Atopic dermatitis and psyche

[fls]

That a physical process can be influenced by a mental process doesn't necessary mean that any given physical process is actually influenced by a mental process.

Right, but what I was getting at is that whether or not a mental process is part of a causal link does not somehow make the condition illegitimate, which seems to be what you are suggesting with the rest of your post.

Wikipedia article cites AD as one of the forms of neurodermatitis.

Does it? It's another good argument against the use of Wikipedia, then.

Speaking of imaginary diseases, large part of skin damage in AD comes from scratching, which is definitely an action of the sufferer. Other than that, it's basically red and dry skin. Scratching is caused by itching. Itching is a feeling. Not necessarily mental thing, I think animals can also feel the itching. Is itching real, or only in my mind?

I think looking at different conditions can help understand the mental differences. Atopic dermatitis starts with abnormal skin; skin that has been made abnormal through an immune reaction leading to inflammation. One of the consequences of this abnormal skin is the feeling of itching. Primary biliary cirrhosis is a liver condition which leads to intense itching in some sufferers, even though the skin itself is normal, and may be due to alterations in opioid receptors. This can then lead to scratching which causes chronic changes in the skin. Lichen simplex chronicus (used synonymously with neurodermatitis) refers to chronic changes in the skin caused by rubbing and/or scratching. The feeling of itching, without a physical abnormality, is the primary cause of the abnormal skin. All three conditions are characterized by lichenification (the pathological description of the skin changes due to scratching/rubbing), but in the first two the lichenification is considered secondary to a pre-existing physical condition, while in the latter it is the primary physical condition.

Linda

 

[El Greco]

I can say, as legitimately, that why on earth would you assume that AD is caused by mental processes? It seems like we have an issue of the burden of proof. Is it up to me to prove that AD isn't caused by mental processes (I'm on the “AD has got nothing to do with the mental” side), or is it up to other people to prove that it is?

The stress-relatedness of AD is referred to something that “everybody knows”, and nobody actually verifies if it's true. Was there any study to actually show that? (I've seen only one, on mice.)

Your searching capabilities must be very limited because this took me the whole of 5 seconds: Stress and atopic dermatitis. If you peruse the "related articles" you will find more studies showing that the link between psychologic factors and AD is a fact.

 

[Baby Nemesis]

Stress weakens the immune system? This doesn't make any sense. Let's take the most modern ointment for the AD. The active substance is Tacrolimus, which works by... weakening the immune system! You put it on the skin, it weakens - locally - the immune system, this stops the allergic reaction from happening in your skin, and AD clears up.

Now, if stress weakens the immune system, it should be the *cure* for AD, not a (partial) cause.

It's good that there are creams like that.

Not all dermatitis is an auto-immune dysfunction. There are several different causes, some which have nothing to do with stress, so stress might not affect them at all.

But weakening doesn't necessarily mean just making it less powerful. the way some people use it, it could sometimes mean impairing its function so it's more likely to develop faults. See, for example, Stress as a trigger of autoimmune disease.

Doing stress reduction techniques can't do any harm anyway.

Being stressed doesn't mean you're to blame for the stress.

There's nothing wrong in advising to avoid stress. But there is something wrong with declaring that the psyche, which is one the things we identify the most - “I *am* my psyche” - is the cause of the disease. Here's how this thinking goes wrong:
1. AD is caused by mental processes.
2. Mental processes are what makes me me.
3. AD is caused by who I am.

But any stress you have isn't part of who you are - it's just something that happens to you. If it was a part of who you are, why would you ever want to get rid of it? But most people do, because they don't identify it as an integral and precious part of their personalities.

Or

1. AD is caused by mental processes.
2. My will is one of my mental processes.
3. AD is caused by my will. I'm sick because I want to be sick.

But people don't will themselves to be stressed. Stress is an emotion. Emotions come on whether you want them or not. I'm sure there can't be many doctors around who'd say all mental processes can cause atopic dermatitis. Some doctors do apparently come across as accusing if they imply that what's happening to someone is coming from processes going on in their own mind. But that's a fault with them, not with you.

 

[Dancing David]

But people don't will themselves to be stressed. Stress is an emotion. Emotions come on whether you want them or not.

Small clarification, 'stress' refers to many things. Yet is seems when you examine it, it is truely just being tired or exhausted. One tends to function better is one is rested and full of resources. Emotions seem more likely to overwhelm or flood when a person is tired.

So as frustrating as it may be, the best way to deal with 'stress', 'burn out' or 'being crispy' is to take care of yourself. Get enough sleep, socialize, don't overindulge, be aware of healthy and unhealthy coping skills.

Changing schedules is important, the body needs down time, eating well and exercise are important as well.

One training I went to recommended the establishment of a routine that tells your body/brain, 'work is over now'. Just something simple to be a symbolic gateway to 'not working'. They also recommended 'getting away'. By actually not taking work home, and making sure to get out of the usual environments as often as possible.

 

[automatthias]

Your searching capabilities must be very limited because this took me the whole of 5 seconds: Stress and atopic dermatitis. If you peruse the "related articles" you will find more studies showing that the link between psychologic factors and AD is a fact.

I've seen this abstract. I think I'd have to read the full text of the publication and review it carefully. I can now only say what my concerns are when looking at abstracts such as this one.

The abstract says “stress impairs the skin barrier function and favors a shift in immunity toward a T helper type 2 cell/allergic response”. I'm not denying this finding. Unless there are methodological flaws in the study. I'd also like to know what does it mean “to impair the skin barrier function” in this context. However, the study is concerned with low-level reactions in the skin. If you're citing this paper as evidence for “stress worsens AD”, you assume that “a shift in immunity toward a T helper type 2 cell means worsening of AD symptoms”. Is it a true assumption?

Let me cite Trisha Greenhalgh:

But surrogate end points have some drawbacks. Firstly, a change in the surrogate end point does not itself answer the essential preliminary questions: “what is the objective of treatment in this patient?” and “what, according to valid and reliable research studies, is the best available treatment for this condition?” Secondly, the surrogate end point may not closely reflect the treatment target - in other words, it may not be valid or reliable. Thirdly, overreliance on a single surrogate end point as a measure of therapeutic success usually reflects a narrow clinical perspective. Finally, surrogate end points are often developed in animal models of disease, since changes in a specific variable can be measured under controlled conditions in a well defined population. However, extrapolation of these findings to human disease is likely to be invalid.(15-17) (source) (via Bad Science)

The paper on dermatitis in mice was published in February 2008. The abstract says:

However, to date, scientific proof of stress-induced neuronal plasticity and neuro-immune interaction in atopy or allergy remains lacking.

The study itself is interesting. Mice exposed to sound stress have developed AD symptoms, if we're to trust used AD readout parameters.

I'm not saying that AD is not, or can't be stress-induced. I just want to point out that there is research still going on, and we'd be hasty to call it “a fact”. The kind of study I'd like to see would not use surrogate outcomes or look for the mechanism, but simply measure end-to-end interactions, like studies on smoking and cancer. For example, take a sample of people, with and without AD. The stress group would do things like, say, write an essay and read it aloud to a group of people. The no-stress group would still come to the premises, but would do something neutral, like watch TV or read a book. Would the stress group be more likely to develop worse AD symptoms? Would any subjects from the non-AD group develop any AD symptoms? Would any subjects from the no-stress, AD group develop worse symptoms? Etc.

Observational studies would also be helpful. Take a sample of people without AD, evaluate their stress level. Follow up on them throughout several years, and see whether there's a correlation between stress levels and the likelihood of developing AD symptoms. Are there any studies like that? I haven't seen any so far.

Since I'd like to move forward, let's assume, for the sake of this discussion, that stress does induce AD symptoms.

Remember the other end of the spectrum I mentioned? How would you go about claims like “AD is caused by problem in relationship with your mother” or “people with certain personality types are susceptible to AD”. Does that sound plausible to you?

 

[El Greco]

Remember the other end of the spectrum I mentioned? How would you go about claims like “AD is caused by problem in relationship with your mother” or “people with certain personality types are susceptible to AD”. Does that sound plausible to you?

"Caused" does seem bunk to me. The cause would most probably have a genetic background. Susceptibility related to personality could be bunk, but I guess it depends on what one means by "personality". For example serotonin imbalances are known to affect certain "personality traits". Could certain chemical imbalances that affect mood (and thus "personality") also affect the probability that AD will manifest ? I don't think we are in position to say so yet, and so the "personality types" theory also seems bunk. But in theory it could have a scientific basis.

 

[automatthias]

"Caused" does seem bunk to me.

Why do you think it's bunk? (Let's consider the softer version, that it's partially caused.)

 

[automatthias]

This question is serious. Why do you think one part of it is bunk and the other isn't? For instance, here's a paper suggesting a link between a personality trait and skin disorders. The paper doesn't use the word 'caused', it settles for 'important implications', but it goes in just that direction.

Alexithymia and dermatology: the state of the art.
CONCLUSION: Present research findings on alexithymia in the field of dermatology suggest important implications for the treatment of some specific dermatological disorders.(...)

Do you still think it's bunk?

 

[Dancing David]

"suggest", is not a very strong word and is used appropriately. So there is an indication for further research but no correlation or causation.

There is some dangerous unsupported allegations in the realm of psychology in that abstract however that are very likely...not going to be substantiated.