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Temperament and character properties of male psoriasis patients
Mehmet Ak, Bikem Haciomeroglu, Yilmaz Turan, Nergis Lapsekili, Ali Doruk, Ali Bozkurt and Ahmet Akar J Health Psychol 2012 17: 774 originally published online 21 November 2011 DOI: 10.1177/1359105311423863 The online version of this article can be found at: http://hpq.sagepub.com/content/17/5/774

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1177/1359105311423863 hpq.com Downloaded from hpq. Turkey. responding to emotional stimulus. Gulhane School of Medicine. Keywords Character. Personality properties should be evaluated while planning therapeutic interventions for psoriasis patients. Email: drmehmetak@gmail. Department of Dermatology.uk/journalsPermissions. temperament Introduction The skin is closely related to mind and it has been accepted as one of the most important body parts that reflects the psychological state of the person and in the evaluation of temperament and character.com at INDIAN INST OF MGMNT on September 13. Maudsley Obsessive Compulsive Inventory. Severity of PASI was predicted by harm avoidance and reward dependence. Psoriasis has been explained as a psychosomatic disorder for a long time (Griffiths and Richards. psoriasis. It is a chronic and disabling Corresponding author: Mehmet Ak. 2006). fear. Etlik-Ankara 06018. and in the socialization process from infancy to adulthood.sagepub. Reward Dependence and Self-Transcendence scores for psoriasis group. shame and excitement.co. Bikem Haciomeroglu. Harm Avoidance. MANCOVA results revealed significantly higher Novelty Seeking. 2001).1177/1359105311423863Ak et al. Turkey Journal of Health Psychology 17(5) 774­–781 © The Author(s) 2011 Reprints and permission: sagepub. The relationship between the skin and the brain begins in the embryonic period. Temperament and Character Inventory.Journal of Health Psychology Article Temperament and character properties of male psoriasis patients Mehmet Ak. Severity of psoriasis was evaluated by the PASI. Ali Doruk. Skin plays an important role in expressing emotions like anger. Mercan and Altunay. 1983.sagepub. 2009).com Abstract Personality properties have an effect on the onset and triggering of psoriasis. The current study aimed to examine the personality of psoriasis patients in relation to the severity of the illness.nav DOI: 10. Ali Bozkurt and Ahmet Akar Gulhane School of Medicine. Skin and brain are originated from ectoderm and some of the hormones and neurotransmitters can affect both of them (Koblenzer. Psoriasis and healthy participants completed the Beck Depression Inventory.423863 HPQXXX10.Yılmaz Turan. Beck Anxiety Inventory. in the development of self-image and self-esteem. Skin disorders such as alopecia and psoriasis are accepted as falling within the category of psychosomatic disorders (Tucker. Nergis Lapsekili. 2013 .

it was aimed to compare the temperament and character properties of psoriasis patients and healthy controls. According to this model... psoriasis patients are reported to have more obsessive compulsive. reward dependence and persistence) and three character dimensions (self-directedness. the severity of the itching and the risk for suicide also increase. Kilic and colleagues (2008) found higher Harm Avoidance and lower SelfDirectedness scores of psoriasis patients compared to healthy controls.. Little is known about the physical. obsessive compulsive disorder and alcohol dependency are more common in psoriasis patients (Boztaş and Polat. 2013 . it has significant effects on the patient’s quality of life. cooperativeness and self-transcendence.Ak et al. Method Participants Patients diagnosed with psoriasis in a dermatology clinic were informed about the study Downloaded from hpq. Mercan and Altunay. Although psoriasis is not a life threatening disorder. avoidant. 1997). Nasreen et al. The relationship between psoriasis and affective disorders and their treatments are multi-dimensional. and to investigate the relationship between the temperament and character properties and the severity of psoriasis. claimed that temperament and character properties of psoriasis patients were not different from healthy controls (Doruk et al...Van Voorhees and Fried. On the other hand. 2009). 2009). Some of the psychiatric disorders such as major depression. With antidepressant treatments. Doruk et al. Gupta et al. and when the severity of depression increases. 2011). personality is a complex system consists of different psychobiological dimensions of temperament and character. harm avoidance. On the other hand. it was found that psychological distress can exacerbate the illness and. Cloninger et al. A few numbers of studies 775 that investigated the temperament and character properties of psoriasis patients have controversial results.com at INDIAN INST OF MGMNT on September 13. itching and insomnia complaints disappear (Mercan and Altunay. Cloninger and colleagues identified four temperament dimensions (novelty seeking. based on Cloninger’s psychobiological personality model. For example. depressive psoriasis patients have itching. vitiligo and neurodermatitis patients were not different from each other in terms of temperament properties.. Although a personality structure specific to psoriasis has not been defined. 2003). In this study. Although psoriasis is an illness without itching. Taner et al. psychological and social factors related to the illness (Rapp et al. 2007. schizoid and passive-aggressive properties than healthy controls (Kilic et al. It is equally seen in men and women and it can begin at any age. different types of psoriatic treatment and patients’ quality of life. 1993). 2008. which affects up to two percent of the population. therefore largely genetically based.. 2008. This dimensional psychological approach to the personality model defined that personality had two fundamental components: temperament and character. suicidal ideas are significantly higher in psoriasis patients compared to patients with non-psychosomatic skin disorders (Boztaş and Polat. 1993). Rubino et al. skin disease. Temperament refers to automatic emotions and responses thought to be moderately heritable. the quality of life of the patients was significantly improved (Coimbra et al. and for the character properties they are similar to healthy controls. 1995). 1999.sagepub. 2007. Generally most of the studies were based on Coloninger’s psychobiological personality theory. in a study that examined the relationship between the severity of psoriasis. Stress and psychosocial factors play an important role both in the onset and exacerbation of the disorder. 2006).. generalized anxiety disorder.. Guler and colleagues (2007) found that psoriasis. 2010). after the treatment. where as character is largely environmentally derived and responsive to learning and maturation (Cloninger. 2006. Gupta and Gupta. 2010. Some of the studies do not show a strong correlation between the severity of the disorder and stress and psychosocial factors (Griffiths and Barker.

BDI. The co-morbidity ratio of psychiatric disorder with psoriasis was 16 percent. 2013 . Harm Avoidance (HA). The control group consisted of 55 healthy participants. All participants were male ranging from 20 to 30 years old. Diagnostic evaluations were made with the SCID-I.  conducted after controlling for BDI. Four patients with obsessive compulsive disorder. age and education level) were similar to the patient group. The mean age of the psoriasis Downloaded from hpq. Thirty-seven items are rated as ‘true’ or ‘false’.  The level of anxiety of participants was assessed by BAI developed by Beck and colleagues (Beck et al. Kose et al. Participants who had any dermatological or systemic disorders other than psoriasis (ie. two patients with generalized anxiety disorder.. BAI and three dimensions as Self-Directedness (SD).sagepub.MOCI scores. Character has were compared in terms of age.com at INDIAN INST OF MGMNT on September 13. (2004) and Arkar (2005) conducted Turkish reliability and validity studies of the scale. Temperament and character properties of the participants were evaluated by Temperament and Character Inventory (TCI). tory is a self-assessment tool consists of 240 items rated as ‘true’ or ‘false’.  BDI consists of 21 self-assessment items exploring the symptoms of depression scored from 0–3. four patients with depressive disorder. Temperament has Results four dimensions. and all participants completed the Beck Depression Inventory (BDI). anxiety. one-way Multivariate Assessment tools Analysis of Covariance (MANCOVA) was Temperament and Character Inventory (TCI). obsessive-compulsive and PASI scores in the psoriasis group. generalized anxiety disorder) and participants who had a low education level were excluded from the study. 1998). DSM-IV Axis I Disorders (ie. Ulusoy and colleagues conducted the reliability and validity study of Turkish version of the scale (Ulusoy et al. hypertension). depression. one patient with panic disorder and one patient with adjustment disorder were excluded from the study.  A self-assessment scale developed by Hodgson and Rachman (1977) evaluates the type and severity of obsessive compulsive symptoms. 1988). Maudsley Obsessive Compulsive Inventory (MOCI). Hisli (1988) conducted the reliability and validity study of Turkish version of the scale. defined as Novelty Seeking (NS). MOCI scores. Statistical analysis Multiple regression analyses were conducted in order to see whether temperament and character properties could be predicted from depression. Beck Depression Inventory (BDI). The Psoriasis Area and Severity Index (PASI) was used by dermatologists in order to evaluate the severity of psoriasis. Beck Anxiety Inventory (BAI) and Maudsley Obsessive Compulsive Inventory (MOCI). In order to examine the differences between the psoriasis and control groups in terms of temperament and character properties. The control group had no physical or psychiatric disorder and their demographic properties (gender. Likert type scale consists of 21 selfassessment items ranging from 0–3. Reward Depend.. diabetes mellitus. Journal of Health Psychology 17(5) Cooperativeness (C) and Self-Transcendence (ST). Beck Anxiety Inventory (BAI). Turkish reliability and validity study of the scale was conducted by Erol and Savasir (1988). BAI and Coloninger’s Temperament and Character Inven. Seventy-three participants diagnosed with psoriasis were interviewed with a psychiatrist and 61 patients were included in the study.The psoriasis group and healthy control groups ence (RD) and Persistence (P).776 and those who accepted to participate were referred to a psychiatry clinic. The control group consisted of voluntary individuals who accompanied the patients in the hospital.

obsessive-compulsive and PASI scores in psoriasis group.05. Transpersonal Identi­ fication (ST2). These four temperament dimensions are closely related to four basic emotions: fear (harm avoidance). Novelty Seeking (NS). The psoriasis group had significantly higher MOCI scores (M = 16. p < . The definition of these increased properties is presented in Table 3.com at INDIAN INST OF MGMNT on September 13. among the temperament properties NS.34 −.22 . Fatigability and asthenia (HA4). HA..27* . 2009. p < . anxiety. only male participants ranging from 20 to 30 years old were included in this study.02 ± 14.17 −.92) was also significantly higher than the mean score of control group (M = 5..39* .15 −. the psoriasis group took significantly higher scores than control group in Extra­ vagance (NS3).13 . to our knowledge. In addition to this. Güler et al.sagepub.01 777 in Table 2. (t = 4.04 ± 12.11 −.64. 2008).41). Multiple regression analyses were conducted in order to see whether temperament and character could be predicted from depression. These confounding effects were not taken into consideration in previous studies (Doruk et al. gender and psychiatric symptoms while investigating temperament and character propertied of psoriasis patients. depression. Moreover.001).37* .77 ± 6. Shyness with Strangers (HA3). Beta weights of significant predictors of temperament and character properties are presented in Table 1. Table 1. one-way MANCOVA was conducted after controlling for BDI. Kilic et al.47** .28 . anger (novelty seeking).68 ± 4. Harm Avoidance (HA). Spiritual Acceptance (ST3) and Self-Transcendence (ST). As can be seen Downloaded from hpq. RD and among the character properties ST scores were found to be higher in psoriasis patients than in healthy controls.15). novelty seeking. In terms of BDI scores.19.28* .14 .51 ± 7.52) and control groups (M = 5.13 Discussion In order to form a homogenous group. reward dependence and persistence) are defined as the heritable differences between individuals’ automatic responses to threat..17).03 . Anticipatory Worry (HA1).18 . Selfforgetfulness (ST1). Depen­ dence (RD3).53. **p < 0. The mean PASI score of the psoriasis group was 9.25 . the possible subclinical symptoms were statistically controlled.14 .04 −.02. there was a significant difference between psoriasis (M = 16. Therefore. p < .001). In this study. (t= 5. Thus.37* .20 ± 6. attachment (reward dependence) and ambition (persistence). novelty and different reward types. psoriasis cases with co-morbid psychiatric diagnosis were excluded from the study.75 ± 8.63 ± 8.03 −. Disorderliness (NS4).Ak et al.92).09 −.06 . The mean of BAI scores of the psoriasis group (M = 17. Reward Dependence (RD).11 ± 6.61) than the control group (M= 8. Psoriasis Group BAI (β) BDI (β) MOCI PASI (β) (β) .17 . although the cases have no psychiatric diagnosis.13 −. anxiety and obsessive compulsive symptoms affect the evaluation of personality properties. Temperament properties are group (23.38l) was not significantly different from the mean age of the control group (26. 2013 . In order to examine the difference between the psoriasis and control groups in terms of temperament and character properties. Temperament dimensions (harm avoidance.001). the current study was the first to control the effects of age. 2007.49* −. BAI and MOCI scores.  Significant predictors of temperament and character properties in psoriasis group TCI   Novelty Seeking (NS) Harm Avoidance (HA) Reward Dependence (RD) Persistence (P) Self-Directedness (SD) Cooperativeness (C) Self-Transcendence (ST) *p < 0.21 . (t = 4.03 .

64 ± 1.24 4.49 ± 1. Anxiety and OC Symptoms TCI Exploratory excitability (NS1) Impulsiveness (NS2) Extravagance (NS3) Disorderliness (NS4) Novelty Seeking (NS) Anticipatory worry (HA1) Fear of uncertainty (HA2) Shyness with strangers (HA3) Fatigability and asthenia (HA4) Harm Avoidance (HA) Sentimentality (RD1) Attachment (RD2) Dependence (RD3) Reward Dependence (RD) Persistence (P) Responsibility (SD1) Purposefulness (SD2) Resourcefulness (SD3) Self-Acceptance (SD4) Congruent second nature (SD5) Self-Directedness (SD) Acceptance (C1) Empathy (C2) Helpfulness (C3) Compassion vs. 2013 .68 ± 2.66 5. **p < 0.77 ± 2.92 ± 1.45 2.17 ± 1.06 ± 2.66 6.46 5.67 4.28 0.  Comparison of psoriasis and control groups in terms of temperament and character properties after controlled for Depression.32 5.57 ± 2.14 19. RD and NS scores were found to be higher than in controls.90 ± 2. HA.59 ± 1.04 0.37 6.42 0.21 ± 2.52 ± 1.93* 2.34 ± 1.58* 3.45 ± 2.43 0. especially impulsiveness scores in psoriasis patients.66* 3.80 3.40 15.33 24.51 4. These properties are important determinants of the individual’s response to stressors and coping mechanisms. revenge (C4) Intergraded conscience (C5) Cooperativeness (C) Self-Forgetfulness (ST1) Transpersonal identification (ST2) Spiritual acceptance (ST3) Self-Transcendence (ST) *p < 0.43 ± 2.31 8.96 ± 1.32 1.14 14.11 ± 2.22 0.93 3.82 5. Guler et al.40 ± 2. manifest in infancy and similar in different cultures (Kose.87 ± 1.43 ± 1.61 5.17 ± 1.57 ± 8.09 ± 1.55 1.55 ± 1.35 4.sagepub.87 ± 1. 2004).59 24.94 4.91 ± 1.61 4.98 0.64 20.59 ± 2. in their study.87* 5.86 0.58 4.59 ± 1.37 4.98 0.89 4.98 ± 1.13 2. Kilic et al. These results lead us to consider that the previous conflicting results might actually be due to not controlling for clinical variables.57 ± 1. 2003.09 ± 1.27 ± 6.36 9.69 6.50 5.25 2.93 4.18 6.96 ± 1.28 4.01 Psoriasis Group N = 61(Mean ± SD) 6.com at INDIAN INST OF MGMNT on September 13.38** inheritable.66 4.17* 3.30 3. it should be taken into account that this study includes only male Downloaded from hpq.24 0.91 ± 1.13 ± 4.90 ± 1.83 ± 5.31 4.48 5.90* 7.47 ± 1.95 5.70 ± 5.65 4.53 ± 1.63 ± 6.61 ± 1.77 14. For example.32 12.07 ± 1.54 21.22 4.91 ± 2.81 ± 2. (2008) found high HA and RD scores in psoriasis patients.58 19.75 ± 6. In the current study.89 ± 4. Different findings have been presented for psoriasis patients in terms of temperament properties.88 4.91 23.39 4.12 4.778 Journal of Health Psychology 17(5) Table 2.004 0.75 4.35 4.81* 4.48 ± 6.09 3.18** 0.41 4.71 5.05.06 ± 1.84 Control Group N = 55(Mean ± SD) 5.86* 5.89 ± 1.95 F 0.64 ± 6.32 ± 2.37 18. However.39 5.66 2.53 7.96 6.86 ± 1.30 ± 4.87 4.77 ± 2.11 ± 1.01 3.88 2.70 ± 2.51 1.18 0.91* 8.25 ± 2.33** 6. Sadock.72 ± 1.85 4.76 2.94 ± 2.00 ± 2. (2007) reported low harm avoidance scores yet high novelty seeking.20** 1.11 ± 1.

relies on social approval Fair. In order to eliminate the possible effect of age and gender on temperament and character properties. These properties. This property is adaptively advantageous for people who face death or illnesses that are inevitable with age (Sadock and Sadock. However no relationship was obtained with NS. might be effective in the onset. Among these properties high HA and RD can be predicted by the severity of PASI. it was aimed to investigate PASI as a predictor of temperament and character properties. considerate.Ak et al. 2013 . fatigability. HA and RD. 2007. High levels of comorbidity of psoriasis and depression might be linked to temperament properties (Gupta and Gupta. socially sensitive.. Table 3. Temperament and character properties of psoriasis patients Temperament and character dimension High NS Description of highness Quick tempered. course and treatment stages of the disorder. enthusiastic. executive and judgmental functioning. Similarly. the severity of PASI scores was positively related to HA and RD scores. impulsive. there was no significant relationship between any of the character properties and PASI. In psoriasis patients.sagepub. anticipatory worry Sentimental. High self-transcendent individuals are generally more fair.com at INDIAN INST OF MGMNT on September 13. 2009). However. In the light of these findings it can be said that dependent. Taner et al. Elovainio et al. which are heritable. Psychosocial support for psoriasis patients is important for the prognosis of the disorder and the previously mentioned temperament and character properties should be taken into consideration while planning therapeutic interventions for psoriasis patients. 1998. Downloaded from hpq. considerate. religious and decent. extravagant and disorderly Anxious. Character can be defined as psychologically self-directedness including rule making. decent Possible biological factor Dopamine 779 Character is largely environmentally derived and responsive to learning and maturation. fatigue and shy. male patients with psoriasis differed from healthy controls in terms of temperament dimensions including high NS. the balance might be kept with this protective and adaptive character property. It can be said that male psoriasis patients have temperament properties such as impulsiveness. religious. 2004). sentimental and avoidant persons have more severe psoriasis symptoms. High HA Serotonin High RD Norepinephrine High ST Undefined participants. only male patients ranging from 20 to 30 years old were included in the study. Many studies showed that higher HA scores leads to proneness to depression. (2004) reported that shyness with strangers and fatigability was important in the development of depressive symptoms. pessimistic. Additionally. In conclusion. in this study. dependent. worrying and dependency. Contrary to the temperament properties that might be related to co-morbid psychiatric symptoms. this is also an important limitation. Van Voorhees and Fried. Since it is a cross-sectional design we cannot talk about causal relationships between psoriasis and temperament and character dimensions. passive avoidance from problems and threats. easily bored. In this study Self-Transcendence scores of psoriasis patients were found to be higher than in controls.

Gupta MA and Gupta AK (1999) Depression modulates pruritus perception. Emul M. Heponiemi T. Hisli N (1988) The validity of the Beck Depression Inventory. Epstein N. Erdem M and Uzun O (2009) Alexytimia. Bulletin of Clinical Psychopharmocology 14: 14. Schork NJ. alopecia areata. Elovainio M. Kalelioglu U. Turkish Journal of Psychology 6(8): 118–122. Gecici O. Character. Behavior Research and Therapy 15(6): 389–395. Journal of the American Academy of Dermatology 28(5 Pt 1): 730–732. Alkın T. Lancet 370(9583): 263–271. Journal of the College of Physicians and Surgeons Pakistan 18(7): 397–400. Cloninger CR (2003) Completing the Psychobiological Architecture of Human Personality Development: Temperament. 2013 . Puttonen S. A study of pruritus in psoriasis. Akdede B et al. Journal of Affective Disorders 83(2/3): 227–232. and reliability of the Turkish Temperament and Character Inventory. Turkish Journal of Psychiatry 17(4): 305–313. Gulec MY. Reis F. Downloaded from hpq. Tunca M. Brown G and Steer RA (1988) An inventory for measuring clinical anxiety: Psychometric properties. Ozbulut O. Annals of the New York Academy of Science 885: 394–395. Gupta MA. Yeni Symposium 41(2): 11. and Coherence. validity. atopic dermatitis and chronic idiopathic urticaria. Dermatoz 1(1): 39–45. Beck AT. Sorias O. Pulkki L and Keltikangas-Jarvinen L (2004) Temperament and depressive symptoms: A population-based longitudinal study on Cloninger’s psychobiological temperament model. Journal of Health Psychology 17(5) Griffiths CE and Richards HL (2001) Psychological influences in psoriasis. Figueiredo A et al. Nasreen S.com at INDIAN INST OF MGMNT on September 13. Cloninger CR. Journal of Dermatology 38(8): 816–819. Coimbra S. Boston: MA: Kluwer. Ak I. Ahmed I and Effendi S (2008) Frequency and magnitude of anxiety and depression in patients with psoriasis vulgaris. Journal of Medical Sciences 29: 1503–1509.780 Future studies should examine the effects of the relationship between psoriasis and temperament and character properties on the treatment response in longitudinal designs. Carvalho A. Belo L. (2011). Gupta AK and Ellis CN (1993) Alcohol intake and treatment responsiveness of psoriasis: A prospective study. (2004) Factorial structure. Clinical and Experimental Dermatology 26(4): 338–342. Archives of General Psychiatry 50(12): 975–990. Turkish Journal of Psychiatry 16(3): 190–204. validity. Journal of the European Academy of Dermatology Venereology 22(5): 537–542. Kulac M and Karaca S (2007) A temperament and character profile in patients with psoriasis. Journal of Consulting and Clinical Psychology 56(6): 893–897. Kose S (2003) A psychobiological model of Temperament and Character: TCI. Griffiths CE and Barker JN (2007) Pathogenesis and clinical features of psoriasis. Aydın N. Kilic A. Hodsgon RJ and Rachman SJ (1977) Obsessionalcompulsive complaints. Kivimaki M. 107–114. A dermatologist-psychoanalyst’s viewpoint. Erol N and Savasir I (1988) Maudsley ObsessiveCompulsive Cheklist. anger-anger management style and temperament-character profiles in males with alopecia areata and psoriasis. British Journal of Dermatology 139(5): 846–850. Svrakic DM and Przybeck TR (1993) A psychobiological model of temperament and character. Gul U and Gulec H (2008) Temperament and character profile of patients with psoriasis. Guler O. Koc E.sagepub. Gupta MA and Gupta AK (1998) Depression and suicidal ideation in dermatology patients with acne. Doruk A. Koblenzer CS (1983) Psychosomatic concepts in dermatology. Ankara. Sayar K. Health-related quality of life in Portuguese psoriatic patients: Relation with Psoriasis Area and Severity Index and different types of classical psoriatic treatment. and reliability of the Turkish Temperament and Character Inventory. Archives of Neuropsychiatry 44: 139–144. In: 24th National Psychiatry and Neurological Sciences Congress. References Arkar H. Oliveira H. Safak C. Archives of Dermatology 119(6): 501–512. (2005) Factorial structure. Tunca Z. Kose S. atopic dermatitis and psoriasis. Mercan S and Altunay I (2006) Psychodermatology: A collaboration between psychiatry and dermatology. vitiligo and neurodermatitis. and should include larger number of participants in terms of age and gender. Boztas H and Polat MU (2010) Psoriasis and psychiatric disorders. Kırpınar I et al.

Psychological Reports 77(2): 547–553. Postgraduate Medicine 121(4): 154–161. Sonnino A. psychological. Van Voorhees AS and Fried R (2009). Feldman SR. Exum ML. Sadock BJ and Sadock V (2004) Kaplan& Sadock’s Comprehensive Textbook of Psychiatry. Downloaded from hpq. Onder M and Arikan Z (2007) Depression and 781 anxiety in patients with Behcet’s disease compared with that in patients with psoriasis. 2013 . Sahin N and Erkmen H (1998) Turkish version of the Beck Anxiety Inventory: Psychometric properties. Reboussin DM. Pezzarossa B. Cosar B. Rubino IA.sagepub. Tucker P (2009) Bald is beautiful?: The psychosocial impact of alopecia areata. Rapp SR. Depression and quality of life in psoriasis.Ak et al. Burhanoglu S. Journal of Health Psychology 14(1): 142–151. Baltimore: Lippincott Williams & Wilkins. Taner E. Fleischer A and Clark A (1997) The physical. Ulusoy M. International Journal of Dermatology 46(11): 1118–1124. Journal of Health Psychology 2(4): 525–537. Calikoglu E.com at INDIAN INST OF MGMNT on September 13. Ciani N and Bassi R (1995) Personality disorders and psychiatric symptoms in psoriasis. Journal of Cognitive Psychotherapy 12(9): 163-172. and social impact of psoriasis.