Skip to main content

Advertisement

SpringerLink
Log in

Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Many dermatology patients experience social anxiety symptoms; however, few studies have investigated vulnerabilities contributing to this distress. Anxiety sensitivity (AS), or the fear of the consequences of anxiety, warrants consideration given its association with social anxiety and dermatological symptoms, respectively. The purpose of this investigation was to investigate the role of AS in social anxiety symptoms in two samples of adults with psychodermatological conditions. AS social, but not physical or cognitive, concerns were hypothesized to demonstrate unique associations with social anxiety symptoms after controlling for relevant variables. Participants completed self-report measures online (Study 1) or in-person (Study 2). Study 1 included 164 participants with active skin conditions (Mage = 31.88; 69.5% female; 83.5% White), and Study 2 included 63 dermatology outpatients (Mage = 51.49; 70.7% female; 65% White). Results revealed AS social concerns was a unique factor contributing to social anxiety symptoms in both samples. This study demonstrates replication, and the findings suggest heightened concerns about the negative consequences related to visible skin conditions may worsen social anxiety symptoms in individuals with psychodermatological conditions. Despite limitations, this study informs the conceptualization of co-occurring psychological and dermatological conditions and highlights the need to evaluate the efficacy of brief AS interventions among patients with psychodermatological conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Available upon reasonable request.

References

  1. Orion E, Wolf R (2013) Psychological factors in skin diseases: stress and skin: facts and controversies. Clin Dermatol 31:707–711. https://doi.org/10.1016/j.clindermatol.2013.05.006

    Article  PubMed  Google Scholar 

  2. Picardi A, Abeni D, Melchi CF et al (2000) Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol 143:983–991. https://doi.org/10.1046/j.1365-2133.2000.03831.x

    Article  CAS  PubMed  Google Scholar 

  3. Magin P, Pond C, Smith W et al (2008) A cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices. J Eur Acad Dermatol Venereol 22:1435–1444. https://doi.org/10.1111/j.1468-3083.2008.02890.x

    Article  CAS  PubMed  Google Scholar 

  4. Aktan Ş, Özmen E, Şanli B (1998) Psychiatric disorders in patients attending a dermatology outpatient clinic. Dermatology 197:230–234. https://doi.org/10.1159/000018002

    Article  CAS  PubMed  Google Scholar 

  5. Hughes JE, Barraclough BM, Hamblin LG, White JE (1983) Psychiatric symptoms in dermatology patients. Br J Psychiatry 143:51–54. https://doi.org/10.1192/bjp.143.1.51

    Article  CAS  PubMed  Google Scholar 

  6. Niemeier V, Harth W, Kupfer J et al (2002) Prevalence of psychosomatic disorders in dermatologic patients. Experiences in 2 dermatology clinics with a liaison therapy model. Der Hautarzt 53:471–477. https://doi.org/10.1007/s00105-002-0380-6

    Article  CAS  PubMed  Google Scholar 

  7. Rasoulian M, Ebrahimi AA, Zare M, Taherifar Z (2010) Psychiatric morbidity in dermatological conditions. Int J Psychiatry Clin Pract 14:18–22. https://doi.org/10.3109/13651500903262370

    Article  PubMed  Google Scholar 

  8. Wessely SC, Lewis GH (1989) The classification of psychiatric morbidity in attenders at a dermatology clinic. Br J Psychiatry 155:686–691. https://doi.org/10.1192/bjp.155.5.686

    Article  CAS  PubMed  Google Scholar 

  9. Mazzotti E, Mastroeni S, Lindau J et al (2012) Psychological distress and coping strategies in patients attending a dermatology outpatient clinic: psychological distress, coping and dermatological disease. J Eur Acad Dermatol Venereol 26:746–754. https://doi.org/10.1111/j.1468-3083.2011.04159.x

    Article  CAS  PubMed  Google Scholar 

  10. Picardi A, Abeni D, Renzi C et al (2003) Treatment outcome and incidence of psychiatric disorders in dermatological out-patients. J Eur Acad Dermatol Venereol 17:155–159. https://doi.org/10.1046/j.1468-3083.2003.00619.x

    Article  CAS  PubMed  Google Scholar 

  11. Renzi C, Picardi A, Abeni D et al (2002) Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol. https://doi.org/10.1001/archderm.138.3.337

    Article  PubMed  Google Scholar 

  12. Dalgard FJ, Gieler U, Tomas-Aragones L et al (2015) The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Investig Dermatol 135:984–991. https://doi.org/10.1038/jid.2014.530

    Article  CAS  PubMed  Google Scholar 

  13. Picardi A, Amerio P, Baliva G et al (2004) Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Dermato-Venereologica 84:213–217. https://doi.org/10.1080/00015550410025264

    Article  PubMed  Google Scholar 

  14. Richards HL, Fortune DG, Weidmann A et al (2004) Detection of psychological distress in patients with psoriasis: low consensus between dermatologist and patient. Br J Dermatol 151:1227–1233. https://doi.org/10.1111/j.1365-2133.2004.06221.x

    Article  CAS  PubMed  Google Scholar 

  15. Jafferany M, Stoep AV, Dumitrescu A, Hornung RL (2010) The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol 49:784–789. https://doi.org/10.1111/j.1365-4632.2009.04372.x

    Article  PubMed  Google Scholar 

  16. Aguilar-Duran S, Ahmed A, Taylor R, Bewley A (2014) How to set up a psychodermatology clinic. Clin Exp Dermatol 39:577–582. https://doi.org/10.1111/ced.12360

    Article  CAS  PubMed  Google Scholar 

  17. Koo JYM, Lee CS (2003) General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS (eds) Psychocutaneous medicine. Marcel Dekker Inc, New York, pp 1–29

    Chapter  Google Scholar 

  18. American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5™, 5th ed. American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596

  19. Stein MB, Walker JR, Forde DR (1996) Public-speaking fears in a community sample: prevalence, impact on functioning, and diagnostic classification. Arch Gen Psychiatry 53:169. https://doi.org/10.1001/archpsyc.1996.01830020087010

    Article  CAS  PubMed  Google Scholar 

  20. Mennin DS, McLaughlin KA, Flanagan TJ (2009) Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. J Anxiety Disord 23:866–871. https://doi.org/10.1016/j.janxdis.2009.04.006

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wittchen HU, Beloch E (1996) The impact of social phobia on quality of life. Int Clin Psychopharmacol 11:15–23. https://doi.org/10.1097/00004850-199606003-00004

    Article  PubMed  Google Scholar 

  22. Bez Y, Yesilova Y, Kaya MC, Sir A (2011) High social phobia frequency and related disability in patients with acne vulgaris. Eur J Dermatol 21:756–760. https://doi.org/10.1684/ejd.2011.1418

    Article  PubMed  Google Scholar 

  23. Montgomery K, Norman P, Messenger AG, Thompson AR (2016) The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. Br J Dermatol 175:930–936. https://doi.org/10.1111/bjd.14719

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Yarpuz AY, Saadet ED, Śanli HE, Özgüven HD (2008) Social anxiety level in acne vulgaris patients and its relationship to clinical variables. Türk Psikiyatri Dergisi 19:1–8

    Google Scholar 

  25. Jowett S, Ryan T (1985) Skin disease and handicap: an analysis of the impact of skin conditions. Soc Sci Med 20:425–429. https://doi.org/10.1016/0277-9536(85)90021-8

    Article  CAS  PubMed  Google Scholar 

  26. Ginsburg IH, Link BG (1993) Psychosocial consequences of rejection and stigma feelings in psoriasis patients. Int J Dermatol 32:587–591. https://doi.org/10.1111/j.1365-4362.1993.tb05031.x

    Article  CAS  PubMed  Google Scholar 

  27. Salman A, Kurt E, Topcuoglu V, Demircay Z (2016) Social anxiety and quality of life in vitiligo and acne patients with facial involvement: a cross-sectional controlled study. Am J Clin Dermatol 17:305–311. https://doi.org/10.1007/s40257-016-0172-x

    Article  PubMed  Google Scholar 

  28. Kent G, Keohane S (2001) Social anxiety and disfigurement: the moderating effects of fear of negative evaluation and past experience. Br J Clin Psychol 40:23–34. https://doi.org/10.1348/014466501163454

    Article  CAS  PubMed  Google Scholar 

  29. Reiss S (1991) Expectancy model of fear, anxiety, and panic. Clin Psychol Rev 11:141–153. https://doi.org/10.1016/0272-7358(91)90092-9

    Article  Google Scholar 

  30. Taylor S, Zvolensky MJ, Cox BJ et al (2007) Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3. Psychol Assess 19:176–188. https://doi.org/10.1037/1040-3590.19.2.176

    Article  PubMed  Google Scholar 

  31. Naragon-Gainey K (2010) Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychol Bull 136:128–150. https://doi.org/10.1037/a0018055

    Article  PubMed  Google Scholar 

  32. Olatunji BO, Wolitzky-Taylor KB (2009) Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychol Bull 135:974–999. https://doi.org/10.1037/a0017428

    Article  PubMed  Google Scholar 

  33. Horenstein A, Potter CM, Heimberg RG (2018) How does anxiety sensitivity increase risk of chronic medical conditions? Clin Psychol Sci Pract 25:e12248. https://doi.org/10.1111/cpsp.12248

    Article  Google Scholar 

  34. Tuckman A (2017) The potential psychological impact of skin conditions. Dermatol Ther 7:53–57. https://doi.org/10.1007/s13555-016-0169-7

    Article  Google Scholar 

  35. Dixon LJ, Lee AA, Viana AG et al (2016) Anxiety sensitivity in dermatological patients. Psychosomatics 57:498–504. https://doi.org/10.1016/j.psym.2016.03.001

    Article  PubMed  Google Scholar 

  36. Dixon LJ, Witcraft SM, McCowan NK, Brodell RT (2018) Stress and skin disease quality of life: the moderating role of anxiety sensitivity social concerns. Br J Dermatol 178:951–957. https://doi.org/10.1111/bjd.16082

    Article  CAS  PubMed  Google Scholar 

  37. Kessler RC, Berglund P, Demler O et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:593. https://doi.org/10.1001/archpsyc.62.6.593

    Article  PubMed  Google Scholar 

  38. Turk CL, Heimberg RG, Orsillo SM et al (1998) An investigation of gender differences in social phobia. J Anxiety Disord 12:209–223. https://doi.org/10.1016/S0887-6185(98)00010-3

    Article  CAS  PubMed  Google Scholar 

  39. Schneier FR, Johnson J, Hornig CD et al (1992) Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 49:282. https://doi.org/10.1001/archpsyc.1992.01820040034004

    Article  CAS  PubMed  Google Scholar 

  40. Litman L, Robinson J, Abberbock T (2017) TurkPrime.com: a versatile crowdsourcing data acquisition platform for the behavioral sciences. Behav Res Methods 49:433–442. https://doi.org/10.3758/s13428-016-0727-z

    Article  PubMed  Google Scholar 

  41. Schmitt J, Ford DE (2007) Understanding the relationship between objective disease severity, psoriatic symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis—a structural equations modeling approach. Gen Hosp Psychiatry 29:134–140. https://doi.org/10.1016/j.genhosppsych.2006.12.004

    Article  PubMed  Google Scholar 

  42. Dixon LJ, Witcraft SM, Perry MM (2019) How does anxiety affect adults with skin disease? Examining the indirect effect of anxiety symptoms on impairment through anxiety sensitivity. Cogn Ther Res 43:14–23. https://doi.org/10.1007/s10608-018-9942-5

    Article  Google Scholar 

  43. Arditte KA, Çek D, Shaw AM, Timpano KR (2016) The importance of assessing clinical phenomena in mechanical Turk research. Psychol Assess 28:684–691. https://doi.org/10.1037/pas0000217

    Article  PubMed  Google Scholar 

  44. Buhrmester M, Kwang T, Gosling SD (2016) Amazon’s Mechanical Turk: a new source of inexpensive, yet high-quality data? In: Kazdin AE (ed) Methodological issues and strategies in clinical research, 4th edn. American Psychological Association, Washington, pp 133–139

    Chapter  Google Scholar 

  45. Shapiro DN, Chandler J, Mueller PA (2013) Using mechanical Turk to study clinical populations. Clin Psychol Sci 1:213–220. https://doi.org/10.1177/2167702612469015

    Article  Google Scholar 

  46. Jafferany M (2007) Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry 09:203–213. https://doi.org/10.4088/PCC.v09n0306

    Article  Google Scholar 

  47. Connor KM, Davidson JRT, Churchill LE et al (2000) Psychometric properties of the social phobia inventory (SPIN): new self-rating scale. Br J Psychiatry 176:379–386. https://doi.org/10.1192/bjp.176.4.379

    Article  CAS  PubMed  Google Scholar 

  48. Dcdas C, Eocap O (2018) Validation of the social phobia inventory (SPIN) in Nigeria. J Psychiatry Psychiatr Disord 02:49–54. https://doi.org/10.26502/jppd.2572-519X0040

    Article  Google Scholar 

  49. Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33:335–343. https://doi.org/10.1016/0005-7967(94)00075-U

    Article  CAS  PubMed  Google Scholar 

  50. Cohen J (1992) A power primer. Psychol Bull 112:155–159. https://doi.org/10.1037/0033-2909.112.1.155

    Article  CAS  PubMed  Google Scholar 

  51. Krüger C, Schallreuter K (2015) Stigmatisation, avoidance behaviour and difficulties in coping are common among adult patients with vitiligo. Acta Derm Venereol 95:553–558. https://doi.org/10.2340/00015555-1981

    Article  PubMed  Google Scholar 

  52. McNally RJ (2002) Anxiety sensitivity and panic disorder. Biol Psychiatry 52:938–946. https://doi.org/10.1016/S0006-3223(02)01475-0

    Article  PubMed  Google Scholar 

  53. McNally RJ (1990) Psychological approaches to panic disorder: a review. Psychol Bull 108:403–419

    Article  CAS  Google Scholar 

  54. Hofmann SG (2007) Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther 36:193–209. https://doi.org/10.1080/16506070701421313

    Article  PubMed  PubMed Central  Google Scholar 

  55. Łakuta P, Przybyła-Basista H (2017) Toward a better understanding of social anxiety and depression in psoriasis patients: the role of determinants, mediators, and moderators. J Psychosom Res 94:32–38. https://doi.org/10.1016/j.jpsychores.2017.01.007

    Article  PubMed  Google Scholar 

  56. Loney T, Standage M, Lewis S (2008) Not just “skin deep”: psychosocial effects of dermatological-related social anxiety in a sample of acne patients. J Health Psychol 13:47–54. https://doi.org/10.1177/1359105307084311

    Article  PubMed  Google Scholar 

  57. Evers AWM, Verhoeven EWM, Kraaimaat FW et al (2010) How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol 163:986–991. https://doi.org/10.1111/j.1365-2133.2010.09984.x

    Article  CAS  PubMed  Google Scholar 

  58. Hashizume H, Horibe T, Ohshima A et al (2005) Anxiety accelerates T-helper 2-tilted immune responses in patients with atopic dermatitis. Br J Dermatol 152:1161–1164. https://doi.org/10.1111/j.1365-2133.2005.06449.x

    Article  CAS  PubMed  Google Scholar 

  59. Cairney J, McCabe L, Veldhuizen S et al (2007) Epidemiology of social phobia in later life. Am J Geriatr Psychiatry 15:224–233. https://doi.org/10.1097/01.JGP.0000235702.77245.46

    Article  PubMed  Google Scholar 

  60. Flint AJ, Peasley-Miklus C, Papademetriou E et al (2010) Effect of age on the frequency of anxiety disorders in major depression with psychotic features. Am J Geriatr Psychiatry 18:404–412. https://doi.org/10.1097/JGP.0b013e3181c294ac

    Article  PubMed  PubMed Central  Google Scholar 

  61. Regier DA, Boyd JH, Burke JD et al (1988) One-month prevalence of mental disorders in the United States: based on five epidemiologic catchment area sites. Arch Gen Psychiatry 45:977. https://doi.org/10.1001/archpsyc.1988.01800350011002

    Article  CAS  PubMed  Google Scholar 

  62. Gum AM, King-Kallimanis B, Kohn R (2009) Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry 17:769–781. https://doi.org/10.1097/JGP.0b013e3181ad4f5a

    Article  PubMed  Google Scholar 

  63. Trollor JN, Anderson TM, Sachdev PS et al (2007) Prevalence of mental disorders in the elderly: the Australian national mental health and well-being survey. Am J Geriatr Psychiatry 15:455–466. https://doi.org/10.1097/JGP.0b013e3180590ba9

    Article  PubMed  Google Scholar 

  64. Stern RS (2004) Dermatologists and office-based care of dermatologic disease in the 21st century. J Investig Dermatol Symp Proc 9:126–130. https://doi.org/10.1046/j.1087-0024.2003.09108.x

    Article  PubMed  Google Scholar 

  65. Kessler RC, Petukhova M, Sampson NA et al (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 21:169–184. https://doi.org/10.1002/mpr.1359

    Article  PubMed  PubMed Central  Google Scholar 

  66. Hedman-Lagerlöf E, Bergman A, Lindefors N, Bradley M (2019) Exposure-based cognitive behavior therapy for atopic dermatitis: an open trial. Cogn Behav Ther 48:300–310. https://doi.org/10.1080/16506073.2018.1504320

    Article  PubMed  Google Scholar 

  67. Woodruff PWR, Higgins EM, du Vivier AWP, Wessely S (1997) Psychiatric illness in patients referred to a dermatology-psychiatry clinic. Gen Hosp Psychiatry 19:29–35. https://doi.org/10.1016/S0163-8343(97)00155-2

    Article  CAS  PubMed  Google Scholar 

  68. Keough ME, Schmidt NB (2012) Refinement of a brief anxiety sensitivity reduction intervention. J Consult Clin Psychol 80:766–772. https://doi.org/10.1037/a0027961

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The University of Mississippi College of Liberal Arts Research Grant for Faculty Research and Creative Achievement supported Laura J. Dixon’s work on this paper.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Mississippi, University, MS, 38677, USA

    Lauren Ellison, Sara M. Witcraft & Laura J. Dixon

  2. Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Laura J. Dixon

Authors
  1. Lauren Ellison
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara M. Witcraft
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura J. Dixon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura J. Dixon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Study 1: University of Mississippi Institutional Review Board, reference number 17-013; Study 2: University of Mississippi Medical Center Institutional Review Board, reference number 2014-0077) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ellison, L., Witcraft, S.M. & Dixon, L.J. Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Arch Dermatol Res 313, 531–537 (2021). https://doi.org/10.1007/s00403-020-02130-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-020-02130-w

Keywords

Search

Navigation