From a psychoanalytical point of view, almost all dermatological disorders
can be considered psychodermatological disorders, because psychoanalytical
conception of psychosomatics is not based on the absence of an organic aetiology, or
on the real somatic condition of the disease. In all of them – either self inflicted or not,
delusional or real, chronic or acute - a psychodynamic approach can be made and can
turn out useful, depending more on the patient than on the disorder itself.
Psychoanalytic evaluation can contribute to the dermatologic practice at many different
levels: a) establishing the level of psychological/psychiatric functioning during the
consultation; b) typifying the kind of unconscious conflicts and emotions that the
patient expresses through his/her complaints and symptoms; c) detecting the defence
mechanisms that the patient uses to cope with reality, with stress and with his disease;
d) choosing the treatment taking into account the unconscious preferences and
meanings of the prescriptions; and e) giving skills to improve doctor-patient
relationship.
What the psychoanalyst hears in the doctor’s consulting room gives him the possibility
to infer that there are unconscious factors which play a role in the motive and time of
consultation, the self-destructive patterns of behaviour that worsen the disease, the kind
of complaint or suffering privileged by the patient, the acceptance or rejection of a
treatment or a medicine and even the location of the lesions.
Keywords: Allergy, Attachment, Doctor-patient relationship, Ego-skin,
Emotional expression, Medical psychology, Psoriasis, Psychoanalysis,
Psychodermatology, Psychodynamic psychotherapy, Psychosomatics, Psychosomatic diseases, Self-injuring, Skin.
