Academic journal article Indian Journal of Psychiatry

Personality Disorders and Its Association with Anxiety and Depression among Patients of Severe Acne: A Cross-Sectional Study from Eastern India

Academic journal article Indian Journal of Psychiatry

Personality Disorders and Its Association with Anxiety and Depression among Patients of Severe Acne: A Cross-Sectional Study from Eastern India

Article excerpt

Byline: Sharmila. Sarkar, Paramita. Patra, Kakali. Mridha, Sudip. Ghosh, Asish. Mukhopadhyay, Rajarshi. Thakurta

Background: In many patients, emotional stress may exacerbate acne. Psychological problems such as social phobias, low self-esteem, or depression may also occur as a result of acne. The presence of acne may have some negative effect on the quality of life, self-esteem, and mood of the affected patients. While some studies have been undertaken about anxiety, depression, and personality patterns in patients with acne, only a few studies have been done to identify specific personality disorders in patients with acne. Furthermore, there is a dearth of data regarding the effect of personality disorder on the psychological states of the patients which prompted us to undertake the present study. Methodology: This was a descriptive cross-sectional study, undertaken in a Tertiary Care Teaching Hospital in Eastern India. Consecutive patients suffering from severe (Grade 3 and 4) acne, attending the Dermatology Outpatient Department, aged above 18 years were included to the study. Results: A total of 65 patients were evaluated with a mean age of 26 years. Personality disorder was present in 29.2% of patients. The diagnosed personality disorders were obsessive compulsive personality disorder (n = 9, 13.8%), anxious (avoidant) personality disorder (n = 6, 9.2%), and borderline personality disorder (n = 2, 3%), mixed personality disorder (n = 2, 3%). All patients with personality disorder had some psychiatric comorbidity. Patients having personality disorder had higher number of anxiety and depressive disorders which were also statistically significant. Conclusion: The present study highlights that personality disorders and other psychiatric comorbidities are common in the setting of severe acne.

Introduction

A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between the mind and the skin.[sup][1] As the brain and the skin have the same developmental origin, i.e., the embryonic ectoderm and are under the influence of the same hormones and neurotransmitters, there might be a close relationship between them. While psychiatrists focus on the “internal indiscernible disease,” dermatologists focus on “external discernible disease.”[sup][2]

Psychological factors might have an important role in the causation of acne in several ways. In many patients, emotional stress may aggravate acne. In a number of patients, psychological problems such as, social phobias, low self-esteem, or depression may arise as a consequence of acne. Moreover, primary psychiatric illnesses such as obsessive-compulsive disorder (OCD) and psychosis may be deeply rooted to a complaint that is focused on acne.[sup][3] The presence of acne might have some negative effect on the quality of life, self-esteem, and mood in adolescents. Acne is associated with an increased incidence of anxiety, depression, and suicidal ideation. The presence of these and other comorbid psychological disorders should be addressed in the treatment of patients with acne, when appropriate. A strong physician-patient relationship and thorough history taking are of paramount importance to identify the patients at risk for the adverse psychological effects of acne.[sup][4] Several studies have showed that psychiatric comorbidity of acne excoriee includes body image disorder, depression, anxiety, OCD, delusional disorders, personality disorders, and social phobias.[sup][5],[6],[7],[8] It is noteworthy that the effect of acne on psychosocial and emotional problems is analogous to the effects of arthritis, back pain, diabetes, epilepsy, and disabling asthma.[sup][9] Acne has a definite association with depression, anxiety, and feelings of social isolation; it affects personality, emotions, self-image, self-esteem, and the ability to form interpersonal relationships. …

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