Speaking the skin: A case study on the treatment of a psychosomatic skin disorder

This article presents a psychoanalytic case study of a patient suffering from chronic recurrent psychosomatic dermatitis, explored within a psychoanalytic framework. The clinical material illustrates how her cutaneous symptoms were understood as carrying unconscious meanings expressed through the body. These psychosomatic manifestations were considered in relation to traumatic experiences in early childhood, particularly the deprivation of the mother's presence, touch and embrace, as well as the mother's emotional inhibition in expressing affection towards her child. These traumatic psychical experiences, which appeared not to have been sufficiently represented in language, may have found expression in skin symptoms when reactivated by an affective trigger, as though the body spoke what could not be expressed in words. This study explores the overdetermined nature of psychosomatic skin symptoms, ranging from demands for love and parental care to secondary gains, such as self‐punishment or avoidance of responsibility. Furthermore, these unconscious dynamics may be associated with the enactment of self‐destructive scenarios. Through interpretations based on the patient's free associations, dreams, parapraxes and flashbacks, together with the analysis of acting‐out episodes and mental and psychosomatic symptoms, the unconscious material underlying the dermatitis was gradually brought into expression and became accessible to insight. During this process, changes in the patient's psychic functioning coincided with a gradual improvement in her dermatological symptoms, with no recurrence reported at follow‐up. The present study suggests that psychoanalytic treatment may contribute to the management of treatment‐resistant idiopathic dermatological conditions with possible psychological dimensions.