Psychological adjustment to disfiguring skin diseases

After diagnosis of a skin disorder, there follows a period of psychological adjustment during which most people are able to cope. Coping is a process that can be described as ‘expending conscious effort to solve personal and interpersonal problems, and seeking to master, minimise or tolerate a stressor’. Many types of coping strategies are possible, including planning; positive re-interpretation; using practical and emotional social support; venting of emotions; suppression of competing activities; emotional, behavioural and cognitive disengagement; and use of humour or religion. Several methods may be used and the methods used may change; skills are used or developed to regain a sense of equilibrium and well-being. Exploring ways of coping can be useful and an assessment tool such as The Brief COPE Questionnaire can help in this regard. Some people appear to cope well and adjust quickly despite an objectively severe skin disease, while others may become very stressed and struggle to cope in the face of an objectively minor skin disorder. Psychological adjustment is a multifactorial and fluctuant biopsychosocial process which centres around three themes: a search for meaning in the experience; an attempt to regain control over the situation and in life generally; and an effort to restore self-esteem.