Psoriasis is a difficult disease to hide. The most common form of the condition, plaque psoriasis, causes raised, discolored lesions made up of dead skin cells that give the skin a scaly appearance. These plaques often appear on the knees, elbows, and scalp. They also tend to shed and leave behind dandruff-like flakes on clothing.

For this reason, the impact of psoriasis on overall health and well-being is more than skin deep; it also can have serious mental and emotional effects. Social anxiety is an especially common complication of psoriasis. Research published in January 2017 in the Journal of Psychosomatic Research reported that the more severe the disease, the higher the level of social anxiety, particularly among teenagers and young adults.

“We live in a culture where how you look is very important,” says Ann Rosen Spector, PhD, a clinical psychologist in Philadelphia. “For anyone who doesn’t look like a model, whether it’s the shape of their body or the state of their skin, it’s easy to feel bad about their appearance.”

There is also evidence the more important appearance is to a person’s feelings of self-worth, the higher their level of social anxiety. The bottom line: Managing the mental side effects of psoriasis is as important as dealing with the physical symptoms.

Tending to Your Emotional Health

When Simon Jury was diagnosed with psoriasis at age 30, the disease was so severe it affected about 80 percent of his body. It took him years to find an effective treatment for his physical symptoms. All the while, he also struggled with the disease’s emotional effects.

“Most of it has been in my mind, thinking people are staring and talking about me,” says Jury. “It is very easy to think people are put off by your psoriasis, but a lot of this can be your mind playing tricks on you, making you feel insecure and anxious.”

Anxiety, as a review of studies published in The Journal of Clinical and Aesthetic Dermatology found, is known to worsen psoriasis, making the symptoms more severe. And having psoriasis can often lead to anxiety, creating a troubling cycle.

Jury says managing his disease involves not just taking medications, but also trying to maintain a positive outlook and state of mind. He adds that people with psoriasis should not be afraid to talk to their doctor about how the disease is affecting their mental health.

The Consequences of Feeling Stigmatized

People with psoriasis often feel stigmatized because of a misconception that the condition is contagious, says Michelle Tarbox, MD, a dermatologist and associate professor at the Texas Tech University Health Sciences Center in Lubbock.

“I’ve had patients who have been kicked out of public pools or asked to leave clothing stores because people do not understand that psoriasis is not a contagious disease,” says Dr. Tarbox.

“One of the most therapeutic things I do during a first visit for psoriasis is touch the psoriatic plaques. This lets me know how thick the plaques are, but it also demonstrates to the patient that I am not afraid of their skin,” she says. “I’ve had some patients who have never had anybody except for family touch their psoriatic plaques, and some have been moved to tears.”

Tarbox says some of her patients don’t date or pursue relationships because they’re afraid of being rejected for their skin condition. In severe cases, she has had “patients whose severe psoriasis led them to contemplate suicide.”

How to Handle and Redirect Negative Thoughts

Cognitive behavioral therapy (CBT) is a form of psychological treatment that can help patients with psoriasis learn to challenge negative thought patterns and behaviors. According to a review of studies published in the journal Psychology Research and Behavior Management, CBT is an effective treatment for psoriasis, helping reduce the severity of symptoms. It was most effective for patients with moderate to severe psoriasis, compared with those who had mild psoriasis.

In addition to therapy, Dr. Rosen Spector suggests examining the relationships in your life to make sure they’re supportive.

“If people are going to focus on your psoriasis and not the qualities that make you who you are, you have to ask if they’re worth having in your life,” she says.

Jury expressed his feelings about his journey through a blog as a way to help himself and others. “It’s not about just finding a treatment for your skin,” he explains. “We need to be treated as a whole, because of the mental health issues that come hand in hand with this disease.”