Illness perception in association with psychological functioning in patients with discoid lupus erythematosus

Funding sources: none. Conflicts of interest: none declared. Dear Editor, Discoid lupus erythematosus (DLE) causes scarring and inflammation; it is therefore unsurprising that the psychological impact on patients is considerable.1 Patients' subjective perceptions of their condition may be a better predictor of psychological outcomes than clinician‐based assessments of severity. The common sense model of self‐regulation of health and illness by Leventhal et al. describes the process by which individuals respond to illness.2 Individuals actively try to make sense of symptoms, forming cognitive and emotional representations, which, in turn, determine their subsequent coping behaviour. Perceiving DLE to have more severe effects may increase patients' distress, which may exacerbate disease activity, operating in a negative feedback loop. Asking patients to draw their illness is a useful way to assess their perceptions. Broadbent et al.3 demonstrated that patients' drawings of damage to their heart predicted outcomes following myocardial infarction. Furthermore, patients whose drawings increased in size over the recovery period reported greater anxiety and poorer recovery at follow‐up, suggesting that drawing size indicates the extent to which patients are preoccupied by their illness.4