Globally, skin conditions are among the most common health conditions and are the fourth leading cause of disability. Along with skin conditions however comes a collection of skin feelings that bubble beneath the surface. And where we know skin conditions have an effect on mental health, it continues to be an important area not only to research but to discuss: with our medical specialists, mental health providers, family, friends and self.
“We know that, as a group, people with skin conditions tend to have higher than average levels of anxiety and depression, but there are lots of differences between individuals and many people cope well,” explains Elaine Clarke, PhD candidate at The University of Sheffield.
“You might think that people with more severe skin conditions would have have more severe anxiety and depression, but this isn’t really the case. This is very interesting, as it suggests that psychological factors play an important role in explaining why some people with skin conditions experience depression or anxiety disorders, while others don’t. If we can understand this better, then we can do more to help the people who are struggling with the emotional side of their skin conditions”.
Elaine’s research focuses on how people feel about themselves and treat themselves, and how this feeds into depression. In particular, anxiety about being around others where negative or intrusive comments can increase self-consciousness. However, Elaine explains, this is not the whole story of how skin conditions can affect people.
“There is so much more to skin conditions than appearance. Skin conditions can affect people’s work, socialising, family and romantic relationships, exercise, sleep and leisure activities”.
They also affect how we ‘talk’ to ourselves and take on our own skin feelings as Elaine describes one type of depression, involving self-critical ‘introjections’ – described like an internal bully who pops up and says horrible things.
“Disgust with ourselves (appearance or behaviour) can certainly form part of that self-criticism,” says Elaine. “I chose to look at disgust in relation to skin conditions because, in theory, some symptoms of skin conditions could be perceived as disgusting, as damage to the body (e.g., bloody injuries) is a well-known trigger for disgust”.
As part of her PhD research, Elaine conducted a study that found that disgust traits were linked with depression in dermatology patients.
“Basically, the more ‘squeamish’ people were, the more depressed they were. I think a particular difficulty about having a skin condition is that you can’t avoid it even if you are very squeamish, like you could for other things. While I’m not suggesting that we should just avoid anything that make us feel uncomfortable, living with a skin condition can force some people to live with some pretty difficult emotions”.
Elaine adds we need to acknowledge that feelings like disgust and anxiety are totally normal and part of being human, no matter how difficult, but to seek help when habitually thinking or feeling negatively about ourselves. There is a large role to be played by self-compassion, another area of Elaine’s research, as a helpful way of dealing with skin conditions.
“Self-compassion involves being sensitive to your own distress and being caring and supportive of yourself. In my study with dermatology patients, results suggested that being self-compassionate helps protect people with skin conditions from becoming depressed. Being self-compassionate can be challenging, but it’s worthwhile”.
Our personal skin feelings are real and they matter, and thankfully there are researchers who are trying to understand the connections between skin conditions and mental health better. The support of friends and family is crucial however self-acceptance and self-compassion is vital, and often the hardest to welcome in.
“When we are caring and supportive of ourselves, we give ourselves the space to truly consider what is right for us and be our best selves”.
Elaine N Clarke is a PhD candidate in the Department of Psychology, The University of Sheffield, UK. Her published article ‘Depression in people with skin conditions: The effects of disgust and self‐compassion’ is free to access.