Just a Psychologist with Psoriasis

I wore a dress to work this week.  The weather has been soooooo hot and my skin isn’t too bad so I thought I could get away with baring my legs. ‘You look gorgeous’, were my husband’s parting words and he’s not biased.  Right?

So, I am on the ward where I work.  There’s no air conditioning and all the patient room doors are open.  Where I am stood writing notes, it’s a rare moment of serenity; everyone is either dozing in bed or quietly getting on with jobs in hand.

On the other side of the ward, the ward round is in progress.  This involves a troupe of junior doctors, nurses, dietitians and physiotherapists following the almighty consultant from bedside to bedside as he makes important and almighty decisions.

The troupe start to descend my corridor and the almighty consultant spots me from across the ward and shouts out in his rich Northern accent,

What’s been biting your legs?’

Everyone stops.  Everyone takes a good long look at my poor, psoriasis spotted legs.  A few patients, who haven’t got out of bed for days, even manage to shift a bit to get a view.

I’m the team psychologist.  I should know how to handle this.  Everyone is now waiting for my reaction.  The truth is I feel ashamed and ugly and I wish I hadn’t listened to my husband that morning when he assured me no-one would notice my skin.

For the first time in my life I don’t respond with an apologetic explanation.  I practice what I preach.  I take a deep breath, I smile, I shake off feelings of shame and I say,

‘It’s psoriasis.  And now you’ve loudly pointed out my imperfections, is it my turn to point out yours?’

Pause, a few giggles from the troupe and almighty consultant put firmly and politely in his place.

Go me!  I was still chuckling about his mortified look and mumbled apology as I drove home later that day.

And I’m still wearing a dress to work, at least while the sun continues to shine.  Bring on those questions and comments. I’m ready for you.

Read this if you want more tips for dealing with questions about your skin.

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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.

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.

The Shame of Psoriasis

What are people thinking about you when they look at you?

OMG how ugly
She looks dirty
That’s disgusting
I don’t want to go anywhere near him in case I catch it

It’s tough to live with those thoughts going around your head and little wonder we try to hide our skin and cover up.

People with psoriasis often rate other people’s reactions to their skin as the main difficulty with the condition.

But are you sure you’re always right about what people are thinking?

A psychology experiment carried out in 1980 took a group of women and made them up with fake scars. The women, who thought they were ‘disfigured’, then had a conversation with a stranger who knew nothing about the experiment. After the conversation, the disfigured women felt stigmatised. They were more aware of the stranger’s behaviours like staring and related this to their appearance. They thought the stranger was reacting negatively to the scar and this affected how favourably they rated the stranger. What women didn’t know was the experimenters had actually removed the scar before the conversation took place so any negative reaction to the (non-existent) scar was imagined. This study tells us that believing you look different heightens your awareness of other people’s behaviour and you are more likely to interpretate their behaviour as negatively related to your appearance – whether or not that is actually the case. Because of this, you are less likely to warm to strangers.

There’s no doubt some people are rude, unpleasant and insensitive. I’ve met a fair few of them. I’ve written about one particularly upsetting encounter here. But perhaps it’s not quite as bad as you think. Try some CBT and see if there is a different way of thinking?

 

Reference

Kleck RE and Strenta A (1980). Perceptions of the impact of negatively valued physical characteristics on social interaction. Journal of Personality and Social Psychology, 39 (5), 861-873.

Sun, Sand, Sea and Psoriasis

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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!