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- Title
PSYCHOLOGICAL TRAUMA IN DERMATOLOGY: 'THE ELEPHANT IN THE ROOM' -- IDENTIFYING THE CHALLENGE -- A POSITION PAPER WITH PILOT FINDINGS.
- Authors
Chouliara, Zoé; Affleck, Andrew; Moss, Tim; Murray, Jennifer
- Abstract
Skin conditions are highly prevalent and tend to be associated with multiple psychological challenges. Many of the psychological challenges faced by patients with skin conditions appear to specifically overlap with the cluster symptomatology of psychological/complex trauma. Nevertheless, the role of psychological trauma in dermatology is under-researched. For the purposes of this paper, previous multidisciplinary research is re-contextualised, using a trauma-informed viewpoint. In addition, the results of a pilot study which correlate the prevalence of psychological trauma in dermatology are presented to highlight the argument. Psychological trauma seems key in psychosocial morbidity of dermatology patients. According to our pilot study, 35.8% met the criteria for post-traumatic stress disorder (PTSD), almost triple the proportion of the general population. Higher levels of PTSD symptoms were associated with higher levels of depression, anxiety, and appearance distress. Complex trauma symptoms were positively associated with appearance distress, self-reported self-harm and suicidal ideation. We are putting forward a trauma-based, trauma-informed and trauma-sensitive explanation of the extent of the psychosocial and affective impact of skin conditions. Such explanation might account for the incongruent clinical severity and subjective reports of distress. In specific, the high distress observed in dermatology -- which is often psychologically experienced by patients as disproportionate to the objectively rated clinical severity of their condition -- could be a manifestation of and/or comorbid with psychological trauma symptoms. Routine screening for psychological trauma might therefore be important for the provision of appropriate and cost-effective management of skin conditions. Training of health professionals in psychosocial aspects of dermatology -- i.e. tier 1 and 2 interventions and basic mental health screen -- as well as increasing access to psychological provision is paramount for early detection, effective management and appropriate referral of traumatised patients, as well as trauma-informed, trauma-based practice. Given the limited and often negligible psychological provision specifically for dermatology, training of dermatology professionals in recognising and responding to psychological trauma presentations in dermatology is paramount. In Scotland, the National Trauma Framework provides a good starting platform for such training in dermatology. The inclusion of Complex PTSD (CPTSD) in the ICD II Classification of Disorders adds to the importance of exploring trauma in dermatology.
- Subjects
PSYCHOLOGY of the sick; ACNE; COST effectiveness; DERMATOLOGY; PSYCHOLOGICAL distress; MEDICAL referrals; MEDICAL screening; MENTAL health; NOSOLOGY; POST-traumatic stress disorder; EMOTIONAL trauma; SELF-evaluation; SELF-mutilation; SKIN care; SKIN diseases; DISEASE management; SEVERITY of illness index
- Publication
Dermatological Nursing, 2020, Vol 19, Issue 4, p18
- ISSN
1477-3368
- Publication type
Article