Personality Characteristics and Their Association with Biological Stress Responses in Patients with Atopic Dermatitis

Abstract

Background: The potential relevance of personality factors on atopic dermatitis (AD) has long been a focus of psychodermatological research. A central premise underlying this line of research is that AD sufferers show a distinct personality profile that may increase the vulnerability to develop or to exacerbate AD especially under stress. Objective: The specific goal of the present study was to assess specific personality traits in AD sufferers and their possible relationship to biological stress responses. Material and Methods: 36 AD patients, 23 patients suffering from psoriasis (PSO) and 37 non-atopic controls were investigated. To determine different personality domains, Spielberger’s State-Trait Anxiety Inventory (STAI), the Questionnaire for Competence and Control (FKK) and the Questionnaire for Stress Vulnerability (MESA) were administered. In order to investigate whether these personality dimensions are related to biological stress responses, AD subjects and healthy controls were confronted with a standardized laboratory stressor (Trier Social Stress Test; TSST). Blood and saliva samples were obtained before and after the stress test to measure endocrine (cortisol, ACTH, catecholamines) and immunological (immunoglobulin-E, cytokines, leukocyte subsets) stress responses. Furthermore, heart rate responses to the stressor and morning cortisol after awakening were recorded. Results: When compared to healthy controls, AD and PSO patients showed significantly higher scores in trait anxiety (STAI) and stress vulnerability (MESA) in situations characterized by failure, job overload, social conflicts and uncertainness. In addition, they scored significantly lower in positive self-concept (FKK). No difference in these personality traits could be detected between AD and PSO subjects. When confronted with the laboratory stressor (TSST), significantly altered endocrine and immune responses in AD patients could be determined which are described elsewhere [J Clin Endocrinol Metab 2002;87:4245–4251; J Neuroimmunol 2002;129:161–167]. However, Pearson correlational analysis indicated no significant correlation between the different personality domains and any of the endocrine, immunological or physiological stress responses. The cortisol response to awakening in the morning, however, was significantly correlated with the stress vulnerability in situations characterized by job overload and criticism. Conclusions: AD patients show a distinct personality pattern, which does not differ from that found in PSO patients suggesting that there may be no specific ‘atopic’ personality type but rather a personality pattern linked to chronic inflammatory skin disorders.