Psychosomatic Medicine 18:209-220 (1956)
© 1956 American Psychosomatic Society

Psychological Factors in the Neurodermatoses

¹ Veterans Administration Hospital, Houston, Texas

A group of 25 male patients in the neurodermatoses group and a comparable group of 22 males with industrial and accidental skin lesions were studied. Since only Rorschach records were available on the latter subjects, the dermatitis group was also compared with 25 rheumatoid arthritics and 20 patients with low-back pain in respect to interview data, TAT, and figure drawings.

Hypotheses concerning the psychodynamics of dermatitis patients were selected from the literature. The following are these formulations together with the findings of the present study as they relate to them:

Masochism. The dermatitis group scores significantly higher than the control group on Rorschach fantasies implying a highly depreciatory self-concept. The dermatitis patient unconsciously thinks of his body in terms of dirt and repulsion. Even the human figure drawings of the dermatitis group dramatize an unclean depreciated body image. TAT stories of the dermatitis group also score significantly high en themes of masochistic pleas to those in authority.

Exhibitionism. Dermatitis patients were not found to differ significantly from the control groups in either their Rorschach responses or TAT stories in respect to fantasies involving bodily exhibition. However, the dermatitis group does score significantly high on Rorschach fantasies involving defense against exhibitionism, with responses that involve covering and hiding of one's body. This is understandable in view of their highly negative body-image fantasies.

Repressed Hostility. The actual Rorschach responses of the dermatitis group are notable for their infrequent reference to hostile symbols or feelings. At the same time, their TAT stories are filled with negative feelings for both parental figures. However, the greater part of the hostile expression in these stories is masochistically directed toward figures who represent the self.

"Armor-plate" Defense. In common with rheumatoid arthritics, the dermatitis group shares special fantasies about the defensive importance of the outer aspect of the body. As revealed through some of their Rorschach responses, both groups think unconsciously of their bodies as surrounded by an impermeable barrier serving to control internal disruption or external threat.

Authoritarian Father. Both in conscious description and in TAT stories, the dermatitis patient refers to a powerful, successful, yet distant father. The dermatitis patient's masochistic plea is aimed at placating this kind of father.

Rejecting Mother. Although the dermatitis patient consciously describes mother as a quiet, neutral person, he unconsciously feels great resentment toward her because he feels that she never gave adequate love and attention, never responded to his masochistic appeal. The dermatitis patients seem to suffer even more anxiety and conflict about their relationships with mother than with father.

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