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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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.

 

Thumb to finger relaxation

IMG_1472The ability to relax can be very helpful, especially when you have a chronic illness like psoriasis.  If you suffer with pain then learning to relax is even more important.  Pain leads to tension which can lead to more pain, more tension on and on in a vicious cycle.Slide1

Relaxation can help with the tension and stop pain from getting worse.  It’s a skill like any other and requires lots of practice.  It’s important to practice at times when you aren’t tense as well as using it as a strategy to cope at more difficult times.  The more you do it, the more effective it will be.

There are many different ways to relax.

This is one method I love.  You can use it when you are tense or irritable, when your pain is getting worse and before bed to help you get a good night’s sleep.

Thumb to Finger Relaxation

Get comfy and remove distractions like the television and your mobile.

Touch your thumb to your index/pointer finger.  Keep it there and think about a time when you felt physically tired in a healthy way, for example after exercise or a strenuous activity.  Imagine you have just swum several lengths or jogged some distance.  Spend a minute or so remembering that feeling of ‘healthy fatigue’.

Touch your thumb to your middle finger and as you do, remember a time when you felt loved and loving.  It could be a warm hug or embrace or a touching conversation.  Spend a couple of minutes remembering that feeling.

Touch your thumb to your ring finger and as you do remember the nicest compliment anyone paid you. What did they say?  Try to accept that compliment now.  Truly believe it and pay the person who gave it to you the respect of accepting it whole-heartedly.  Remember that feeling for a minute or so.

Touch your thumb to your little finger and as you do remember the most beautiful place you’ve ever been.  Visualise it in your mind.  Remember the scent and noise, the ambiance and the temperature.  Enjoy this image for a minute or two.

That’s it.

You can do this exercise anywhere and it only takes around 10 minutes.

If you enjoyed that, why not try a mindful minute.

Please comment below or share if you found this useful.

With thanks to my beautiful hand model in the photograph.

Sun, Sand, Sea and Psoriasis

image

It’s beach weather and that can be very stressful for people with psoriasis. Whilst most people are thinking about sand castles and seashells, we are thinking about skin, skin, skin.

Our options for the beach are:
* Stay away
* Go but cover up
* Brave it in beach attire

Neither option is the right one and I have done all three at various times in my life. Here are my beach tips whether you decide to cover up or strip off.

1. Pick the right swimsuit. In my time I have worn long surf shorts with a tankini top and I also own a stylish modestkini (yes that is a thing!). I wear a wetsuit to swim in the sea which is quite sensible on the Welsh coast even when your skin is perfectly perfect.

2. Wear sunscreen. Whilst the UVB rays can be helpful, burning never is.

3. Try waterproof camouflage make-up. I spent a wonderful afternoon with a Red Cross camouflage make-up consultant and I came away with a prescription for my exact skin colour. The service is now provided by Changing Faces. I urge you to book yourself in and see what a good concealer can do.

4. Use a few windbreaks. It will give you privacy, as well as keep the sea breeze from chilling you.

5. Let your children/partner/beach buddy bury your legs in the sand. Cover your plaques, exfoliate and keep them entertained at the same time.

6. Be prepared for comments and questions so it doesn’t ruin your day if someone asks about your skin. Read this for more advice about dealing with unwanted attention.  This blog post might help too.

7.  Identify your thoughts that are making you feel anxious.  Try some CBT techniques to challenge them.

Enjoy!

Psoriasis and Stress

It’s usually taken as read that stress makes psoriasis worse but in actual fact there is very little research evidence to suggest that this is the case. To date no-one has been able to track stressful life events in a large enough group of people with psoriasis to see whether an increase in their symptoms followed on from an increase in stress. A recent study by Berg et al (2008) used daily diaries to try and link stress to psoriasis flare-ups. They found no pattern between the two factors.

The strongest form of evidence is found in research studies that have asked people whether they think stress makes their skin worse. And although most people tend to say yes, what’s not clear is how accurate a judgement people can truly make. For a start most people are quite likely to have been told by their GP or dermatologist that stress makes psoriasis worse, and this is most definitely going to influence any reply. On top of that, like the straw that broke the poor camel’s back, people may be more bothered by their skin when under stress. Their psoriasis may be the same all the year but it’s only when work is going badly and the kids have all got winter vomiting virus and the in-laws have arrived for three weeks over Christmas that they begin to notice and be bothered by their skin more than usual.

An additional problem is that people who are finding life stressful may not lead the healthiest of lifestyles. They might not find the time to apply their creams properly, might drink the odd glass (or bottle) of wine, eat take-away food for ten days in a row and may be getting less sleep. All of which may result in a flare of symptoms.

Believing that stress is responsible for your psoriasis may not be that helpful either. I found in a research study that the people who believed stress was a causal factor in their psoriasis were more likely to be anxious, depressed and stressed out than those who didn’t believe that stress was related, despite no differences in the level of psoriasis. In other health conditions researchers have found that if people believe stress is causing the problem then they feel less in control and this low self-efficacy results in low mood.

What we do know for sure is that having psoriasis is stressful and therein lies an additional compounding problem. If your psoriasis is bad you will probably feel stressed: but which came first? It’s a classic chicken and egg situation.

So there is no firm medical evidence to suggest that stress causes psoriasis, but given that psoriasis causes stress and stress in itself is bad for you, it might be wise to take measures to relax and de-stress.

Some people find this easier than others but for most of us relaxation is a skill that has to be learned and practised. Good relaxation is not about getting an extra hour in bed on a Sunday morning or spending a fortune on designer shoes.   Instead it’s about learning to become aware of your body; your muscle tension, your breathing and your thoughts, and learning to reverse the signs of stress and tension. A bit of stress is not bad for us. It helps us to perform and get though difficult situations. It’s when it becomes prolonged that it becomes a problem. The key is to practice relaxation regularly and at times when you are not stressed or tense. Then when you do come under fire those skills should come in to play like second nature. Watch out for tips on how to relax in future posts.

References

Berg M; Svensson M; Brandberg M; Nordlind K (2008) Psoriasis and stress: a prospective study. Journal of the European Academy of Dermatology and Venereology : JEADV ;22(6):670-4.

O’Leary, C.J., Higgins, E. and Creamer, D., Weinman, J., (2004). Perceived Stress, Stress Attributions and Psychological Distress in Psoriasis. Journal of Psychosomatic Research 57(5):465-71.