Previous chapters have described the emotional and psychological effects of skin disease on the individual. However, as is the case with most illnesses, skin disease has an impact on a person's relationships, which inevitably affects, and is affected by, the individual's condition. In this chapter we consider the impact that skin conditions have on different relationships and consider some of the social situations in which difficulties regarding the skin condition may arise. Furthermore, the readerwiH be introduced to some self-help techniques which can be learned and used in social situations.
Researchers have sought to examine the impact skin disease has on patients' relationships. One study considered the social aspects of psoriasis (Dungey and Buselmeir, 1982). Because of its visibility, the condition evokes a range of responses in those who come into contact with people with the condition. Psoriasis is sometimes considered dirty, ugly or even contagious by both non-affected people and by those suffering from the condition. This has implications for personal and intimate relationships, with patients reporting that they may avoid social contact, especially where the possibility of intimacy may arise.
In an examination of the effect of vitiligo on sexual relationships, 158 vitiligo sufferers between the ages of 16 and 79 were given a questionnaire on their beliefs regarding intimate relationships (Porter etal., 1987). One-quarter of those surveyed said that they believed that their skin condition had negatively affected their sexual relationships. Between 10 and 15 per cent of those surveyed indicated that their skin condition had limited their ability to find a partner, stating that the number and frequency of sexualrelationships was limited, as also were the locations where sexual relationships might occur. Contrary to what one might expect, the findings of the study suggested that the majority of patients felt more embarrassed in non-sexual interpersonal relationships than they did in intimate sexual and social relationships. A possible explanation for this may be that, since more than half of the sample interviewed were married, with an average age of 38 years, it was likely that they had been involved in long-term relationships. In these cases the issue of their disfigurement was not something new, and possibly the people who were reporting had already established coping mechanisms. The possibility of a new sexual encounter was probably less likely than a social non-sexual one. It is reasonable to assume, therefore, that they would be more anxious about nonsexual socialising. The authors of the study suggest that psychological counselling could be beneficial if it addressed problems of self-esteem and body image.
The way a person copes with these and similar situations may depend on their self-esteem and body image as well as the social skills that they have in place.
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