Skin Deep

A mind-body approach to a healthy life.

Psychodermatology: Four Myths That Can Keep Your Skin From Getting Better

Psychodermatology: Busting skin myths that can keep you hurting


An exclusively biological approach to treating skin disorders can lead to four myths about skin - myths that can work against you and keep skin symptoms persisting. Psychodermatology isn't only about therapies; it's about viewing skin in a way that's fundamentally different from dermatology. Dermatologists see skin from a biological perspective; we see skin from a biological and a psychosocial perspective. Psychodermatology practitioners treat skin the way a psychotherapist treats behavior -- by learning how it responds to emotional and environmental stressors and helping to moderate those responses. Our success has debunked the following skin myths.

Myth #1: Medical problems need medical solutions.
The more we learn about how much emotional and psychological states influence our physical states, and vice versa, the more the line blurs between these categories. Take warts, for example. They're definitely medical because they're caused by viruses. Specific medical and surgical treatments make warts go away. These treatments work for many people, but not for everyone.

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The Ballerina's Plantar Wart

Sophie was a high school senior who couldn't get rid of the wart on the bottom of her right foot. Medicine would eliminate it for a while, but then it would return. During our first session I quickly learned that Sophie had put her heart and soul into ballet, but she wasn't sure if she wanted to keep at it beyond high school because the odds of becoming a professional ballerina were so slim. Her recurrent wart forced her to stop dancing. The wart, in effect, resolved her ambivalence about continuing with ballet.

Under hypnosis, Sophie conjured images of the viruses that were causing her wart and her immune system attacking it. She envisioned her foot clear of the wart. She also recognized her ability to make decisions using her heart and her mind, and to leave her skin out of the decision-making process. Sophie came to understand that her skin was giving voice to something that she couldn't admit to herself - that she didn't really want to pursue dancing professionally After three weeks, her wart disappeared for good.

Sophie's emotional stress may have weakened her immune system, tipping the balance in favor of the virus and making her susceptible to relapse. Our knowledge of the precise mind-skin pathway in cases like this is in its infancy. But clearly Sophie's wart was medical and psychological, and she needed medical and psychological treatments to cure it. The same is often true for people with psoriasis, hives, eczema, allergic rashes, and many other skin conditions. Sometimes psychological tools alone do the job with skin symptoms.


Myth #2: If a skin symptom has no psychological component, psychological tools have no role.
Psychological therapies can't cure the underlying cause of such symptoms, but they can offer substantial relief. Take liver disease. There's nothing psychological about it or the intense itching that it often causes. But hypnosis and other psychodermatology tools can help people with liver disease feel less itchy. The symptoms improve even though the disease process is unchanged.

There may be other benefits. Research has found hypnosis helpful for people who have suffered severe burns. They heal faster, feel less pain, and are less likely to develop infections and other complications compared with burn patients who receive only medical treatment.

Myth #3: Sensitive skin is always a disadvantage.
Sensitive skin is tough for dermatologists to treat because it's prone to adverse reactions to all sorts of things - emotions, environmental exposures, sometimes even the very medicines that are used to treat it. Skin that's emotionally sensitive tends to resist medical treatment, much as a gasoline fire rages even when deluged with water. But sensitive skin is the easiest kind of skin for psychodermatologists to treat because we focus on the emotions that are fanning its flames.
Some people's skin is especially emotionally reactive. Their mind-body link is very close. This tendency is in part genetic and in part the result of life experiences. Physical or emotional trauma tends to bring the mind and body closer.

Myth #4: To treat a skin problem effectively, you first need to diagnose the problem.
This makes perfect sense, except that many dermatological symptoms have no clear diagnosis. It's common to see intense itching with no sign of an allergy or a burning rash that seemed to come from nowhere. But the lack of a physical diagnosis is not an obstacle to psychodermatology practitioners. We successfully treat skin symptoms that defy physical diagnosis. I would go as far as to say that the particular skin disorder is often beside the point. This is counterintuitive, but let me explain.
When emotional turmoil is upsetting your skin, the symptoms that it produces depend on who you are - your genetic predisposition, your environment, viruses latent in your body, your psychosocial history. The same stressful event can trigger intense itching in one person, but cause a painful rash, hives, herpes, or psoriasis in another person.

 

Carl's Embarrassing Rash

Carl, a 38-year-old hospital administrator in a tumultuous marriage, had been having an affair for several months. Three days after it ended, his symptoms started: a painful rash on his scrotum (sometimes called red scrotum syndrome). He had a complete medical workup, but the doctors couldn't arrive at a definitive diagnosis. He saw a series of dermatologists and other medical specialists, and each practitioner prescribed a different medication. He took 21 medications in all, but nothing worked.Then Carl got a copy of Skin Deep and started doing self-hypnosis. He saw some results, and then he called me for therapy sessions by phone.

Our sessions were very intense. Carl revealed that one of the flashpoints in his marriage was his ambivalence about having children. His wife had fertility problems, and for a while they planned to adopt a Russian baby. But when it came time for them to fly to Russia, Carl developed a phobia to airplanes. His phobia grounded their adoption plans. Once he talked about this, his skin began to improve. After the two phone sessions, Carl said that the pain was gone. But the redness lingered.
As we filled in more of his background and why he was conflicted about becoming a father, he recalled that when he was a child his father was nasty and self-centered. As an adult, Carl found out that his father had molested his sister. Though he was appalled by his father's behavior, he also saw, to his horror, that he was sometimes like his father: nasty and self-centered. The whole notion of becoming a father was linked in his mind to becoming his father.

As he grew more aware of his tendency to imitate his father, he also realized that his skin symptoms were functioning as a kind of "sexual police" - they were barring him from going back to the other woman and giving him a chance to save his marriage.Carl never saw the other woman again, and he and his wife reconciled. Over the course of nine phone therapy sessions, his rash gradually faded. Its psychological "cause" had faded, too.


Psychodermatology is successful for patients who, like Carl, don't have a dermatological diagnosis because it treats the individual, not just the physical symptoms. This approach brings to mind the wisdom of Hippocrates when he said, "Who has the disease is as important as the disease they have." Psychodermatology practitioners delve into your personal history of dreams and disappointments, family relationships and childhood dramas to find the emotional switch that may be turning on your skin symptoms. Then we help develop ways to shut the switch off. Hypnosis and psychotherapy were able to help Carl get rid of his painful rash - something that 21 different medicines couldn't accomplish.

For more information see my site and my book Skin Deep: A Mind/Body Program for Healthy Skin.  You can download the free e-book edition there.

Ted Grossbart is on the faculty at Harvard Medical School and the author of the book Skin Deep.

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