Am I Doing Something Wrong?

Unpacking Psoriasis and Self-Blame

The uncertainty of living with psoriasis and psoriatic arthritis is often one of the hardest parts of coping with the condition. I often find myself questioning why it first developed, or why it flares up at some times and calms down at others. With every new symptom comes the instinct to search for a cause. It’s part of being human. We’re wired to seek patterns, especially when we’re suffering. When your body is doing something you can't explain, it’s only natural to ask: What am I doing wrong?

I’ve asked myself this question for decades. But what I’m really telling myself is, You’ve done something wrong. This is your fault. This pattern of thinking can lead to self-critical thoughts like, “If I were more disciplined, maybe my skin would be better,” as well as comparisons to others: “That person cured their psoriasis with diet so why can’t I?”

These feelings of self-blame are often compounded by the advice we’re given about lifestyle choices that may help. We’re told to manage stress, exercise more, avoid alcohol, maintain a healthy weight, and steer clear of triggers like sunburn, tattoos, and smoking, all of which can feel like they’re within our control. We also hear anecdotal success stories in the media or on social platforms about people who’ve cleared their skin through diet or lifestyle changes and wonder why we can’t do the same.

It becomes easy to feel that your inability to control psoriasis is your fault. Over time, this thinking can take an emotional toll, leading to low self-esteem and psychological distress.

The Complexity of Psoriasis

Though it’s human nature to feel responsible for our symptoms, it’s important to remind ourselves that psoriasis is a complex immune-mediated condition. It’s influenced by a wide range of factors, including genetics, social relationships, working conditions, access to healthcare, and broader socioeconomic and environmental contexts. Studies show that economic hardship, air pollution, environmental toxins (like cadmium, mercury, and lead), hormone fluctuations, certain medications, and infections (e.g., strep throat) can all influence flare-ups and the severity of psoriasis.

This helps me remember that my flare-ups are likely triggered by multiple factors, many of which are completely out of my control.

Developing Self-Compassion

There’s growing evidence that a gentler, more compassionate approach to yourself can improve both mental health and body image. A recent study found that people with psoriasis who practiced self-affirmation, reminding themselves of their values and strengths, experienced less depression and anxiety after just two weeks. They also reported feeling more positive about their bodies. This approach can help combat feelings of self-blame.

Three Tools to Build Self-Compassion

1. Try using self-affirmations
   Repeat phrases like “I am not defined by psoriasis” or “I am worthy and loved” especially during moments of self-doubt.

2. Talk to yourself like a friend
   When self-critical thoughts arise, ask yourself: “What would I say to a loved one?” Say that to yourself instead. Treat yourself with the same care and support.

3. Try soothing touch
   Place a hand gently on your heart or give yourself a light hug. Offer comfort to yourself, without judgment.

Living with Uncertainty

Living with a chronic, unpredictable illness like psoriasis demands a new relationship with uncertainty. It means learning to sit with the not-knowing and resisting the urge to blame ourselves for every flare-up. It means replacing the question, “What did I do wrong?” with a more compassionate one: “What do I need right now?”

Psoriasis doesn’t make you weak, lazy, dirty, or broken. It makes you someone living with a complex, chronic illness. Psoriasis is not your fault. You are not doing anything wrong. And you don’t have to carry it alone.

You can find more ideas for developing self-compassion at:

The Compassionate Mind Foundation

Dr Kristen Neff’s Self Compassion website

Reference

Łakuta, P. (2021). Brief self-affirmation intervention for adults with psoriasis for reducing anxiety and depression and boosting well-being: Evidence from a randomized controlled trial. Psychological Medicine, 1–11. https://doi.org/10 .1017/S0033291721004499

This article was first published in Pso Summer 2025 - the fabulous magazine produced by the Psoriasis Association. Join the Psoriasis Association - you know you want to.