Studies of the Personality of Patients Suffering from Urticaria

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Abstract
Summary A series of 35 unselected patients suffering from urticaria were submitted to personality study. The following findings were obtained: Two-thirds of the patients studied stated spontaneously that they missed parental, especially maternal, affection as children. Their belief that they were unloved was sometimes justified, but more often than not it was illfounded. It arose from the excessive need of these patients for affection, or the dearth of affection was unconsciously self-engendered. As children these patients reacted, in about equal numbers, to a situation which was in fact, or at least for them, frustrating in an aggressive or submissive manner. Both behavior patterns were carried over into adult life. Half of the patients adopted either an ingratiating pleading, or an overaccommodating, pleasing attitude toward their environment. They were insecure within themselves, thrived on praise, were unduly afraid of disapproval and criticism, and reacted disproportionately to harsh words and actions. As a carry-over from childhood, they still hoped to buy affection and praise by exemplary conduct. Fear of endangering the good will of others, which they badly needed, curbed their aggressiveness, though their pleading and pleasing attitude not infrequently called forth a response opposite to the one that was desired. Need for love was by no means less intense in the other half of the patients studied. But far from begging for what in fact or fantasy had been denied them, they demanded what they regarded as their due, complained if they did not get it, became embittered, hard, and harsh, or adopted a manifestly vindictive attitude. They were chronically dissatisfied, testy and morose, and all in all, made a nuisance of themselves. Their aggressive behavior was partly reactive and partly defensive in origin; partly it had an unconscious masochistic aim. Disturbing events entailing anticipated or actual withdrawal of love frequently preceded the onset and relapses of urticaria. These disturbing events were quite dramatic in some instances whereas in others it can only be fully understood and appreciated if the susceptibility and sensitivity of the patients studied to experiences of this nature are taken into account. In 19 of the 25 patients considered, disturbing events of the nature described preceded the onset of their urticaria. Some brief examples have been reported. Two typical case histories have been given in some detail. Psychopathological mechanisms found to be operative in urticaria are: repressed aggressiveness, masochism, repressed exhibitionism, and regressive revival of infantile skin erotism. It has been suggested that urticarial wheals represent a token demonstration of the skin manifestations of infantile fury. Instead of hurting, scratching, and attacking their love-denying objects these individuals scratch themselves and develop "attacks" of urticaria. Urticarial wheals seem to represent a compromise between an unconscious desire to draw the observer's attention to the sufferer's skin on the one hand, and feelings of guilt and a need for self-punishment for these wishes on the other. Revival of infantile skin erotism in affection-starved individuals may well account for the pleasurable sensation often experienced by patients on rubbing and scratching their cutaneous swellings. A secondary gain can sometimes be noted.

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