Coping With the Mental and Emotional Burden of Chronic Hives

A look at the ways CU can impact mental and emotional health, with seven topics to discuss with a healthcare provider.

Medically reviewed in September 2021

Many skin disorders have a negative impact on a person’s mental and emotional health, and chronic hives are no exception.

Known by the clinical term urticaria, hives are a rash of red welts that appear on the skin. They are often itchy. They are sometimes accompanied by angioedema, patches of swelling that occur in the deeper layers of the skin. Hives are categorized as chronic when symptoms persist for six weeks or longer—the clinical term for this is chronic urticaria, or CU. Most cases of CU fall into the category of chronic spontaneous urticaria, where the cause of the symptoms is unknown and a trigger for the hives cannot be identified.

Here we will look at the emotional and mental burden of chronic hives, as well as the importance of working with a healthcare provider.

Burden of CU
CU often comes with a number of burdens and challenges, and it is important to pay attention to the ways in which CU impacts your life. Here are a few things that you should pay attention to and discuss with your healthcare provider:

  • Mood and anxiety. Do you have any feelings of depression or anxiety? Research shows that disorders like depression and anxiety are more common among people who have CU. Though the relationship between CU and mood and anxiety disorders is not fully understood, your healthcare provider can recommend strategies to help you address these feelings.
  • Sleep. Does CU affect your ability to sleep? Do uncomfortable symptoms keep you awake at night? Does emotional distress about the condition make it difficult to relax when it’s time for bed? It can be helpful to keep notes on the number of hours you sleep, the quality of your sleep, and how often you feel tired or worn down.
  • Work and school. How often do you miss workdays or classes because of CU? In what ways does CU impair your ability to do your job or perform academically?
  • Personal life. How does CU impact your life outside of work or school? Are you able to participate in the activities you want to participate in? Do CU symptoms prevent you from going out? Does having CU put a strain on your relationships?
  • Stigma. Do you feel embarrassed or stigmatized because of CU? Stigma refers to feelings of being judged or looked at unfavorably—for example, people treating you as diseased or contagious because you have hives. Stigma is a major challenge to people with skin disorders.
  • Stress. Pay attention to your stress levels. In addition to the many sources of stress found in everyday life, people with CU must also face stress brought on the uncomfortable symptoms and the frustration of having to manage a chronic condition. Stress can also trigger hives for some people.
  • Healthcare costs. Are you concerned about the costs of treating chronic hives, such as paying for healthcare appointments and medications? If costs are a concern, this is something to bring up with your healthcare provider.

These are just some of the concerns that are commonly reported by people with CU, but it is important to remember that every person’s experience with hives is different.

Working with a healthcare provider
When faced with any condition where symptoms persist, it is important to work with a healthcare provider who understands the condition and how to treat it. CU is most often treated by an allergist or a dermatologist. Even in cases of chronic spontaneous urticaria, where the cause of the hives is unknown, there are treatments available, and many are able to achieve clear skin or a reduction in symptoms.

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Gerasimos N. Konstantinou and George N. Konstantinou. "Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis." Clinical and Translational Allergy, 2019. Vol. 9.
Paul Schaefer, MD, PhD. "Urticaria: Evaluation and Treatment." American Family Physician, May 2011. Vol. 83, No. 9.
B.F. O'Donnell, J. Simpson Rlawlor, M. Morgan, M.W. Greaves. "The impact of chronic urticaria on the quality of life." British Journal of Dermatology, 1997. Vol. 136.
Samantha Gluck. "What is Stigma?" HealthyPlace, Oct. 2019.
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UpToDate. "Chronic spontaneous urticaria: Treatment of refractory symptoms."

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