Psyche and the skin

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Psyche and the skin
PSYCHE AND THE SKIN
Itchiness. A severe or even mild itch, whether localized or generalized, is, in the absence of any prior external or internal disease, most likely to be psychogenic. Often this itch may occur in an area highly endowed with nerve endings, such as around the genitals or the anal area. Various possible psychological reasons and explanations have been given for this particular symptom. These include displaced sexual gratification; a need for self-inflicted injury to satisfy masochistic impulses; the relief of tension by the neuromuscular exercise of scratching, and the expression of shame, guilt, or exhibitionistic traits.
Eczema. There are three forms of eczema, all occurring in adults, which are thought to have a strong emotional basis. These are: the so-called discoid eczema, which occurs in coin-shaped spots, mainly on the limbs, and which is extremely itchy; dyshidrotic eczema, which occurs about the fingers and toes, as small, itchy bubbles under the skin; and lichen simplex, which is a well-localized thickened area of skin which is extremely itchy. Lichen simplex may occur on any area of the body, but always in an easily accessible place. Sufferers of these forms of eczema obviously require treatment to the skin and, in addition, an understanding doctor to help them sort out, or at least talk over, the underlying problems or anxieties.
Trichotillomania. This is not such a rare condition, but it is one which frequently goes unrecognized in its minor form. Principally, it occurs in children who seek neurotic satisfaction through pulling out their own hair. Usually they select the hair of the scalp, and less often the eyebrows. The principal element in the psychodynamic of children is the turning on oneself of unexpressed rage at rejecting parents. This is the transformation of a sadistic instinct into a masochistic one. Hair pulling may be missed if it is not considered in relation to patients thought to have ringworm, alopecia areata, etc.
Adults who inflict this condition on themselves are often deeply disturbed individuals, usually with sexual conflicts which, basically, resolve around the notion that sex is dirty, filthy, and repugnant; they contrive to 'shed' these feelings by pulling out their hair and making themselves less likely objects of sexual attention.

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