A Review of the Influence of Personality Disorders on the Development of Skin Diseases

Personality disorder is a type of mental disorder in which a rigid and unhealthy pattern of thought, performance, and behavior is observed in a person. A person with a personality disorder has difficulty in understanding and communicating with situations and people. This causes significant problems and limitations in relationships, social activities, and understanding of diseases. The presence of personality disorders in sick people leads to the development of the disease and increases the level of stress and depression in patients. Among the diseases observed in patients suffering from personality disorders such as dual personality, the presence of stress, depression, harming themselves, scratching the skin, and causing self-inflicted wounds are mentioned. Personality disorders usually start in adolescence or early adulthood. There are different types of personality disorders. Some types may become less apparent during middle age. Types of personality disorders are classified into three clusters based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one other personality disorder. To diagnose a disorder, showing all signs and symptoms is unnecessary. Cluster A personality disorders are characterized by abnormal and unusual thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster B personality disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. There is increasing evidence about the negative impact of personality disorders on various physical, mental, and emotional aspects of healthy and sick people. Psychotherapy can help a person understand the effects of their behavior on others, learn to manage or cope with symptoms and reduce behaviors that cause problems in functioning and relationships. The type of treatment depends on the specific personality disorder, its severity, and the individual's condition. If personality disorders are not treated in people, the level of many diseases such as depression, cardiovascular diseases, and skin diseases will increase. Skin diseases are conditions that affect the skin. These diseases may cause rashes, inflammation, itching, or other skin changes. Some skin diseases may be genetic, while lifestyle and psychological factors such as severe obsessions and personality disorders may cause others. Both the skin and the central nervous system are derived from the ectoderm during embryogenesis. Their anatomical-functional relationship has been known for a long time. However, many aspects of this relationship are not fully understood. There are several studies that confirm the link between Dermatosis and mental illness. The findings of studies conducted in the field of psychiatry show that infectious-parasitic Dermatoses are the most common skin diseases in more than 70% of patients with mental disorders. The general explanation for this complication is that the physical condition of many mental patients decreases, which is associated with a decrease in immune defense and, as a result, an increase in sensitivity to skin infections. Considering the importance of skin diseases and the effect of personality disorders on this type of disease and the explanations provided, the question raised here is the relationship between personality disorders and skin diseases in various studies in the field of psychiatry. What results have been obtained and what requirements have been recommended regarding the reduction of this disease through psychotherapy?

The current study is a review study that includes papers published in domestic and foreign journals available in SID, PubMed, Google Scholar, Magiran, Springer, Wiley, Web of Science (ISI), Scopus, Science direct, and ProQuest databases. The range of years 2020 to 2022 was used. Papers were searched using the keywords "acute skin diseases, skin diseases, personality disorders, mental disorders" and their English equivalents. As a result of the initial search of papers, there were 156 articles, of which 74 apapers remained in the screening stage, and at the end, 12 papers were subjected to content analysis.

This review study showed that personality and mental disorders have an effect on the development of skin diseases and controlling these disorders is considered as a solution to reduce the complications of skin diseases.

In general, it can be concluded that in order to reduce the complications of skin diseases, paying attention to the personality and mental disorders of people can increase the patient's understanding of the disease and reduce the level of complications of this disease. Psychotherapy of the last century uses biological, psychological, and social factors at different levels significantly in the pathogenesis of each disease, through complex interactions in the treatment of diseases. There are many ontogenetic, anatomical, and functional connections between the skin, the psyche, and the immune system. These connections are the reason that Neuro-immunological mechanisms are often involved in the pathogenesis of Dermatoses. This is why skin diseases are classified as "paradigm" psychosomatic diseases. The skin is the only organ that is completely visible, and therefore the patient can always observe it closely. Patients are free to act on their ideas about pathogenic mechanisms. This means that, as mentioned above, clinicians, especially in the field of dermatology, must examine (and respect) patient disease models. However, skin lesions are visible not only to the patients themselves but often to other people as well. For example, patients with Dermatosis are often exposed to stigma: skin diseases may cause hatred or fear of contagion. Therefore, feelings such as embarrassment about one's illness, or disgust expressed by other people, may affect the patient's outlook on life. Some patients actually anticipate and experience imaginary stigma even in the case of minimal skin lesions. The fact that skin is very visible has also contributed to psychoanalytic theories and interpretations of psychoanalysts interested in psychosomatic medicine for skin diseases.