Only skin deep : examining vitiligo from a biopsychosocial perspective
The research outlined in this thesis stems from empirical work carried out with vitiligo sufferers over a period of 3 years, from 1995 to 1998. Vitiligo is a pigmentation disorder, which causes the destruction of melanocytes in the skin. The affected areas lose their pigmentation resulting in the appearance of irregular white patches over the surface of the skin. Although the appearance of the skin can change dramatically, vitiligo does not cause any pain or physical discomfort, nor is it in any way physically limiting. Therefore the psychological effects of the disfiguring nature of this condition can be studied independently of other physical changes. The present research was prompted by the recognition that empirical studies in the field of psychodermatology are scarce, especially with regard to the effects of skin disease on psychological health. Vitiligo provides a unique opportunity to examine the psychological impact of disfigurement in the absence of other variables such as pain, or trauma. Furthermore, unlike other skin conditions, such as eczema and psoriasis, few empirical studies have been carried out to examine the impact of a patient's psychological state on the progression of vitiligo and therefore, an opportunity to undertake some preliminary research in this field was identified. The main thesis of the research outlined herein is that mental state and physiological state are not independent of each other for vitiligo sufferers. A patient's psychological state may influence the onset or progression of their condition, and the appearance of the condition may impact upon a patient's psychosocial functioning. With this hypothesis in mind, a series of studies were undertaken, examining the interaction between mental and physiological state in vitiligo. Four central hypotheses were examined: 1. Newly diagnosed vitiligo patients experience a higher proportion of stressful life events in the year preceding the onset of their condition, than a matched clinical sample. 2. Psychological counselling using cognitive behaviour therapy helps to improve the body image, self esteem and quality of life of vitiligo patients and may impact upon the progression of their condition. 3. Being involved in a non-directive support group helps to improve the body image, self esteem and quality of life in vitiligo sufferers. 4. Variation exists across vitiligo sufferers regarding their beliefs about the onset, course and symptomatology of their condition. These beliefs will vary according to demographic variables. It is anticipated that amongst others, the present study may be of interest to clinical and counselling psychologists and counsellors working in the field of disfigurement, dermatologists, nurses, general practitioners and other health professionals who have face-to-face contact with dermatology patients, and health and social psychologists involved in research in this field.