Repressed Anger Can Cause Psoriasis

September 24, 1997
By E.J. Mundell

Repressed anger may trigger both the onset of psoriasis and individual 'flare-ups' of the disease, according to a mental health researcher.

Many patients with the skin ailment "have the type of personality constellation where they have trouble expressing anger effectively," said Dr. Madhulika Gupta, an associate professor of psychiatry at the University of Western Ontario in London, Ontario, Canada.

Psoriasis occurs when immature skin cells rise to the surface of the skin, forming hard, itchy areas which sometimes crack and bleed. The disease is chronic and can occur in outbreaks severe enough to require hospitalization. According to the National Psoriasis Foundation (NPF), worldwide figures show that 1% to 3% of people have psoriasis.

While working at the University of Michigan in Ann Arbor, Gupta led a study which included detailed psychological profiles of 137 individuals with psoriasis. One test determined each participant's score on a psychological rating system known as the Anger Expression Scale.

"Anger-expression came up as being the most important correlate of early-onset versus late-onset psoriasis," said the researcher. Psoriasis can begin at any point in life. Gupta labeled those who first experienced the disease before the age of 40 as "early-onset" cases.

"The younger-onset people had more psychopathology and (repressed) anger," Gupta said in an interview with Reuters.

According to Gupta, psychology may have a role to play in individual psoriasis outbreaks as well. "When you talk to patients with psoriasis, a lot of them will make a very direct link between a stressful life situation and a flare-up of their psoriasis."

The stress is often from an unresolved interpersonal conflict. Gupta cites the example of one 40-year-old man whose psoriasis outbreak forced him into the hospital. "He had had a fight with his brother about some inheritance issues," she explained. "He felt he didn't speak out because he didn't want to hurt his brother's feelings." The man told Gupta, "'this is what caused my psoriasis to flare up.'"

Gail Zimmerman, executive director of the NPF, said Gupta's findings are "not surprising," since "stress has long been known to trigger or worsen psoriasis for a certain group of people with the disease."

Gupta believes psychiatric counseling and treatment may help some psoriasis sufferers ward off painful outbreaks. "Issues regarding anger management, especially when you've got a recurring problem, would be important," she said.

The NPF agree, pointing to "medications, behavior modification, relaxation and exercise" as possible means of cutting down on stress. Their Web site can be found at http://www.psoriasis.org.