• Peter James


This chapter summarizes the psychological mechanisms that can contribute to the formation and expression of dermatological symptoms. It will also review the psychosocial impact of skin diseases generally and raise many research questions which need urgent attention. A number of specific conditions will be presented, with a view to drawing implications for current health care practice.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexander, F. (1950) Psychosomatic Medicine: Its Principles and Applications, Norton, New York.Google Scholar
  2. Allen, K. and Harris, F. (1966) Elimination of a child’s excessive scratching by reinforcement procedures. Behaviour Research Therapy, 4, 79.Google Scholar
  3. Arnetz, B., Fjellner, B., Eneroth, P. and Kallner, A. (1985) Stress and psoriasis: psychoendocrine and metabolic reactions. Psychosomatic Medicine, 47, 528–41.Google Scholar
  4. Arnetz, B., Fjellner, B., Eneroth, P., and Kallner, A. (1991) Endocrine and dermatological concomitants of mental stress. Acta Dermato Venereologica, (Stockholm), Suppl. 156, 9–12.Google Scholar
  5. Bar, L. and Kuypers, B. (1973) Behaviour therapy in dermatological practice. British Journal of Dermatology, 88, 591–8.Google Scholar
  6. Baughman, R. and Sobel, R. (1976) Emotional factors in psoriasis, in Psoriasis, (eds E. Farber and E. Cox), Yorke Medical Books, New York.Google Scholar
  7. Bayer, C.A. (1972) Self monitoring and mild aversion treatment of trichotillomania. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 13–20.Google Scholar
  8. Beck, A.T. (1976) Cognitive Therapy and the Emotional Disorders, International University Press, New York.Google Scholar
  9. Benoit, L.J. and Harrell, E.H. (1980) Biofeedback and control of skin cell proliferation in psoriasis. Psychological Reports, 46, 831–9.Google Scholar
  10. Bjornberg, A., Lowhagen, B. and Tergberg, J. (1979) Skin reactivity in workers with and without itching. Acta Dermatovenereologica, 59, 49–53.Google Scholar
  11. Bornstein, P.H. and Rychtarik, R.G. (1978) Multi-component behavioural treatment of trichotillomania; Behavioural Research and Therapy, 16, 217–20.Google Scholar
  12. Brocq, L. and Jacquet, L. (1891) Notes pour servir à l’histoire des névrodermites. Annales de Dermatologie et de Syphilographie (Paris), 97, 193.Google Scholar
  13. Brown, D. (1972) Stress as a precipitant of eczema. Journal of Psychosomatic Research, 16, 34.Google Scholar
  14. Brown, D. and Bettley, F.(1971) Psychiatric treatment of eczema; a controlled trial. British Medical Journal, 2, 729–34.Google Scholar
  15. Buckwalter, K. (1982) The influence of skin disorders on sexual expression. Sex Disability, 5, 98–106.Google Scholar
  16. Cataldo, M., Varnia, J., Ruso, D. and Estes, S. (1980) Behaviour therapy techniques in the treatment of exfoliative dermatitis. Archives of Dermatology, 116, 919.Google Scholar
  17. Chang, C., Lee, M., Chiang, Y. and Ly, Y. (1991) Trichotillomania: a clinical study of 36 patients. Taiwan I Msaiah-Tasa-Chih, 90 (2), 176–80.Google Scholar
  18. Connors, C.K. (1980) Behavioural and psychophysiological aspects of Raynaud’s disease, in Comprehensive Handbook of Behavioural Medicine, Vol. 1, (eds. R.J. Ferguson and H.L. Taylor), Springer, New York, pp. 29–40.Google Scholar
  19. Cordle, C.J. and Long, CG. (1980) Trichotillomania. Journal of Behaviour Therapy and Experimental Psychiatry, 11, 127–30.Google Scholar
  20. Cotterill, J. (1981) Dermatological non-disease. British Journal of Dermatology, 104, 611–19.Google Scholar
  21. Cotterill, J. (1983) Psychiatry and skin disease, in Recent Advances in Dermatology, (eds A. Rook and H. Maibach), Churchill Livingstone, Edinburgh, pp. 189–212.Google Scholar
  22. Cotterill, J.A. (1989) Psychiatry and the skin. British Journal of Hospital Medicine, 42, 401–4.Google Scholar
  23. Cox, N.H. and Wilkinson, D. (1992) Dermatitis artefacta as the presenting syndrome in autoerythrocyte sensitization syndrome, British Journal of Dermatology, 126 (1), 86–9.Google Scholar
  24. Crawford, D. (1988) Aversion therapy in the treatment of trichotillomania. Behavioural Psychotherapy, 16, 57–63.Google Scholar
  25. Daniels, I.K. (1973) Treatment of urticaria and severe headache by behaviour therapy. Psychosomatics, 14, 347–51.Google Scholar
  26. Dean, J., Nelson, E. and Moss, L. (1992) Pathological hair-pulling: a review of the literature and case reports. Comprehensive Psychiatry, 33 (2), 84–91.Google Scholar
  27. Duller, P. and Gentry, W. (1980) Use of biofeedback in treating chronic hyperidrosis: a preliminary report. British Journal of Dermatology, 103, 143.Google Scholar
  28. Edwards, A., Shallow, W., Wright, T. and Dignam, E. (1976) Pruritic skin disease, psychological stress, and the itch sensation. Archives of Dermatology, 112, 339–43.Google Scholar
  29. Engles, W.D. (1982) Dermatologic disorders. Psychosomatics, 23 (12), 1209–19.Google Scholar
  30. Fabbri, R. and Dy, A.J. (1974) Hypnotic treatment of trichotillomania: two cases. International Journal of Clinical and Experimental Hypnosis, 22, 210–15.Google Scholar
  31. Fabisch, W. (1980) Psychiatric aspects of dermatitis artefacte. British Journal of Dermatology, 102, 29–34.Google Scholar
  32. Farber, E., and Nall, N. (1974) The natural history of psoriasis in 5,600 patients. Dermatologica, 148, 1.Google Scholar
  33. Farber, E., Bright, R. and Nall, M. (1968) Psoriasis, a questionnaire survey of 2144 patients. Archives of Dermatology, 98, 248–59.Google Scholar
  34. Faulstitch, M., Williamson, D., Duchman, E. et al. (1985) Psychophysiological analysis of atopic dermatitis. Journal of Psychosomatic Research, 29 (4), 415–17.Google Scholar
  35. Fava, G., Perini, G., Santonastaso, P. and Fornash, C. (1980) Life events and psychological distress in dermatologic disorders. British Journal of Medical Psychology, 53, 277–82.Google Scholar
  36. Felix, R. and Shuster, S. (1975) A new method for the measurement of itch. British Journal of Dermatology, 93, 303.Google Scholar
  37. Finlay, A. and Kelly, S. (1987) Psoriasis — an index of disability. Clinical and Experimental Dermatology, 12,8–11.Google Scholar
  38. Finlay A.Y., Khan, G.K., Luscombe, D.K. and Salek M.S. (1990) Validation of sickness impact profile and psoriasis disability index. British Journal of Dermatology, 123 (6), 751–6.Google Scholar
  39. Ford, C.V. (1984) The Somatization Disorders, Elsevier Biomedical, New York.Google Scholar
  40. Freedman, R. (1989) Quantitative measurement of finger blood flow during behavioural treatments for Raynaud’s disease. Psychophysiology, 26 (4), 437–41.Google Scholar
  41. Freedman, R., Ianni, P. and Wenig, P. (1983) Behavioural treatment of Raynaud’s disease. Journal of Consulting and Clinical Psychology, 51, 539–49.Google Scholar
  42. Freedman, R., Keegan, D., Migaly, P. et al. (1991) Plasma catecholamines during behavioural treatments for Raynaud’s disease. Psychosomatic Medicine, 53 (4), 433–9.Google Scholar
  43. Fritz, G. (1979) Psychological aspects of atopic dermatitis. Clinical Pediatrics, 18, 360–4.Google Scholar
  44. Garrie, E., Garrie, S. and Mole, T. (1974) Anxiety and atopic dermatitis. Journal of Consulting and Clinical Psychology, 42, 742.Google Scholar
  45. Gaston, L., Crombez, J., Lassonde, M. et al. (1991) Psychological stress and psoriasis. Acta Dermato Venereologica, (Stockh), Suppl. 156, 37–43.Google Scholar
  46. Gilchrist, B. (1982) Pruritis. Archives of Internal Medicine, 142, 101–4.Google Scholar
  47. Graham, D. (1950) The pathogenesis of hives. Proceedings of the Association for Research in Nervous and Mental Disease, 29, 987–1009.Google Scholar
  48. Graham, D. (1972) Psychosomatic medicine, in Handbook of Psychophysiology (eds N. Greenfield and R. Sternbach), Hutt, New York, pp. 839–924.Google Scholar
  49. Gupta, M., Gupta, A. and Hakerman, H. (1987) Psoriasis and psychiatry. General Hospital Psychiatry, 9, 157–66.Google Scholar
  50. Gupta, M., Gupta, A., Schork, N. et al. (1990) Psychiatric aspects of the treatment of mild to moderate facial acne. International Journal of Dermatology, 29 (10), 719–21.Google Scholar
  51. Hajek, P., Jakoubek, B., and Radii, T. (1990) Gradual increases in cutaneous threshold induced by repeated hypnosis of healthy individuals and patients with atopic eczema. Perceptual and Motor Skills, 70 (2), 549–50.Google Scholar
  52. Hajek, P., Jakoubek, B., Kyhus, K. and Radi, T. (1992) Increase in cutaneous temperature by hypnotic suggestion of pain. Perceptual and Motor Skills, 74, 737–8.Google Scholar
  53. Haynes, S., Wilson, C., Jaffee, P. and Britton, B. (1979) Biofeedback treatment of atopic dermatitis. Biofeedback and Self Regulation, 4, 195–209.Google Scholar
  54. Hollender, H. and Abram, H. (1973) Dermatitis factitia, Southern Medical Journal, 6, 1279–85.Google Scholar
  55. Home, D.J. (1977) Behaviour therapy of trichotillomania. Behavioural Research and Therapy, 15, 192–6.Google Scholar
  56. Horne, D.J., White, A. and Varigas, G.A. (1989) A preliminary study of psychological therapy in the management of atopic eczema. British Journal of Medical Psychology, 62 (3), 241–8.Google Scholar
  57. Hughes, J., Barraclough, B., Hamblin, L. and White, J. (1983a) Psychiatric symptoms in dermatology patients. British Journal of Psychiatry, 143, 51–4.Google Scholar
  58. Hughes, H., Brown, B., Lawlis, G. and Fulton, J. (1983b) Treatment of acne vulgaris by biofeedback, relaxation and cognitive imagery. Journal of Psychosomatic Research, 27, 185–91.Google Scholar
  59. Jobe, J., Sampson, J., Roberts, D. and Beetham, W. (1982) Induced vasodilation as treatment for Raynaud’s disease. Annals of Internal Medicine, 97, 706–9.Google Scholar
  60. Jobe, J., Sampson, J., Roberts, D. and Kelly, J. (1986) Comparisons of behavioural treatments for Raynaud’s disease. Journal of Behavioural Medicine, 9, 89–96.Google Scholar
  61. Jones, M. (1980) Conversion reaction. Psychological Bulletin, 87, 127–41.Google Scholar
  62. Jordan, J. and Whitlock, F. (1974) Atopic dermatitis, anxiety and conditioned scratch response. Journal of Psychosomatic Research, 18, 297.Google Scholar
  63. Juhlin, L. (1981) Recurrent urticaria. British Journal of Dermatology, 104, 369–81.Google Scholar
  64. Keefe, F., Surwit, R. and Pilon, N. (1979) A 1 year follow up of Raynaud’s patients treated with behavioural therapy techniques. Journal of Behavioural Medicine, 2, 385–91.Google Scholar
  65. Keefe, F., Surwit, R. and Pilon, N. (1980) Biofeedback, autogenic training and progressive muscle relaxation in the treatment of Raynaud’s disease. Journal of Applied Behaviour Analysis, 13, 3–11.Google Scholar
  66. Kenyon, F. (1966) Psychosomatic aspects of acne. British Journal of Dermatology, 78, 344.Google Scholar
  67. Koo, J.Y.M. (1979) Psychodermatology: Current Concepts, Crawley, Upjohn.Google Scholar
  68. Koo, J. and Smith, L. (1991a) Obsessive-compulsive disorders in pediatric dermatology practice. Paediatric Dermatology, 8 (2), 107–13.Google Scholar
  69. Koo, J.Y. and Smith, L.L. (1991b) Psychological aspects of acne. Paediatric Dermatology, 8 (3), 185–8.Google Scholar
  70. Kraus, S.J. (1970) Stress, acne and free fatty acids. Psychosomatic Medicine, 32, 503.Google Scholar
  71. Kuno, Y. (1956) Human Perspiration, C. Thomas, Illinois.Google Scholar
  72. Leichtman, S., Burnett, J. and Robinson, H. (1981) Body image concerns of psoriasis patients. Journal of Personality Assessment, 45 (5), 478–84Google Scholar
  73. Lim, C. and Tan, T.C. (1991) Personality, disability and acne in college students. Clinical and Experimental Dermatology, 16 (5), 371–3.Google Scholar
  74. Lyell, A. (1979) Cutaneous artefactual disease. Journal of American the Academy of Dermatology, 1, 391–407.Google Scholar
  75. Mackie, D. (1991) The psychology of skin disorders. The Practitioner, 235, 356–60.Google Scholar
  76. McLaughlin, J.G. and Nay, R.W. (1975) Treatment of trichotillomania using positive coverants and response cost. A case report. Behaviour Therapy, 6, 87–91.Google Scholar
  77. McMenamy, C.J., Katz, R.G. and Gipson, M. (1988) Treatment of eczema by CMG biofeedback and relaxation training. Journal of Behavioural Therapy and Experimental Psychiatry, 19 (3), 221–7.Google Scholar
  78. Mannino, F.V. and Delgardo, R.A. (1969) Trichotillomania in children. American Journal of Psychology, 126,505–11.Google Scholar
  79. Manusov, E.G. and Nadeau, M.T. (1989) Hyperidrosis: a management dilemma. Journal of Family Practice, 28 (4), 412–15.Google Scholar
  80. Matussek, P., Agerer, D. and Seibt, G. (1985) Aggression in depressives and psoriatics. Psychotherapy and Psychosomatics, 43, 120–5.Google Scholar
  81. Medansky, R. (1980) Dermatopsychosomatics: an overview. Psychosomatics, 21, 195–200.Google Scholar
  82. Medansky, R.S. and Handler, R.M. (1981) Dematopsychosomatics. Journal of the American Academy of Dermatology, 5 (2), 125–36.Google Scholar
  83. Meichenbaum, D.H. and Jaremko, M. (1982) Stress Prevention and Management, Plenum Press, New York.Google Scholar
  84. Melin, L., Frcdcrikscn, T., Noren, P. and Swebilius, B. (1986) Behavioural treatment of scratching in patients with atopic dermatitis. British Journal of Dermatology, 115, 467–74.Google Scholar
  85. Merluzzi, T.V., Glass, CR. and Genest, M. (1981) Cognitive Assessment, Guilford Press, New York.Google Scholar
  86. Meynadier, J., Guillot, B., Boulanger, A. et al. (1985) Aetiology of chronic urticaria, in The Urticarias, (ed. R. Champion), Churchill Livingstone, Edinburgh.Google Scholar
  87. Minnuchin, S. (1974) Families and Family Therapy, Harvard University Press, Cambridge, Mass.Google Scholar
  88. Morse, R.M., Perry, H.O. and Hurt, R.D. (1985) Alcoholism and psoriasis. Archives of Dermatology, 9, 396–9.Google Scholar
  89. Motley, R.J. and Finlay, A.Y. (1989) How much disability is caused by acne? Clinical and Experimental Dermatology, 14 (3), 194–8.Google Scholar
  90. Munzel, K. and Schandry R. (1990) Atopic eczema: psychophysiological reactivity with standardized stressors. Hautarzt, 41 (11), 606–11.Google Scholar
  91. Musaph, H. (1968) Psychodynamics in itching states. International Journal of Psychoanalysis, 49, 336–40.Google Scholar
  92. Orton, C. (1981) Learning to Live with Skin Disorders, Souvenir Press, London.Google Scholar
  93. Parsons, T. (1951) The Social System Process, Free Press, New York.Google Scholar
  94. Payne, R., Payne, C. and Marks, R. (1985) Stress does not worsen psoriasis. Clinical and Experimental Dermatology, 10, 239–45.Google Scholar
  95. Pegum, J.S. and Baker, H. (1979) Dermatology, Baillière Tindall, London.Google Scholar
  96. Pines, D. (1980) Skin communication. International Journal of Psychoanalysis, 61, 315.Google Scholar
  97. Price, M.L., Mottahedin, I. and Mayo, P.R. (1991) Can psychotherapy help patients with psoriasis? Clinical and Experimental Dermatology, 16 (2), 114–7.Google Scholar
  98. Rajka, G. (1975) Atopic Dermatitis, W.B. Saunders and Co, Eastbourne.Google Scholar
  99. Ratcliff, R. and Stein, N. (1968) Treatment of neurodermatitis by behaviour therapy — a case study. Behavioural Research and Therapy, 6, 397.Google Scholar
  100. Rechardt, E. (1970) An Investigation into the Psychosomatic Aspects of Prurigo Besnier, Psychiatric Clinic of Helsinki University Central Hospital.Google Scholar
  101. Rees, L. (1957) An aetiological study of urticaria and angioneurotic oedema. Journal of Psychosomatic Research, 2, 172.Google Scholar
  102. Rees, L. (1976) Stress, distress and disease. British Journal of Psychiatry, 128, 3–18.Google Scholar
  103. Reeve, E., Bernstein, G. and Christenson, G. (1992) Clinical characteristics and psychiatric comorbidity in children with trichotillomania. Journal of the American Academy of Childhood and Adolescence Psychiatry, 31 (1), 132–8.Google Scholar
  104. Risch, C. and Ferguson, J. (1981) Behavioural treatment of skin disorders, in The Comprehensive Handbook of Behavioural Medicine, Vol. 2, (eds R.J. Ferguson and H.L. Taylor), Spectrum Inc., New York, pp. 29–40.Google Scholar
  105. Roth, H., Kierland, R. and Rochester, M. (1964) The natural history of atopic dermatitis. Archives of Dermatology, 89, 209–14.Google Scholar
  106. Russell, M.L. (1986) Behavioural Counselling in Medicine, Oxford University Press, New York.Google Scholar
  107. Ryan, T. (1991) Disability in dermatology. British Journal of Hospital Medicine, 46 (1), 33–6.Google Scholar
  108. Sampson, J.B. (1977) Effects on anxiety of temperature response to cold water immersion. Annual Meeting of the Society for Psychophysiological Research. Abstract.Google Scholar
  109. Savin, J. (1980) Itching, in Recent Advances in Dermatology, 5, (eds A. Rook and J. Savin), Churchill Livingstone, New York, pp. 221–335.Google Scholar
  110. Savin, J., Paterson, W., Oswand, I. and Adam, K. (1975) Further studies of scratching during sleep. British Journal of Dermatology, 93,. 297–302.Google Scholar
  111. Seville, R. (1977) Psoriasis and stress. British Journal of Dermatology, 97, 297–302.Google Scholar
  112. Sheehan-Dare, R., Henderson, M. and Cotterill, J. (1990) Anxiety and depression in patients with chronic urticaria and generalized pruritus. British Journal of Dermatology, 123 (6), 769–74.Google Scholar
  113. Shelley, W. and Arthur, R. (1959) Studies on cowhage. Archives of Dermatology, 72, 399–406.Google Scholar
  114. Sheppard, N.P., O’Loughlin, S.O. and Malone, J.P. (1986) Psychogenic skin disease. British Journal of Psychiatry, 149, 636–43.Google Scholar
  115. Shuster, S. (1979) Stress and psoriasis. British Journal of Dermatology, 97, 297–302.Google Scholar
  116. Shuster, S., Fisher, G.I.K., Harris, E. and Binnell, D. (1978) The effect of skin disease on self image. British Journal of Dermatology, 99 (Suppl. 16), 18–19.Google Scholar
  117. Sneddon, I. and Sneddon, J. (1981) Acne excorie — a protective device. British Journal of Dermatology, 91 (Suppl. 19), 29.Google Scholar
  118. Sperber, J., Shaw, J. and Bruce, S. (1989) Psychological components and the role of adjunct interventions in chronic idiopathic urticaria. Psychotherapy and Psychosomatics, 51 (3), 135–41.Google Scholar
  119. Stambrook, M., Hamel, E., and Carter, S. (1988) Training to vasodilate in a cooling environment. Biofeedback-Self-Regulations, 13 (1), 9–23.Google Scholar
  120. Stanley, M., Swann, A., Bowers, T. et al. (1992) A comparison of clinical features of trichotillomania and obsessive-compulsive disorder. Behaviour Research Therapy, 30 (1), 39–44.Google Scholar
  121. Stein, D.J and Hollander, E. (1992) Dermatology and conditions related to obsessive-compulsive disorder. Journal of the American Academy of Dermatology, 26 (2), 237–42.Google Scholar
  122. Steptoe, A. (1989) Psychophysiological interventions in behavioural medicine, in Handbook of Clinical Psychophysiology, (ed. G. Turpin), Wiley, Chichester.Google Scholar
  123. Sternbach, R.A. (1966) Principles of Psychophysiology, Academic Press, Orlando.Google Scholar
  124. Tonnesen, M. (1979) Pruritis, in Dermatology in General Medicine, (eds T. Fitzpatrick, K. Arndt, W. Clark et al.), McGraw-Hill, New York.Google Scholar
  125. Turk, D., Meichenbaum, D. and Genest, M. (1983) Pain and Behavioural Medicine, Guilford Press, New York.Google Scholar
  126. Van Moffaert, M. (1982) Psychosomatics for the practising dermatologist. Dermatologica, 165, 73–87.Google Scholar
  127. Van Moffaert, M. (1986) Training future dermatologists in psychodermatology. General Hospital Psychiatry, 8 (2), 115–18.Google Scholar
  128. Vitulano, L.A., King, R.A., Scahill, L. and Cohen, D. (1992) Behavioural treatment of children and adolescents with trichotillomania. Journal of the American Academy of Childhood and Adolescence Psychiatry, 31(1), 139–46.Google Scholar
  129. Walton, R. (1960) The application of learning theory to the treatment of a case of neurodermatitis, in Therapy and Neuroses, (ed. H. Eysenck), Pergamon Press, New York, pp. 272–4.Google Scholar
  130. Walton, R. (1985) Stress factors in dermatology. Stress Medicine, 1, 55–60.Google Scholar
  131. Watson, D., Thorp, R. and Krisber, J. (1972) Case study in self-modification: suppression of infantile scratching. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 213.Google Scholar
  132. Weinstein, M. (1984) Psychosocial perspective on psoriasis. Dermatology Clinic, 2, 507–15.Google Scholar
  133. Whitlock, F.A. (1976) Psychophysiological Aspects of Skin Disease, W.B. Saunders & Co, Eastbourne.Google Scholar
  134. Williams, D. (1951) Management of atopic dermatitis in children Archives of Dermatology and Syphilology, 63, 545.Google Scholar
  135. Worden, J.W. (1991) Grief Counselling and Grief Therapy, Tavistock Publications, London.Google Scholar
  136. Wu, S.F., Kinder, B., Trunnel, T. and Fulton, J. (1988) Role of anxiety and anger in acne patients. Journal of the American Academy of Dermatology, 18, 325–33.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

Authors and Affiliations

  • Peter James

There are no affiliations available

Personalised recommendations