Purpose: This study aimed to explore the association between patient-intrinsic factors, environmental exposures, and improvement in psychosocial adaptation among individuals with chronic spontaneous urticaria (CSU). Methods: We conducted a single-center retrospective cohort study by reviewing medical records of 84 CSU patients aged 18–65 years who attended a tertiary dermatology outpatient clinic between January 2023 and January 2024, with follow-up of at least 3 months. Data on demographic characteristics, disease severity (measured by UCT score), and psychosocial adaptation (assessed via the Chinese version of the Patient Attitude and Self-Adaptation Questionnaire, PASQ-CSD) were extracted from electronic health records, while environmental variables—including monthly averages of temperature, humidity, PM2.5 levels, and pollen concentration—were obtained from national meteorological and environmental monitoring platforms. Improvement in psychosocial adaptation was defined as an increase of ≥5 points in PASQ score during 3–6 months of follow-up. Results: The mean age of participants was 44.27 ± 14.86 years, with 55.9% being female. Although no significant differences were observed in UCT scores (P = 0.402) or PARS-3 scores across treatment groups, PASQ scores showed statistically significant intergroup variation (P = 0.015). Occupational distribution differed significantly among groups (P = 0.034), whereas marital status did not (P = 0.219). No direct causal relationship was identified between medication type and psychological improvement; however, findings suggest that sociodemographic roles and environmental stressors may act as potential modifiers. Conclusion: These results indicate that psychosocial adaptation in CSU patients is influenced by multiple contextual factors, highlighting the need for integrated biopsychosocial assessment in clinical management and supporting future prospective studies on environment–psychology interactions.