The relationship between the presence of childhood traumas, adult attachment styles, and temperament characteristics in patients with psoriasis

Psoriasis is a chronic, recurrent, inflammatory disease characterised by shiny, pearlescent-white squames located on sharply circumscribed, circular, erythematous plaques or papules of variable size in various parts of the skin. Psoriasis is a predominantly psychosomatic disease which is most commonly associated with psychogenic factors. The aim of this study was to evaluate the differences between cases with psoriasis and healthy controls in terms of the presence of childhood traumas, adult attachment styles and temperament characteristics, to determine the levels of depression and anxiety during the evaluation, to investigate the relationship of these conditions with disease characteristics and disease severity, and to focus on mental health as well as physical symptoms in treatment. The study included 60 psoriasis cases who were admitted to Pamukkale University Dermatology Outpatient Clinic and 60 psoriasis cases who were hospitalised in Pamukkale University Dermatology Service. The healthy control group consisted of 60 healthy volunteers who fulfilled the necessary conditions for the study and had similar age and gender characteristics with the patient group. Sociodemographic Data Form, SCID-5-CV (Structured Clinical Interview for DSM-5 Disorders, Clinician Version), Psoriasis Area and Severity Index (PASI), Childhood Trauma Questionnaire, Adult Attachment Scale, TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Autoquestionnaire), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale were administered to the participants who agreed to participate in the study with informed consent. Stressful life events and their ongoing effects were found to be significantly higher in individuals with psoriasis than in the healthy control group. The participants in the psoriasis group had significantly higher levels of depression and anxiety during the evaluation compared to healthy controls, and their physical neglect and abuse scores and total scores on the childhood traumas scale were higher than the participants in the healthy control group. In adults diagnosed with psoriasis, anxious/ambivalent attachment scores, one of the insecure attachment styles, were significantly higher than healthy controls. In addition, depressive and irritable temperament characteristics were significantly higher in the psoriasis group than in the control group. When psoriasis and healthy control groups were evaluated together, childhood traumas and insecure attachment styles were positively correlated with anxiety and depression scores. There was also a positive correlation between childhood traumas and insecure attachment styles. However, no significant relationship was found between these findings and disease severity. Our findings suggest that place of residence, loss of an infant, experiencing physical abuse, ongoing effects of stressful life events, a family history of psoriasis and anxious/ambivalent attachment may be factors that increase the risk of developing psoriasis. Based on the results of this study, it is emphasized that a multidisciplinary treatment approach, which addresses the individual as a biopsychosocial-cultural whole and focuses on mental health, should be adopted in the management of psoriasis patients, rather than treatment that solely focuses on skin symptoms. Key words: Psoriasis, childhood trauma, attachment, temperament