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Psoriasis is a chronic, inşammatory disease which is characterized by exacerbations and remissions and seen 1-3% of the general population. The etiology of psoriasis is not clear. The close relationship of this disease with psychological factors indicates psychosomatic disorders. Although the relationships between patients with psoriasis and anxiety and depressive symptoms have been the subject of studies, personality pathology has been neglected in this regard. Two psoriasis patients with a diagnosis of narcissistic personality disorder were examined in this report. Perspectives to medical conditions and the possible effects of axis II diagnoses to the treatment success of the patients were discussed.
Case A: Forty-year-old male patient was admitted to the psychodermatology polyclinic with skin rash, şaking and itching complaints. Patient was treated and followed up with the diagnosis of psoriasis. The score of PASI (Psoriasis Area Severity Index) was 18.04 and DLQI (Dermatology Life Quality Index) was 8. A history of childhood trauma was detected in the anamnesis. Patient was enrolled in psychiatric interviews. As a result of the psychiatric interviews and psychometric evaluations (Rorschach Test, Rosenberg Self-Perception Test, SCID-II), narcissistic personality disorder was revealed in this patient.
Case B: Forty two-year-old male patient was admitted to the psychodermatology polyclinic with skin rash, şaking and itching complaints. According to the history, patients have received treatments for psoriasis. The scores of PASI and DLQI were calculated as 53.5 and 30. Psychiatric interview was requested due to the medical histories of psychiatric treatment and social resistance to the treatment. Rorschach Test, Rosenberg Self-Perception Test and SCID-II were administered to the patient. As a result of the psychiatric interviews and psychometric evaluations, this patient was diagnosed as narcissistic personality disorder. Psoriasis is a psychosomatic skin disease that is frequently accompanied by psychiatric disorders. Although the role of normal and abnormal personality traits on the initiation and progression of disease could not be shown clearly in the limited number of studies investigating personality characteristics in patients with psoriasis, it has been suggested that these patients have conşictual-combative personality. Alexithymia, a personality trait, was shown to be relatively common in patients with psoriasis. According to Sifneos, patients with alexithymia frequently show narcissistic, psychosomatic, passive, aggressive personality traits. In addition, some researchers draw attention to the narcissistic injury in the formation of skin diseases.