Determinants of social anxiety and social avoidance in psoriasis outpatients

Abstract

Psychological stressors can contribute to the first manifestation and to later exacerbations of psoriasis. As a result of the visible and disfiguring skin lesions, psoriasis patients often develop feelings of social anxiety and stigmatization and consecutive social avoidance, which can in turn affect employment and social activities and lead to psychological distress and impairment of quality of life. However, great differences regarding social anxiety and social avoidance can be observed between different individuals, even if their disfigurement appears comparable. We intended to assess the joint impact of disease severity, mood, coping strategies, perceived social support and personal resources on social anxiety and social avoidance in psoriasis outpatients. Forty-nine psoriasis outpatients filled in self-report questionnaires (Adjustment to Chronic Skin Diseases Questionnaire, Sense of Coherence scale, Social Support Questionnaire). The PASI score was assessed by the patients' dermatologist. Social fear/avoidance showed a high and significant correlation to impairment in quality of life (0.58, P ≤ 0.001). In regression analysis, disease severity, feelings of helplessness and perceived social support jointly explained 74% of the variance of social anxiety/avoidance. Physicians treating patients with psoriasis must be aware of physical, psychological and social aspects of the disease and need to use a multidimensional approach.