study were assessed, and the following demographics were noted: age, gender, education level, and duration of urticaria. The researchers used the urticaria activity score (UAS) to estimate the intensity of CIU, and a well-established tool from psychology, the Temperament and Character Inventory (TCI), to measure dimensions of temperament. The TCI measures a host of characteristics, including novelty-seeking, harm-avoidance, reward dependence, impulsiveness, fear of uncertainty, shyness with strangers, openness to warmth, and self-acceptance, among many others.

So, how exactly does a patient’s personality contribute to disease onset? The answer may lie in the signals that the brain sends to the body, including where it sends neurotransmitters like serotonin and dopamine. In the Postepy study, patients with CIU scored higher on TCI measures like novelty-seeking, extravagance, and disorderliness than did those in the control group. CIU patients had lower scores on the TCI for cooperativeness, social acceptance, empathy, helpfulness, and compassion, among other traits. Duration of CIU correlated positively with self-directedness, responsibility, and self-acceptance measures.

The findings, which demonstrate that CIU patients have distinctive temperament and character dimensions, open up interesting avenues for further study and treatment and add more evidence that psychosomatic approaches may yield some benefit in treating patients with dermatologic conditions.