Psychosomatic Syndromes and Symptom Severity in Chronic Psoriasis

OBJECTIVE: To investigate whether and the extent to which psychosomatic syndromes and psychopathology are associated to psoriasis severity. METHOD: Consecutive 282 outpatients with chronic psoriasis were assessed for psychopathology (with the Mini International Neuropsychiatric Interview), psychosomatic conditions (with the Diagnostic Criteria for Psychosomatic Research, DCPR), severity of psoriatic symptoms (with the Psoriasis Area and Severity Index, PASI), and illness-related quality of life (with the Dermatology Life Quality Index, DLQI). RESULTS: Psychopathology was diagnosed in 26.6% patients while at least one DCPR syndrome in 67% of them and higher psychosomatic severity (>1 DCPR syndrome) in 29.1%. Higher symptom severity (PASI>20) was significantly more prevalent in patients with greater psychosomatic severity (29.1%) (d=1.25) – particularly, alexithymia (29.4%; d=0.83) – and poorer quality of life (DLQI>10) (d=0.86). Furthermore, after controlling for psychopathology, psychosomatic severity, and alexithymia, together with lower illness-related quality of life, independently predicted severity of symptoms, with large effect size (d=0.78 and d=1.75, respectively). CONCLUSIONS: DCPR clusters can be suggested as a useful tool for identifying psychological distress in psoriasis, significantly linked to both subjective (quality of life) and objective factors (severity of lesions and extension of affected skin areas) of the illness experience.