title: Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study.
abstract: BACKGROUND
  It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors.
  
  
  METHODS
  Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively.
  
  
  RESULTS
  Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis.
  
  
  CONCLUSIONS
  These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress.
authors.affiliation: Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, University of Rome 'La Sapienza', Rome, Italy. a.picardi@idi.it
authors.forename: A
authors.initials: A
authors.lastname: Picardi
authors.forename: P
authors.initials: P
authors.lastname: Pasquini
authors.forename: M S
authors.initials: MS
authors.lastname: Cattaruzza
authors.forename: P
authors.initials: P
authors.lastname: Gaetano
authors.forename: C F
authors.initials: CF
authors.lastname: Melchi
authors.forename: G
authors.initials: G
authors.lastname: Baliva
authors.forename: D
authors.initials: D
authors.lastname: Camaioni
authors.forename: A
authors.initials: A
authors.lastname: Tiago
authors.forename: D
authors.initials: D
authors.lastname: Abeni
authors.forename: M
authors.initials: M
authors.lastname: Biondi
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological; D014820:Vitiligo / Q000209:etiology / Q000523:psychology*