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Psychopathology and Psychological Problems in Patients with Burn Scars

Epidemiology and Management

  • Therapy In Practice
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses.

Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13–23% and 13–45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury.

Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.

In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.

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Acknowledgements

This study was financially supported by the Dutch Burns Foundation, Beverwijk. We thank Mrs J. Hamers, Ms C. Koele, Ms I. Lemmens, and Ms S. van de Voorde for their help with the literature search. We are also indebted to Ms P. Doupi and Mrs B. Aler for their help in the preparation of the manuscript.

Neither the authors, nor any of the persons mentioned in this acknowledgement have any affiliation with profit-based organisations.

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Authors and Affiliations

  1. Department of Research, Dutch Burns Foundation, PO Box 1015, 1940 EA, Beverwijk, The Netherlands

    Nancy E. E. Van Loey

  2. Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands

    Maarten J. M. Van Son

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  1. Nancy E. E. Van Loey
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  2. Maarten J. M. Van Son
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Correspondence to Nancy E. E. Van Loey.

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Van Loey, N.E.E., Van Son, M.J.M. Psychopathology and Psychological Problems in Patients with Burn Scars. Am J Clin Dermatol 4, 245–272 (2003). https://doi.org/10.2165/00128071-200304040-00004

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