Introduction
Depigmentation is a cosmetic concept. It has both voluntary and involuntary aspects. The first is the voluntary whitening of the skin, known in Cameroonian jargon as ‘pickling’. As for the second, it is acquired independently of the individual’s will and raises a number of questions. In 2020, Cauchie differentiates vitiligo from other skin diseases because it is neither painful nor contagious. It appears most of the time on areas of friction, and on visible areas that attract the attention of those around them, who themselves know little about the disease. In this article, we present the psychological mechanisms that cause suffering in people with vitiligo, through a clinical evaluation of the experiences of a 54-year-old woman with non-segmental vitiligo.
The Judgement Vitiligo Patients Receive
The skin is the evidence of a person’s presence in the world, and the place where the body is judged. It is a symbol of belonging, because it distinguishes or links the individual from others according to skin tone or other characteristics. In the case of vitiligo sufferers, they seem to belong to no standard of body colour, because of the change in their appearance. This gives rise to a feeling of loss of identity and leads to significant psychological distress. This leads to a problem in managing change in people with vitiligo.
Presentation of the Case
Our case is one of the participants evaluated for the research of the master 2 thesis of the Department of Psychology of the University of Douala Cameroon entitled: ‘body image and quality of life in people with vitiligo’. This case will be referred to as AF for the sake of confidentiality.
Case History
Patient AF is 54 years old, the mother of four children, all of whom are already financially independent. She is currently in her second marriage. She is a make-up artist by profession but is also interested in other income-generating activities. She is the second in her family to suffer from this condition, although it started a little late (aged 49) after a divorce, illness and the loss of her job. Initially, she went to see a dermatologist without any satisfactory solution, as she had a new spot every day. She went downhill, had an intense intellectual drive, and ended up depressed. Her regular visits to doctors, psychiatrists and psychologists led her to understand that she had to mourn her old image (appearance) and accept her new social presentation.
Results
The Body Image Questionnaire (BIMQ) is a 19-item questionnaire used to measure body satisfaction. The patient’s score was 75, indicating a high level of body satisfaction. Cooper Smith’s Self-Esteem Inventory (SEI) is a 58-item self-assessment questionnaire for expressing feelings, opinions and reactions. The score obtained is 33, indicating a low level of self-esteem. However, the presence of defence mechanisms that had an impact during the test was noted in the score of 5 for lying. The Goldberg Anxiety and Depression Scale, which is an indicative test, assesses the presence or absence of anxiety and depression. It shows that the participant displays negative affects related to her appearance.
Discussion
The change in skin tone induced by vitiligo affects the individual psychologically, since it is an involuntary change. Individuals express attitudes of resistance to the change in their appearance, depending on their beliefs, personal resources and social consideration. The cognitive-behavioural model postulates that behaviour is mainly influenced by learning that takes place within a social context. Taking the example of individuals who continually devalue themselves, Beck believes that this behaviour predisposes them to depressive thoughts and symptoms. He concludes that negative thoughts become automatic in the course of maturation and experience and influence emotional reactions without our being aware of it. However, it is not the norms themselves that generate suffering, but the way in which society reminds us of them through looks, that generates suffering in the vitiligo community. The theory of the mirror stage explains the importance of the signifier in the identification process.
Conclusion
Body image is a complex concept that is used in several specialties. Indeed, people with chronic diseases need to reclaim their body image, which is not always easy since it involves several factors present in the construction of body image.
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