Linear IgA and the Meanings of Skin: An Interpretative Phenomenological Analysis of Living with a Rare Dermatological Disease

Yıl 2023, Cilt: 3 Sayı: 1, 10 - 26, 30.06.2023

Saba Basoglu Yavuz

Öz

Linear immunoglobulin A (Linear IgA) bullous dermatosis is a rare, idiophatic and specific dermatological condition characterized by blisters forming in the skin and mucous membranes. Linear IgA is known to be an autoimmune disease, however, it is also defined as a group of Medically Unexplained Symptoms, since the exact mechanism of lesion development is not well understood and the treatment is contentious. Although Linear IgA is identified as being strongly related to psychological features, these have been investigated by a very small number of studies. The study presented here can be the first qualitative psychological research on Linear IgA. It employs Interpretative Phenomenological Analysis (IPA) in order to engage in a deeper examination of the impact of undergoing Linear IgA experience, and how the patient attempts to make sense of the skin. The participant is 50 years old male who lives with Linear IgA for ten years. Data collection was designed in the form of a semi-structured, one-to-one, in-depth interview, which lasted ninety minutes to elicit the detailed stories, thoughts and feelings from the participant. Five superordinate themes emerged from the analysis of the participant’s experiences. Findings suggest that Linear IgA affects the participant’s life by the appearance of skin, which shapes how he construes himself and his social world. The skin also represents a projector, which allows him to see his own emotions, fantasies and existential concerns. These findings were discussed by engaging in a dialogue with both clinical psychological and phenomenological philosophical literature.

Anahtar Kelimeler

Interpretative Phenomenological Analysis, Self Representations, Qualitative Research, Psychodermatology, Linear IgA, Medically Unexplained Symptoms, Psychosomatics, Skin-Ego

Teşekkür

I would like to offer my special thanks to the participant, without whom there would not be any findings. I would also like to thank Prof. Dr. Sibel A. Arkonaç for supervising the data analysis to reinforce my self-reflections and critical awareness, and Asst. Prof. MD. Serhat Yüksel, a faculty member at Dogus University Clinical Psychology Doctorate Program, for encouraging me to improve the quality and validity of this IPA research. I would like to express my sincere gratitude to BA. (Hons) Simon Riley for the English language editing of the manuscript.

Linear IgA ve Tenin Anlamları: Nadir Görülen Bir Dermatolojik Hastalık Yaşantısının Yorumlayıcı Fenomenlojik Analizi

Öz

Linear immünoglobulin A (Linear IgA) bülöz dermatoz, mukoza zarında ve deri yüzeyinde yayılmış kabarma ve yaralar ile seyreden nadir görülen, idyopatik bir cilt rahatsızlığıdır. Linear IgA, otoimmün bir hastalık olarak tanımlanmakla birlikte, belirtilerin arkasında yatan mekanizma tam olarak anlaşılmamış olup, tedavi yöntemi ve etkileri halen tartışmalıdır. Bu nedenle, Tıbbi Olarak Açıklanamayan Belirtiler grubu içinde de yer almaktadır. Linear IgA’nın psikolojik faktörlerle önemli ölçüde bağlantılı olduğu belirtilmesine rağmen, bu konuda yapılan oldukça az sayıda çalışma bulunmaktadır. Bu çalışma ise, bir Linear IgA vakasının niteliksel psikoloji yaklaşımı ile ele alınan ilk araştırma olabilir. Bu vaka çalışmasının gayesi Açıklayıcı Fenomenolojik Analiz yöntemini kullanarak, Linear IgA tanısı almış olan bir katılımcının, süregiden hastalık deneyiminin etkilerini ve ten üzerinden kurduğu anlam dünyasını derinlemesine bir şekilde incelemektir. Katılımcı on yıldır Linear IgA ile yaşamakta olan 50 yaşında bir erkektir. Veriler, katılımcının deneyimlerine, düşünce, duygu ve hikayelerine detaylı bir şekilde yer vermek amacıyla tasarlanmış olan, doksan dakika süren, yarı yapılandırılmış, birebir ve derinlemesine bir mülakat ile toplanmıştır. Katılımcının deneyiminden beş üst tema ortaya çıkmıştır. Bulgular, Linear IgA’nın katılımcının yaşamında yarattığı etkilerin merkezinde tenin görünürlüğünün yer aldığına, bunun üzerinden kendisine ve hayata dair inşa ettiği anlamları aksettirdiğine; tenin aynı zamanda katılımcıya kendi duygularını, fantezilerini, hatta varoluşsal kaygılarını gösteren bir projektör konumunda olduğuna işaret etmektedir. Bu bulgular, klinik psikoloji alan yazını ve fenomenolojik felsefe arasında bir diyalog kurarak tartışılmıştır.

Anahtar Kelimeler

Yorumlayıcı Fenomenolojik Analiz, Benlik Temsilleri, Linear IgA, Niteliksel Araştırma, Psikodermatoloji, Tıbbi Olarak Açıklanamayan Belirtiler, Psikosomatik, Deri-Ben

Kaynakça

• Andersen, P. A., & Guerrero, L. K. (2008). Haptic behavior in social interaction. In M. Grunwald (Ed.), Human haptic perception: Basics and applications (pp. 155-165). Birkhauser.
• Anzieu, D. (2016). The Skin- Ego. (N. Segal, Trans.). Karnac. (Original work published 1995)
• Aralı, G., & Arslan, C.F. (2019). Geleneksel sınıflandırma sistemlerine karşı uygulanabilir yeni bir rehber: Psikosomatik araştırmalara yönelik tanı ölçütleri (DCPR). Klinik Psikiyatri, 22, 228–242.
• Arkonaç, S. A. (2017). Psikolojide söz ve anlam analizi: Niteliksel duruş. Hiper Yayın.
• Bryant, K. D., DeNunzio, M. J., & Ford, M. D. (2016). Linear IgA dermatosis after infliximab infusion for ulcerative colitis. Journal of the American Academy of Dermatology, 2, 448-450. http://dx.doi.org/10.1016/j.jdcr.2016.09.002
• Cauza, K., Hinterhuber, G., Sterniczky, B., Brugger, K., Pieczkowski, F., Karlhofer, F., Klaus, W., & Foedinger, D. (2004). Unusual clinical manifestation of linear IgA dermatosis: A report of two cases. Journal of the American Academy of Dermatology, 51, 112-117. http://dx.doi.org/10.1016/j.jaad.2004.01.05
• Chorzelski, T. P., Jabłońska, S., & Maciejowska, E. (1991). Linear IgA bullous dermatosis of adults. Clinics in Dermatology, 9(3), 383-392.
• Cieurzo, C, & Keitel, M.A. (1999). Ethics in qualitative research. In M. Kopala, & L.A. Suzuki (Eds.), Using qualitative methods in psychology (pp. 63-75). Sage.
• Cooper, K., Glaesser, J., Gromm, R., & Hammersley, M. (2012). Challenging the qualitative- quantitative divide: Explorations in case- focused causal analysis. Continuum.
• Danese, A., & Lewis, S.J. (2017). Psychoneuroimmunology of early-life stress: The hidden wounds of childhood trauma?. Neuropsychopharmacology Reviews, 42, 99–114. http://dx.doi.org/10.1038/npp.2016.198
• Díaz, M. S., Morita, L. B., Ferrari B., Sartori, S., Greco, M. F., Sobrevias Bonells, L., González-Ense˜nat, M. A., Vicente Villa, & M. A., Larralde, M. (2019). Linear IgA bullous dermatosis: A Series of 17 cases. Actas Dermosifiliogroficas, 110(8), 673-680.
• Egan, A. C., Smith, E. P., Taylor, T. B., Meyer, L. J., Samowitz W. S., & Zone, J. J. (2001). Linear IgA bullous dermatosis responsive to a gluten-free diet. The American Journal of Gaastroenterology, 96(6), 1927-1929.
• Elbrecht, C. (2012). Trauma healing at the Clay Field: A Sensorimotor approach to art therapy. Jessica Kingsley.
• Emanuel, E. J., Wendler, D., & Grady, C. (2000). What makes clinical research ethical?. Journal of the American Medical Association, 283, 2701–2711. Farr, J., Nizza, I. E., & Smith, J.A. (2021). Achieving excellence in interpretative phenomenological analysis (IPA): Four markers of high quality. Qualitative Research in Psychology. http://dx.doi.org/10.1080/14780887.2020.1854404
• Ferreira, H., & Vilarinho, C. (2018). Linear IgA dermatosis: An atypical manifestation of a rare disease. Pediatrics and Neonatology. 59, 324-325. Fernandes, K. A. P., Galvis, K. H., Gomes, A. C. M. S., Nogueira, O. M., Felix, P. A. O, & Vargas, T .J. S. (2016). Linear IgA and IgG bullous dermatosis. Anais Brasileiros de Dermatologia, 91(5:1), 32-34. http://dx.doi.org/10.1596/abd1806-4841.20164630
• Gadamer, H.G. (2004). Truth and method (3th ed). (J. Weinsheimer, D.G. Marshall, Trans.). Continuum. (Original work published 1960)
• Giacomello, G., Scholten, A., & Parr, M. K. (2020). Current methods for stress marker detection in saliva. Journal of Pharmaceutical and Biomedical Analysis, 191, 1-14.
• Herlin, L. K., Deleuran, M, Pallesen, K., & Bregnhøj, A. (2022). Combined dapsone and sulfapyridine for the treatment of therapy-resistant linear IgA bullous dermatosis: Two case reports. Journal of the American Academy of Dermatology, 21, 119-122.
• Husserl, E. (1970). Phenomenology: Edmund Husserl’s article for the Encyclopedia Britannica (1927). (R.Palmer, Trans.). Journal of the British Society for Phenomenology: Husserl’s Shorter Works, 2, 21-35.
• Husserl, E. (2000). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy: Edmund Husserl Collected Works Vol. 3. (R. Rojcewitz & A. Shuwer, Trans.). Kluwer Academic Publishers.
• Kandemir, G., & Ak, İ. (2013). Tıbben açıklamayan belirtilerin psikiyatrik yönü. Psikiyatride Güncel Yaklaşımlar, 5(4), 479-506.
• Klaus, K., Rief, W., Brähler, E., Martin, A., Glaesmer, & H., Mewes, R. (2013). The distinction between “medically unexplained” and “medically explained” in context of somatoform disorders. International Journal of Behavioral Medicine, 20, 161-171.
• Laurent, H. K., Stroud, L. R., Brush, B., D’Angelo, C., & Granger, D. A. (2015). Secretory IgA reactivity to social threat in youth: Relations with HPA, ANS, and behavior. Psychoneuroendocrinology, 59, 81-90.
• Lazslo A.A. (2006). Somatization or psychosomatic symptoms?. Psychosomatics, 47(2), 163-166.
• Marques-Feixa, L., Castro-Quintas, A. , Palma-Gudiel, H., Romero, S., Morer, A., Rapado-Castro, M., Martín, M., Zorrilla, I., Blasco-Fontecilla, H., Ramírez, M., Mayoral, M., Mendez, I., Martín-Gonzalez, N. S., Rodrigo-Yanguas, M., Monteserín-García, J. L., & Fa˜nan´as, L. (2022). Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment. Brain, Behavior, and Immunity, 103, 122–129.
• Mercan, S., & Altunay, İ. K. (2006). Psikiyatri ve dermatolojinin ortak çalışma alanı: Psikodermatoloji. Türk Psikiyatri Dergisi, 17(4), 305-313.
• Merleau-Ponty, M. (1979). Le Visible et invisible. Gallimard.
• Merleau-Ponty, M. (1945). Phénoménologie de la perception. Gallimard.
• Pietkiewicz, I., & Smith, J. A. (2012). A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. Czasopismo Psychologiczne, 18(2), 361-369.
• Popescu, I. A., Vata, D., Statescu, L., Grajdeanu, A. I., Porumb-Andrese, E., & Patrascu, A. (2019). The psycho-emotional impact of patients with autoimmune bullous dermatoses. Bulletin of Integrative Psychiatry, 25(1), 49-56.
• Romero-Martínez, A., Lila M., Conchell, R., González-Bono, E., & Moya-Albiol, L. (2014). Immunoglobulin A response to acute stress in intimate partner violence perpetrators: The role of anger expression-out and testosterone. Biological Psychology, 96, 66– 71.
• Smith, J. A. (1996): Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology & Health, 11(2), 261-271.
• Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, method and research. Sage.
• Smith, J. A. (2011): Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review, 5(1), 9-27. http://dx.doi.org/10.1080/17437199.2010.510659
• Taşçıoğlu G., Çakıcı E., & Cirhinlioğlu F. G. (2021). Somatization level among psychosomatic dermatology patients: Relationship with dyadic adjustment, gratitude, forgiveness, and perfectionism. Alpha Psychiatry, 22(3), 165-170.
• Tsai, I. C., Chia-Yu, C., Chen, H. J., Wang, L. F., & Haien-Ching, C. (2010). Linear IgA bullous dermatosis: A clinical study of 16 cases at National Taiwan University Hospital. Dermatologica Sinica, 28, 21-26.
• Vargas, T. J. S., Fialho, M., Santos, L. T., Rodrigues P. A. J. B., Vargas, A. L. B. S. J., & Jeunon-Sousa, M. A. (2013). Linear IgA dermatosis associated with ulcerative colitis: Complete and sustained remission after total colectomy. Anais Brasileiros de Dermatologia, 88(4), 600-603. http://dx.doi.org/10.1590/abd1806-4841.20131949
• Vedhara, K., Fox, J. D., & Wang, E. C. Y. (1999). The measurement of stress-related immune dysfunction in psychoneuroimmunology. Neuroscience and Biobehavioral Reviews, 23, 699–715.