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Body image and mental health: The psoriasis connection

As part of mental health awareness week, the Mental Health Foundation (MHF) have released a new report on the interaction between body image and mental health. Our Medical Writer Alex Teahan has written a thought piece on the report,  where he shines a spotlight on psoriasis in relation to mental health and body image issues.

As part of mental health awareness week, the Mental Health Foundation (MHF) has released a new report on the interaction between body image and mental health. Our body image – how we think and feel about our bodies - is a result of various individual, family and cultural influences; in western cultures which emphasise materialism, consumption and celebrity lifestyles, people often fare worse in terms of body image and mental health, where poor body image increases the risk of depressive symptoms, psychological distress, disordered eating and eating disorders.1

The term ‘poor body image’, also described as ‘body dissatisfaction’, refers to a feeling of being unsatisfied with our bodies, either due to its appearance or the way it functions.1 The MHF survey found that one in five people report feelings of shame, just over one-third report ever feeling depressed or anxious, and one in eight have had suicidal thoughts or feelings due to their body image.1

People with long-term health conditions are at a high risk for body dissatisfaction, particularly when the symptoms physically change the body and are accompanied with chronic pain – which can affect the way we experience and perceive our bodies, particularly where the pain is localised.1 Many adults in the survey with a health problem or disability that substantially limited their daily activities reported feeling shame (31%) or feeling down or low in the last year (47%) because of their body image, and 50% felt their body image negativity affected their self-esteem, compared with individuals without a limiting condition (18%, 32% and 36%, respectively).1

As part of our reporting on the MHF survey and raising awareness for this important week, we wish to shine a spotlight on psoriasis in relation to mental health and body image issues. Psoriasis is an inflammatory, auto-immune skin disease, which causes the skin to grow many times faster than normal.2 This most often causes plaque psoriasis, where red, raised and scaly patches of skin may appear anywhere on the body, in one location or in many, or someone may develop a different type of psoriasis (palmoplantar or guttate, to name two).2 People with psoriasis often experience physical discomfort such as pain and itch, functional problems in their social life, home life, work or relationships, and have a higher risk for experiencing psychological issues compared to the general population, such as low confidence, poor self-esteem and mental illness.2

Up to one-third of people with psoriasis worry, feel anxious and stressed due to their condition.3 The physical discomfort of psoriasis contributes to psychological distress, particularly itch,4 however the two largest contributors are the belief they are being judged on the basis of their skin disease and engaging in avoidance behaviours to hide their condition.3

The belief we are being judged for how our bodies look and the motivation for hiding parts we dislike is related to why we are predisposed to judge ourselves and develop a negative body image; how our family and peers feel and speak about bodies and appearance, exposure to images of ‘idealised’ or unrealistic body images through media or social media, and the pressure to look a certain way or to match an ‘ideal’ body type all contribute to it.1 ‘Internalisation of the ideal’ refers to when people have an internal image of the perfect body which they compare themselves against and internalise their own body image as shameful by comparison.1 Qualitative research on the experiences of people with psoriasis supports this: “Respondents (especially female respondents) were acutely aware of a (largely media generated and unrealistic) societal ideal of perfect skin”.5 Alongside the awareness of this ideal, participants described embarrassment, shame, impaired self-image, low self-esteem, self-consciousness and stigmatisation.5

As a part of this column, we interviewed Claire,* who shared her experiences of living with psoriasis:

For a while psoriasis did have a negative effect on my body image. I never had my legs bare. As I’ve got older, I care much less about it. I’m used to it and I’m a personal stylist now so that has helped me work with it rather than against it. It’s part of who I am now and that’s fine.I struggled with anxiety for a long time and had a bout of depression which were independent from the psoriasis.

From having psoriasis and studying personal styling, body confidence is a very important topic to me. I often reference my psoriasis when talking to people and tell them it’s a part of me and that I work with it rather than against it. This principle works for all matters of body image issues.

People are not always understanding or tactful and that is their issue. I’m quite happy these days to walk around in a bikini on holiday, which does mean I get a few looks. It really is their problem though and not mine. I’m confident in my image. My style, personality and empathy more than make up for it.

Claire*

Claire has clearly attained a level of body confidence and satisfaction which protects her from this comparison to an unrealistic ideal and consequential psychological difficulties, and as she mentioned her, experiences working as a personal stylist helped her to accept her condition and ‘work with it rather than against it’. Her confidence relates not just to her body, but also her style, personality and empathy, which indicates she has high self-esteem which does not solely depend on her body image. This is the ideal perspective we should be working towards on a cultural level; however, many people do not have this kind of experience, perspective or resilience as protective factors.

Tackling the causes of body dissatisfaction across society is a vital step towards ameliorating the negative impact it can have on mental health. The MHF recommends both regulatory and industry-led initiatives, particularly in advertising and social media, to find innovative ways to stop exacerbating body image concerns and promote a positive body image through diverse representation, breaking down our cultural image of an ideal body type and providing people with a true representation of the variety which occurs in reality.1 With no one ideal body image as a comparator, there would be less dissonance between what we feel we should look like and what we actually look like. To briefly illustrate this in terms of psoriasis, this could include involving people with psoriasis of varying severity and symptom location in advertising media to normalise their appearance on a cultural level; the same applies for the diverse representation of other groups at high risk of developing body-image related mental health problems such as those with other long term conditions, obesity, disabilities, children and young people, minority ethnic groups and the LGBT community.1

The MHF also recommends, among other initiatives, the development of a body image and media literacy toolkit as a compulsory element of education. This would mean people from a young age have the skills to expose the hidden motivations in media, decode the messages that may contribute to their body dissatisfaction, and be conscious of when a message is encouraging active comparison to an unrealistic ideal. By increasing awareness of how these messages are constructed and why, people will be equipped to actively deconstruct the influence of media on their thinking and be less likely to internalise the messages.1

A detailed analysis of the interactions between body image and mental health, how this applies to people with psoriasis and how as a culture we can move towards protecting people from harm due to unrealistic expectations of their bodies is beyond the scope of this article; to find out other facts around body image and mental health and what the MHF recommend to combat these issues, read the full report here.

*The interviewee’s name has been changed to protect her anonymity

References

1. Mental Health Foundation: Body image, research report. Available from https://www.mentalhealth.org.uk/publications/body-image-report [Last accessed May 2019].

2. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007; 370(9583): 263-271. doi:10.1016/S0140-6736(07)61128-3.

3. Langley RGB, et al. Psoriasis: epidemiology, clinical features, and quality of life. Annals of the rheumatic diseases, 2005; 64(suppl 2): ii18-ii23.

4. Reich A, et al. Pruritus is an important factor negatively influencing the well-being of psoriatic patients. Acta dermato-venereologica, 2010; 90(3): 257-263.

5. Magin P, et al. The psychological sequelae of psoriasis: Results of a qualitative study. Psychology, Health & Medicine, 2009; 14(2): 150-161. doi:10.1080/13548500802512294.

16th May 2019

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