Body Image Has Key Role in Psoriasis Severity Perception, Acceptance, and Disability

woman looking into broken mirror, mirror, broken, reflection
woman looking into broken mirror, mirror, broken, reflection
Clinical and positive psychological variables that contribute significantly to psoriasis disability were identified.

In patients with psoriasis, years of education, impact on social life, and body image significantly contribute to disease disability, and body image-related cognitive fusion is a significant mediator of disease severity and acceptance and psoriasis disability, according to study findings published in Behavioral Sciences.

The cross-sectional exploratory study included 75 patients with psoriasis (mean age 54.99 ± 13.72; 52% male) who responded to a sociodemographic and clinical questionnaire, the Psoriasis Disability Index (PDI), the Cognitive Fusion Questionnaire–Body Image (CFQ-BI), the Acceptance and Action Questionnaire–II (AAQ-II), and the Self-Compassion Scale (SCS). The cohort was intended to be representative of Portugal’s population and included participants from all regions of the country and with varying professions.

The average length of clinical diagnosis of psoriasis was 23.96 years. Most participants were satisfied with their current treatment, had no other diseases, and did not take anxiolytics and antidepressants. The disease did not have a great impact on their social life, and their family had no history of psoriasis.

After conducting a path analysis and hierarchical multiple linear regression, the investigators found that the variables that significantly contributed to psoriasis disability were years of education, impact on social life, and body image, all of which accounted for 70% of the variance. Body image-related cognitive fusion was a significant mediator in the relationship between disease severity and acceptance, and psoriasis disability.

“The implications of this study are considered to be extremely relevant, since it will allow additional information to be provided to psoriasis patients, appropriated to their educational level, aiming to reduce distorted perceptions of disease severity and intervene in the ability to accept this specific and important chronic health condition,” the researchers stated.

Limitations of this study are related to the small number of participants and the nature of the instruments, which are all self-reporting.

“Acceptance of the disease is a strong determinant of quality of life in psoriasis patients,” the study authors commented. “It is associated with body image-related cognitive fusion, which has a buffering effect on the consequences of psoriasis. Perceiving the disease as an obstacle and being aware that the health locus of control is internal determines the degree of acceptance of psoriasis. Acceptance of the disease and satisfaction with the body and its positive image are associated with feelings of personal happiness.”


Almeida V, Leite A, Constante D, et al. The mediator role of body image-related cognitive fusion in the relationship between disease severity perception, acceptance and psoriasis disability. Behav Sci (Basel). 2020;10(9):E142.