Psoriasis is a common immune-mediated condition associated with substantial physical and psychological comorbidities. Due to the visibility of their skin lesions patients commonly report experiences of stigmatisation and social rejection including facial expressions of disgust. Initial work, using functional Magnetic Resonance Imaging (fMRI), suggests that patients block out facial expressions of disgust as a coping mechanism, adopted by patients to protect themselves against the aversive reactions from others. Through a series of related studies utilising quantitative and qualitative methods, this body of work investigates disgust processing in psoriasis patients and explores patients experiences of aversive social encounters. This thesis reports the differential processing of emotional facial expressions and emotionally evocative scenes in psoriasis patients compared to healthy controls. In contrast to previous work patients did not show an attenuated response to disgusted facial expressions in the bilateral interior insula, a brain region implicated in disgust processing. However, in this larger patient cohort, individual disgust processing traits (including disgust propensity and sensitivity), clinical factors (disease severity and duration) and emotional dysregulation (alexithymia) were identified as being individual modifiers of disgust processing. Furthermore, skin clearance was found to modify affective processing at the neural level. Psoriasis was found to have a significant impact on patients social interactions and patients reported a wide range of responses to the appearance of their skin. Wasted opportunities for positive interactions were identified from the data along with potential targets for future psychological interventions. Finally, the development of a public engagement initiative, The Psoriasis Shout Out (PSO), is included to highlight the importance of translating research data into tangible initiatives for the benefit of patients. The PSO aims to deliver activities which address the psychosocial aspects of psoriasis and challenge widespread misconceptions of the disease amongst the general public.
- public engagement