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Traumatic Stress in Chronically Ill Skin Patients – Impact and Coping

Introduction Patients with chronic progressive skin diseases such as atopic dermatitis, psoriasis, and autoimmune dermatoses frequently experience that in spite of intense in or outpatient treatment, no significant or enduring improvement occurs. They feel that their skin cannot protect them against their environment and surrounding but is injured by and vulnerable to external stimuli and internal stressors instead. They feel helpless during treatment and are confronted again and again with the helplessness of those treating them. I will call this type of life experience – as would be the case in other severe organic and pathological diseases – ‘traumatization’, ‘torture’, as some patients call it, torment. Such traumatization considerably affects the psychosocial development of a child as well as its attachment and relation patterns. Imagine a toddler with severe atopic dermatitis whose mother is stressed beyond her abilities due to her child’s skin disease, which in turn increases the child’s distress as it senses its mother’s strain. According to the current view in stress research [Egle et al., 2000], the experience to be held securely and reliably by the mother causes an activation of dopaminergic fibres in the brain stem, leading to a release of endorphins. These endorphins make social interactions and social affects a pleasant experience to the infant and contribute to its well-being which in turn constitutes a stimulating protection against stressors (table 1). In contrast, if a child with itching and inflamed skin does not experience being held safely and carefully, but associates loving touch with pain, it may develop a so-called insecure attachment style. ...