Relationship between anger and pruritus perception in chronic idiopathic urticaria

Abstract

Objective: There is evidence that chronic idiopathic urticaria (CIU) is associated with personality based difficulties in emotional regulation as measured by the Toronto Alexithymia Scale (Maniaci et al., 2006). In alexithymic individuals inner tension and psychophysiological arousal associated with negative affects cannot be reduced efficiently by (verbally) expressing and disclosing inner feelings (Pennebaker et al.,, 1987) and this difficulty can contribute to an increased emotional distress and an ontogenetically earlier behavioural-expressive manifestation of affect (Taylor et al., 1997). On the basis of these assumptions we hypothesized a significant relationship between pruritus perception as a major symptom of CIU and the experience of negative emotions. Methods: 41 patients with CIU were compared to 44 psoriasis patients and 49 healthy controls concerning alexithymia (TAS–20), psychopathology (SCL–90-R), and state and trait anger (STAXI). Pruritus severity was assessed on a 5 point Likert scale. Results: CIU scored higher on measures of alexithymia, anxiety, depression and state anger compared to healthy controls. There was no difference between CIU patients and psoriasis patients with regard to alexithymia, however psoriasis patients scored higher on measures of anxiety and depression. In stepwise multiple regression analysis including age, sex, skinstatus and psychodiagnostic questionnaires state anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. In psoriasis patients depression was the only significant predictor of pruritus severity explaining 12% of variance, which is in line with a previous study by Gupta and colleagues (1994). Discussion: The authors are unaware of any previous study showing a relationship between state anger and pruritus perception in chronic idiopathic urticaria or any other skin disorder. We suggest possible pathophysiological pathways and discuss therapeutic implications. Literatur: Gupta MA, Gupta AK, Schork NJ, Ellis CN. Depression modulates pruritus perception. Psychosom Med 1994, 56;36-40. Maniaci G, Epifanio MS, Marino MA, Amoroso S. The presence of alexithymia investigated by the TAS-20 in chronic urticaria patients: a preliminary report. Allerg Immunol 2006, 38;15-9. Taylor GJ, Bagby RM, Parker JDA: Disorders of affect regulation. Alexithymia in medical and psychiatric illness. Cambridge, Cambridge University Press, 1997. Pennebaker, J.W., Hughes C., O’Heeron, R.C. (1987) The psychophysiology of confession: Linking inhibitory and psychosomatic processes. J Pers Soc Psychol 52, 781-793.