Could childhood stress cause psoriasis?

Did you know that stressful experiences in your childhood may have increased your chances of developing psoriasis?

Known as ACEs, Adverse Childhood Experiences are anything but ace. They include physical, emotional and sexual abuse, witnessing domestic violence or growing up with household substance abuse.

It was always clear that such traumas could affect people as adults but now researchers across the globe are discovering that they have an even more powerful impact on your health as an adult.

Having a history of ACEs increases your risks of health-harming behaviours such as smoking, drinking or eating too much of the wrong stuff but what’s even more fascinating is that these experiences have an effect on the way the brain develops in childhood.

People who have a certain level of ACEs experience changes in their neurological, immunological and hormonal development. There seems to be something about being in threat mode frequently during childhood that wires the brain to be prepared for danger increasing tissue inflammation and resulting in long-term changes in immune response.  This leads to tissue damage and long-term wear and tear on the body.

There is convincing evidence that people who experience ACEs are at much higher risk for many long term health conditions like auto-immune disorders like psoriasis, cancer, lung disease, heart disease and mental health illness even when you’ve controlled for differences in lifestyle choices.  They can even shorten your life by 20 years and the more ACEs you have the higher your risk.

In one long term study (Danese et al, 2007), childhood abuse was associated with elevated CRP levels, white blood cell counts, and other markers of inflammation 20 years later.

But can we do anything about it?
Years of research have made the link indisputable but the next big challenge is what to do about it. Obviously prevention and early intervention is key but what about those people in adulthood whose traumas are in the past?

I have psoriasis and a fairly significant ACE score. Do I need to just accept that this is the way I developed or can I reverse things?  The research is still in it’s infancy.  We know we can help people cope with trauma but what we don’t know is whether that reverse the neurological and immunological changes?

Helping adults heal is the next big challenge.  The brain has plasticity and can change at any age, so perhaps meditation and mindfulness practice can help to improve things.

It’s also important to remember that whilst a higher score means your risk is higher, it doesn’t determine your future.  Many factors such as a loving parent, grandparent or supportive school teacher can promote resilience so that lots of people with high scores do very well indeed.

One final thing to think about: I developed psoriasis when I was 13 years. I did have adverse childhood experiences to contend with – but psoriasis was another enormous ACE to add to my load and now I wonder for me whether it all became a bit of a vicious circle.

If you want to know more, then watch this excellent TED talk: Nadine Burke Harris TED talk

or watch this informative short animation: ACEs // Public Health Network in Wales

You can score your own ACEs here: Take the ACE quiz

Reference

Danese A. et al (2007). Childhood maltreatment predicts adult inflammation in a life-course study. Proc Natl Acad Sci U S A; 104(4):1319-24.

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So you’ve got psoriasis? Cheer up love, it could be worse

imageYou know logically there are far worse things to have than psoriasis.  A glance at the evening news will tell you there are hideous things happening to millions of people across the world at every moment.  But someone telling you that having psoriasis is not so bad by comparison does not make you want to put on your dancing shoes and throw a celebratory party.  It makes you want to throttle them. And then put on your dancing shoes to kick them when they’re down on the floor.

I’m not going to tell you to cheer up.  I’ve had psoriasis for over 30 years.  I know all about the soreness, the flaking, the pain, the embarrassment, (pause for breath), the restrictions to life, the unpleasant treatments, the uncertainty and the horrible out of control feeling it brings but I honestly believe you can be happy despite having this condition.  It’s just not as simple as someone telling you to look on the bright side because it could be worse.

There’s an exciting and developing field of psychology devoted to helping people feel positive and happy whatever their circumstances.  If you think of a scale with misery at one end and ecstasy on the other, traditionally a psychologist would aim to help someone move from the depression end to somewhere in the middle of the scale; a neutral point.  Recently psychologists have begun to focus on helping people move towards the happiness end of the scale instead of just aiming for an absence of low mood.

Positive psychology therapy involves techniques such as learning to savour the moment and connecting with other people and there is good scientific evidence that these strategies can help with clinical depression.  You can read more about these simple yet powerful techniques on the Action for Happiness website.

It would seem that being happy has more benefits than the simple joy it brings.  In the 1930s, a large group of Catholic nuns were required to write a 2-3 page autobiography before entering the convent and then went on to live very similarly structured lives.  Many years later psychologists discovered and analysed these autobiographies rating the nuns’ cheerfulness.  They discovered that the positive nuns lived longer by 10 years.  A whopping 54% of cheerful nuns reached the age of 94 years compared with only 15% of the least cheerful ones.  Evidence that it’s not only nice to be happy, it’s good for you too.

Living with psoriasis is not easy.  Often it feels like I’ve turned up to an elegant cocktail party in fancy dress by mistake.  Everyone else looks like they belong to the Kardashian clan and I’ve come as Hellboy.  Oh the shame of being the only guest to miss the ‘bring your flawless skin’ memo.

So yes, it could be worse and yes, it could be better.  The long and the short of it is I have psoriasis and there’s no cure.  I struggle with accepting that but I am determined to enjoy my life in spite of it.  I want to be happy.  I am more than skin.

Follow my blog for tips about coping with psoriasis.

Living with psoriasis. Are you MAD?????

psoriasisPsoriasis is hateful.

I developed it as a young teenager, just what I didn’t need at a time when my body was already going through some huge and alarming changes.  I’ve spent my life since in a battle against psoriasis, seeking out new tactics to beat it into submission and most often going undercover; hiding my skin away from the world, pretending to be normal while all the time, under my clothes, I’m plastered with red hot patches of skin, sore, flaking and peeling.  It’s been a long, hard campaign and in reality my enemy doesn’t even exist.  It’s just me fighting me.  At times I’ve felt very low and I’m not alone.

So many people with psoriasis suffer with clinical levels of anxiety and depression.  People with psoriasis can even feel suicidal.  I understand this.  It’s a difficult condition to live with; painful and unsightly and in a world where appearance is so important, it’ easy to feel disgusting and ashamed.  It’s hardly surprising this would affect your mood.

A review ‘Psoriasis and Associated Psychiatric Disorders’ was recently published in the Journal of Clinical and Aesthetic Dermatology.  The authors reviewed research papers published between 1990 and 2015 looking at psoriasis and mental disorders.  The most prevalent psychiatric problems were sleep (more than 50% of people with psoriasis) and sexual disorders (a depressing 71% of people with psoriasis).  They also found papers reporting an association with schizoid traits, schizophrenia, substance abuse, bipolar disorder and eating disorders.

Problems with dependency and eating may be understood as coping strategies and of course you don’t sleep or feel too sexy with all that itching and flaking going on, but the connection with bipolar disorder and schizophrenia is less easy to understand.

From closer reading, it would seem that the association with schizophrenia is mainly based on a paper which found that people with schizophrenia have a higher risk for psoriasis rather than the other way around.  It’s a bit like saying that a large number of newspapers are published online, but that doesn’t mean that a high rate of online content is newspapers.  Some of the other evidence reported in the review came from a small number case studies where psoriasis cleared up after anti-psychotics were administered.   When psychiatrists talk about schizoid personality or traits the main characteristics are social isolation, intimacy avoidance and restricted affections.  Well duh.  It’s hardly surprising to act like this when you are covered in psoriasis.

Whichever way you look at it, having psoriasis can make you feel bonkers at times.  But it doesn’t have to be that way.  I have one, unique life, albeit a life marred by flaking skin, but I want to be happy and enjoy it.  Sure, I would bite the hand off someone offering me a cure, but until that happy day comes, I want to make the most of my life in spite of my skin.  I believe I can.  There are many psychological strategies and techniques to help you cope with your skin.  You can learn these on your own with the many self help resources available online or find a good psychologist to lead the way.

Reference

Ferreira BI, Abreu JL, Reis JP, Figueiredo AM. (2016). Psoriasis and Associated Psychiatric Disorders: A Systematic Review on Etiopathogenesis and Clinical Correlation. J Clin Aesthet Dermatol;9(6):36-43.

 

Psoriasis. Good for your soul?

I was at a paediatric psychology network conference and listened to a very interesting presentation on positive personal growth following trauma or illness (Green 2009) and I wondered if this linked to psoriasis in any way.

This presentation highlighted the surprising evidence that many people do well after ill health or having something traumatic happen to them. In some cases, they do even better than those who have not had a similar traumatic experience.

The speaker gave lots of evidence. Of a group of adults who had been abused as children, 45% were classified as resilient and had no psychological problems. When compared to a group of adults who had not been abused they were actually functioning better. The same story was seen in a large sub group of children and adults who were involved in the ferry disasters, Herald of Free Enterprise and The Jupiter, in the 1990s. The same pattern is seen in survivors of cancer and heart attacks, women with impaired fertility and even in those who have lost a child.

So what does this mean? I don’t think the evidence suggests that people ‘benefit’ from these awful events. They are affected and no doubt those who have lost loved ones or even aspects of their own functioning still grieve, but these events and illnesses have helped them to reflect and perhaps value the good things in life. We heard a very moving quote from a father who had lost two daughters in the Hillsborough disaster “It sounds ridiculous, I know, but I think I have come out of it a better person. But I’ll always be a chipped cup…..” (Times Online)

So how does this relate to psoriasis? Can we find anything good from this condition? I did struggle with this at first being so focussed on the negatives (flaking, itching, soreness, embarrassment). But thinking away from the immediate symptoms I do think of myself as a caring person, I don’t judge a book by its cover and I am empathic. Would I have chosen to be a clinical psychologist had I grown up blemish free? I don’t know the answer to that. I would quite happily give my psoriasis away (any takers? No?) but it has taught me to cope with life’s challenges and it has taught me not to worry about the small things. A bad hair day would not have me diving under the duvet like many people I know. It has made me think about the connection between alcohol and psoriasis in a new light too. Perhaps we are not drinking to forget, maybe we are just enthusiastic party animals!

Depression and psoriasis

Many of us with psoriasis feel down about our skin. The research evidence looking at the link between depression and psoriasis is itself quite gloomy. One recent study conducted in Italy found that over 60% of people with psoriasis have symptoms of clinical depression (Eposito, 2006). Compare that to approximately 10% of people in the general population.

But how do you know if the way you are feeling is clinical depression? We all get low from time to time but feeling low is considered to be clinical depression when five or more symptoms from the following list have been present over a two week period, and at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure*:

  • Depressed mood most of the day, nearly every day;
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 of body weight in a month), or decrease or increase in appetite nearly every day;
  • Insomnia or hypersomnia nearly every day;
  • Psychomotor agitation or retardation nearly every day;
  • Fatigue or loss of energy nearly every day;
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day;
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Feeling depressed about psoriasis is tricky because as we all know there is no cure for psoriasis. If someone could wave a magic wand and rid you of this disease then this is likely to be an effective cure for your low mood. Sadly there is no magic wand (or cream or tablet) to cure your skin so what can you do instead?

The symptoms of depression can be treated using anti-depressant medication and/or a psychological therapy. However a treatment that only aimed to improve the symptoms of depression would miss the bigger picture. It would be hard to treat depression without tackling the root cause: psoriasis. It is a Catch 22 situation because we know that treating psoriasis is not so easy. Perhaps equally important is to learn to cope with psoriasis so that it has less of an impact on your mood. If you can’t get rid of it then you need to learn how to live with it. How well you cope with this condition can determine how happy and fulfilled your life is. Learning to identify negative or unhelpful thoughts, changing behaviour and relaxation may be the tools to coping. Look out for tips relating to these strategies in future posts.

If you have read the list of symptoms above and think that you are depressed then please visit your GP to discuss treatment options.

* Taken from the DSM IV – The Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (American Psychiatric Association, 1994) – the current reference used by mental health professionals and physicians to diagnose mental disorders.

Reference

Esposito M, Saraceno R, Giunta A, Maccarone M, Chimenti S:An Italian Study on Psoriasis and Depression.Dermatology 2006;212:123-127