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How to Care for Your Mental Health While Living with Psoriasis

By Claire Gillespie
Reviewed by Allison Truong, M.D.
October 10, 2022

As if skin lesions and joint stiffness weren’t enough to deal with, psoriatic disease tends to affect people in multiple ways—and they’re not all physical. People with psoriasis often struggle with their mental health, too.

In fact, in a recent survey, our psoriasis community members were asked how much psoriasis and/or psoriatic arthritis impact their mental health. Nine percent of respondents said ‘extremely,’ 34 percent said ‘very much,’ and 34 percent said ‘somewhat.’ Only 4 percent said their psoriatic disease didn’t impact their mental health at all.

And the level of impact is likely to be clinical. “Up to 84 percent of patients with psoriasis have a coexisting psychiatric diagnosis,” says Alia Ahmed, M.D., a psycho-dermatologist practicing in London, England.

So it’s important that people with psoriatic disease are aware of the risks and ways to care for their own mental health while also managing their psoriasis.

The Mental Health Impact of Psoriasis

Psoriasis is specifically linked to an increased risk of depression, Ahmed notes, most commonly when people have severe psoriatic disease. A population-based cohort study published in the Archives of Dermatology found that people with psoriasis have a 39 percent increased risk of being diagnosed with depression than those without the disease.

Similarly, in the survey, 35 percent of people who responded reported significant depressive symptoms. These included having little interest or pleasure in doing things and feeling down, depressed, or hopeless more than half the days in the previous two weeks. To be given a diagnosis of depression, people must have had at least two of the five symptoms mentioned above for at least two weeks, although depressive symptoms can last weeks, months, or years.

But it doesn’t stop at depression. Forty percent of members with psoriatic disease reported significant anxiety symptoms. They said they felt nervous, anxious, on edge, or weren’t able to stop or control their worrying more than half the days in the previous two weeks.

Ahmed says that at the time of diagnosis, people with psoriasis have been shown to have a higher prevalence of alcohol misuse, bipolar disorder, anxiety disorders, and self-harm, and are more likely to be taking medication to manage their mental state.

People with psoriasis are at risk for numerous other psychological health issues, says Evan Rieder, M.D., a board-certified dermatologist and psychiatrist at NYU Langone Health in New York City, including sexual dysfunction, poor self-esteem, poor quality of life, and even suicidal ideation.

It’s important to note that although people with psoriasis are more likely to have psychological and psychiatric comorbidities, psoriasis alone does not cause these illnesses. Sometimes, these conditions may occur before, during, or after a person’s psoriasis diagnosis.

The Body-Mind Connection

Why people with psoriatic disease have higher rates of mental health concerns isn’t clear and is likely due to a variety of factors.

“The reasons for this are complex and not fully elucidated,” Rieder says. “However, there is some evidence to suggest that stress and autoimmune inflammation can serve as triggers for some mental health conditions in a similar way that they do for psoriasis.”

Ahmed points out that people with psoriasis may be socially isolated and have feelings of failure, which can have a huge impact on mental health. In the survey, 65 percent of people who responded said their psoriasis interferes with their social activities and relationships. Many of them attributed feelings of isolation and anxiety over social interactions to feeling self-conscious about their psoriatic symptoms.

When people described how their mental health interferes with their personal relationships and social activities, the top themes included isolating from others, feeling self-conscious, feeling withdrawn, overthinking, and having anxious thoughts. And when both psoriasis and psoriatic arthritis play a part, it’s a double whammy. “Breakouts determine how I dress and what I wear. Joint pain determines what activities I participate in or don’t participate in,” wrote one person.

Because people with psoriasis often find it difficult to express their emotions, they may be more likely to miss opportunities to disclose how they’re feeling. “Ultimately, this leads to poor coping and may aggravate psychological distress,” says Ahmed.

Ways to Keep Yourself Mentally Healthy

First of all, make sure you’ve got the best treatment plan in place for your psoriasis. “Best” means best for you––there are many treatment options, and everybody’s response to them is unique. If you don’t feel that your current psoriasis treatment is working, make an appointment with your dermatologist to talk about your symptoms and available alternatives. This is also a good time to talk about how your psoriatic disease is affecting what Ahmed describes as “key quality of life aspects”—including sleep, exercise, relationships, clothing choices, and work or studies. Some insurance companies will cover medications if psoriasis is severely affecting the person’s quality of life.

“Understanding the impact of psoriasis on the life of the patient is the best way to ensure optimal treatment,” Ahmed explains. “This is the first step to taking control of the associated mental health aspects.”

Lifestyle factors also play an important role, Ahmed points out. For instance, reducing alcohol intake, quitting smoking, making healthy food choices, and increasing exercise can all have a positive impact on mental health. All of these lifestyle changes may also improve your psoriasis, which will make you feel better physically and mentally.

To increase knowledge about psoriasis and gain more social support, Ahmed recommends joining patient support groups and online groups like our psoriasis community. By connecting with others going through similar challenges and staying informed, you’ll feel more empowered to make the right decisions about your psoriasis and your mental health. Someone with a similar type of psoriasis may also recommend a strategy that may work for you.

Treatment for Mental Health Concerns

If mental health issues still exist despite good medical management, this may be a sign that other therapies are needed, such as psychological interventions and, in some cases, oral medications to deal with symptoms of psychological distress.

And if you have psoriatic disease and an official mental health diagnosis, like anxiety or depression, it’s really important to keep up with your treatment for both. “Let your healthcare provider know if you are struggling to manage the two together,” says Ahmed.

Consider asking for a referral to a specialist at a psychodermatology clinic, where doctors manage patients with skin disease that also have an associated psychological component. This may help you manage your psoriatic and mental health issues side by side. Unfortunately, there aren’t a lot of these clinics, so they can be difficult to find.

At the same time, try to talk to people you trust about how your skin affects your life, and never be scared to ask for a second opinion if you’re not satisfied with the care you’re getting from your doctor.

“If you feel low about your skin, or about life, in general, please let your doctor know, because there are lots of things we may be able to do to help,” Ahmed says.

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