Psychosomatic Medicine 22:377-390 (1960)
© 1960 American Psychosomatic Society

Rosacea and Morbid Reddening

Some Psychoanalytic Aspects

The severe emotional disturbances observed in subjects suffering from rosacea or morbid reddening, as allied skin disorders, were the subject of the present investigation. It consisted of the psychoanalytic observation of 5 female patients whose treatment lasted 9 months to 3 years, with follow-up interviews over periods up to 15 years. Some of the findings were verified in another series of 15 subjects seen in interviews.

The subjects have all revealed abnormally strong identification with the father, forced to the surface by exhibitionistic impulses. Paternal identification contributed also significantly to the subject's characteristic tendency to form relationships in folie à deux. Closer examination revealed in this identification and its various but interrelated manifestations, an ego defense. As such it emerged as a power system of attraction and determent, consisting in centrifugal order of the introjected, the exhibited, and the projectional object of paternal identification. The system aimed at guarding the ego against what superficially appeared as external dangers but which in fact were paranoidally conceived endopsychic threats. The inner tensions were found to be accumulation of infantile aggressive impulses, situated in the oral and anal ego nuclei. This was borne out by the presence of numerous oral-aggressive symptoms and their marked aggravation during the frequent states of regression which followed whenever the principal defense, the projectional object of parental identification, was lost or threatened with downfall. The onset of the reddening disorders was found to coincide with the loss of this principal defense, the projectional object of paternal identification, and the outbreak of the regressive symptoms which this loss invariably entailed.

The observation of the subjects pointed further to the conclusion that the tensions accumulated in the nuclear foundations of the ego resulted from privations and adverse stimulations suffered in infancy, brought about and maintained by the mother, who was in every case suffering from a severe neurotic or psychotic disorder.

Attention has been drawn to the close similarity of the prophylactic ego defenses of the clinical subjects and the same defenses displayed in the ecologic life of animals. The view has been put forward that the two defense systems are part of a genetic unity. Reddening, it has been suggested, in man is, in conjunction with other physiological reactions, a surviving component of a primeval prophylactic system.