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Dating
Dating and getting closer
When you're looking for a partner, psoriasis can feel like a barrier to closeness. Dr. Robert H. Reiner (see bio below), a prominent clinical psychologist, explains how to help keep your skin from getting in the way.
In my practice, I see both married and single patients with psoriasis. For both of these groups, the problem can often become a barrier to the establishment of intimacy. But it is certainly more challenging for someone who is single and dating.
Severity and security
Within any group of people with psoriasis, disease severity is a major issue. But another important factor is the basic security or self-esteem of the patient. For example, there are people who catastrophize, which means that they make things seem worse than they really are by focusing on the worst possible outcome. When these people suddenly start having flaky patches on their face, they simply refuse to go out. They think that if they do, people will stare or turn away in disgust.
The desire to hide is understandable. The problem is, once a person begins behaving that way, which is called behaving protectively, their symptoms tend to get worse—not the psoriasis itself, but the psychological symptoms that go along with the disease. Both the image of what they look like and other people's reactions to their appearance become exaggerated in their mind. These exaggerations become their distorted realities. If you expect the worst possible reaction, you're bound to "see" it.
On the other hand, I have a patient whom I consider very secure. He's had psoriasis his whole life—a pretty bad case. I've seen it when it's all over his chest. He tells me he sometimes gets it on his genitals. But it never seems to stop him. He is very confident with women and he's had girlfriends all his life. All things being equal, if someone has low self-esteem, psoriasis is going to bother him or her even more. The more secure a person is, the less psoriasis tends to affect him or her.
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Be as direct as possible, as early as possible
When it comes to meeting someone for the first time, looks are, unfortunately, very important. The dating ritual really is a kind of checklist of getting past certain things. A blind date is the first level—"Are your looks and general personality acceptable enough that I would want to get to know you?"
Because of this, I can't stress enough how important it is for people to be as direct as possible about their psoriasis, as early as possible. What I usually advise is this: if it's visible, bring it up right away. By bringing psoriasis out in the open and talking about it, you will defuse the other person's fear or anxiety. Things that are not talked about are left to the imagination– which usually makes them seem worse than they really are.
Even consider telling someone over the phone before you meet. Say, "I want to let you know, I have a skin condition called psoriasis. It's not contagious, and it sometimes looks worse than it is. I am going through a tough stage right now, but that won't last long; if you would rather wait a couple of weeks to meet me, I'll understand."
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The power of proactive behavior
By being open about psoriasis, you are communicating some very positive things about yourself: that you are somebody who can be counted on to be honest and direct, and that you are an initiator—"I'm kind of going out on a limb here by disclosing this to you. I don't want you to get spooked when you see me. I also want to reassure you that you can't catch it."
You are also demonstrating consideration, honesty, and the courage to expose yourself. Most importantly, you are being proactive by not waiting for things to come to you. This helps you gain a sense of control. The more you control the things that you can control, the less likely you are to feel thrown by the things you cannot control.
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How to describe psoriasis
One good way to describe psoriasis is "growing too much skin." It accurately explains the condition and is easier to deal with. People will then realize: "Oh, they just have too much skin. No big deal." This reduces the odds that someone will be "shocked" by your appearance, or needlessly worried that your condition might be contagious.
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Humor can help
Humor can be a terrific help in making people feel more at ease with psoriasis. I can't stress enough how important it is. For example, you might say, "This is psoriasis…proof that you can have too much of a good thing." But remember, if you don't know how to tell a joke, or your timing is off, this strategy won't work so well. You don't want it to seem contrived or forced.
If you do want to use humor, I recommend careful role-playing, rehearsing, and practicing. Imagine you are on a date, and think, "How am I going to say it?" Then, role-play it over and over again—at home, in the office, alone, or with a friend.
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Helping others say what they feel
When people are afraid or nervous about dating someone with psoriasis, you want to open as many doors to them as possible. By doing this, you are communicating your own confidence, diminishing their anxiety, and reassuring them that you aren't being deceitful. Consider this approach:
- Say something like, "Sometimes people are squeamish about this and I understand. Sometimes I gross myself out with it." This is what someone is probably thinking anyway, so it's a good icebreaker.
- When you're in the middle of a bad flare, say, "Obviously, I'm having a tough time with my skin right now. It isn't always this bad."
- It's also important to tell somebody, "I want you to understand what this condition is about. If you have any questions, feel free to ask."
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Getting more intimate
The closer you get to becoming physically intimate, the more important it is to be honest and direct. The last thing you want is to wake up with someone in the morning, and agonize while this person sees your psoriasis for the first time. If that happens, you may feel awkward, and the person may think you were hiding the truth.
Some people might need time to get used to your psoriasis. Don't try to hide it—inform them. Start by reminding people that psoriasis is not contagious. Tell them that you understand if they're a little squeamish about it. And reassure them that you are doing everything you can to deal with it. Also mention that psoriasis has ups and downs—it's not a constant thing.
In the short run, talking about psoriasis may seem difficult, but in the long run, it can help you become closer with another person. If someone is interested in becoming a larger part of your life, they are going to want to know about these things—just as you would want to know about them. And by being open and honest, you are communicating to them that you would like them around in your future.
| Dr. Robert H. Reiner, Ph.D., is a licensed psychologist who has been practicing for 22 years. He is a faculty member in the Department of Psychiatry at NYU Medical Center, where he teaches cognitive behavioral therapy and behavioral medicine to psychiatric residents and psychology interns. Dr. Reiner is also the executive director of Behavioral Associates, a dual clinical and consulting firm that he founded in 1988. Located in the upper east side of Manhattan, the firm provides behavioral medicine, stress management, and cognitive behavioral psychotherapy programs.
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