Stress, attachment and skin diseases: a case‐control study

Abstract

AbstractObjectives In this case‐control study we tested the hypothesis of an association between some psychosomatic skin diseases, attachment style and stress.Patients and methods A total of 177 cases and 194 controls seen between November 1992 and November 1993 at the Istituto Dermopatico dell'lmmacolata (IDD) in Rome, were enrolled into the study. Cases were outpatients with first diagnosis of hyperidrosis, chronic urticaria, generalized pruritus or alopecia areata. Controls were outpatients seen in the same period of time with first diagnosis of pigmenled nevi, keratosis or mycosis. The presence and weight of life stress events were assessed by u standard precoded questionnaire based on the Schedule of Recent Experiences (SRE) and on the Life Experiences Survey (LES). The attachment style was assessed by a modified version of the Shaver and Hazan questionnaire about feelings in a love relationship. We calculated 3 scores for each individual and classified study subjects in 2 groups: 1) "free" (= secure attachment); 2) "not free" (not secure attachment: anxious‐ambivalent or avoidant). Questionnaires were self‐administered in the presence of a trained psychologist. Adjusted odds ratios (OR) were calculated using a multiple logistic function.Results No association was found between the different stress scores and the skin diseases considered. The crude odds ratio for life stress events in the previous year was 1.4 (95% CI 0.8–2.7). After multiple adjustment for age, sex, marital status and education, the estimated OR was 1.6 (95% CI 0.8–3.0). One significant association emerged between the adult attachment style defined as “not free” and psychosomatic skin diseases: the adjusted OR was 4.0 (95% CI 1.4–12).