Hypnosis as a treatment method in psychosomatic medicine

The Role of Psychological Stress in Skin Disease

Background:

Numerous case reports and studies have suggested that psychological stress may have a role in the onset or exacerbation of a variety of skin diseases.

Objective:

We review the literature pertaining to the role of psychological stress in the exacerbation of psoriasis, urticaria, eczematous dermatitis, herpesvirus infections, and other skin diseases; discuss potential mechanisms of stress-induced skin disease; and review studies and case reports of psychotherapeutic interventions that have been found helpful in the therapy of skin diseases.

Conclusions:

There is evidence linking psychological stress to exacerbation of certain skin diseases. Both the clinical and the basic science evidence, however, can be hard to interpret in light of the difficulty of defining and quantifying psychological stress as well as the questions regarding the etiologic significance of neuroimmunologic findings in skin diseases.

The role of psychological stress in skin disease

BACKGROUND

Numerous case reports and studies have suggested that psychological stress may have a role in the onset or exacerbation of a variety of skin diseases.

OBJECTIVE

We review the literature pertaining to the role of psychological stress in the exacerbation of psoriasis, urticaria, eczematous dermatitis, herpesvirus infections, and other skin diseases; discuss potential mechanisms of stress-induced skin disease; and review studies and case reports of psychotherapeutic interventions that have been found helpful in the therapy of skin diseases.

CONCLUSIONS

There is evidence linking psychological stress to exacerbation of certain skin diseases. Both the clinical and the basic science evidence, however, can be hard to interpret in light of the difficulty of defining and quantifying psychological stress as well as the questions regarding the etiologic significance of neuroimmunologic findings in skin diseases.

A case study of pruritic eczema treated by relaxation and imagery

A 25-yr.-old white, married female was treated for chronic pruritic eczema through the use of frontalis EMG, relaxation, and imagery training. The biofeedback readings, ratings of the pruritus (0 to 5) and ratings of skin smoothness (0 to 5) were made over 10 sessions. Although the EMG measures did not decrease significantly, the rash disappeared completely. A 1-yr. follow-up confirmed disease control.

Hypnotherapy for incontinence caused by the unstable detrusor

Fifty incontinent women with proved detrusor instability completed 12 sessions of hypnosis (symptom removal by direct suggestion and "ego strengthening") over one month. This was continued at home with a prerecorded cassette, and all patients were followed up for at least six months. At the end of the 12 sessions 29 patients were entirely symptom free, 14 improved, and seven unchanged. Three months later cystometry in 44 of the patients showed conversion of the cystometrogram to stability in 22 and a significant improvement in a further 16; only six showed no objective improvement. Seven patients relapsed (three after bereavement). Further treatment was given and five out of six patients were rendered symptom free again. Patients with detrusor instability were not found to have a noticeably increased susceptibility to hypnosis. It is concluded that psychological factors are very important in "idiopathic" detrusor instability and that hypnotherapy is effective for incontinence due to this disorder.

Management of the persistent somatizer

Patients who suffer and complain of symptoms for which no adequate organic pathology is found present serious management problems. Patients who display somatization phenomena are discussed with respect to incidence, psychopathology and predisposing factors-social and cultural, early life experiences, personality characteristics and individual psychodynamics. Although primary prevention of somatization is not yet feasible, early recognition and treatment are possible. The role of the psychiatrist includes: formulation of diagnosis; assessment for therapy; planning of treatment; and, at times, becoming the primary therapist. The family physician has the best opportunity for early detection and prevention of chronicity of somatization phenomena. Pharmacotherapy, behavior modification and some newer approaches in the management of these persistent somatizers are discussed.