The Emotional Impact of Acne

Dermatologist, Psychologist Talks About the Emotional Impact of Acne

Teen girl with acne crying
Photo: LeoGrand / Getty Images

Acne is more than just skin deep; for many people, it takes a high emotional toll. Loss of self-confidence, changes in self-esteem, depression and anxiety are all common when you are dealing with acne.

Many people are slow to admit these feelings, so everyone thinks they're the only ones who feel this way. It's far from the truth!

Dermatologist and clinical psychologist Richard Fried, M.D., Ph.D., explains the emotional impact of acne, what to do if acne is affecting your life, and how to get your dermatologist to take your acne seriously.

Besides physical aspects of acne, how else does acne affect those who have it?

Dr. Fried: One of the things I'll always tell doctors when I'm lecturing on acne and other skin problems is we should never dare to have the audacity to make an assumption, based on the so-called clinical severity, about how emotionally impacted the sufferer is.

You can have people who are just sad about it, aggravated about it, wishing they didn't have it, or you can see people who literally are unable to function, literally are not able to do the things they want to or have to do.

What does the data specifically show? Approximately 20% to 34% of people with acne suffer clinically meaningful anxiety and depression. Data show higher levels of unemployment, higher levels of divorce, higher levels of suicide [in people with acne]. So, it's a big deal.

Why does acne affect us so deeply?

Dr. Fried: We live in a society that is not very tolerant of imperfections of the skin, imperfections of the body.

So you can say that all of us, to some degree or another, are put at vulnerability -- are put at risk.

It's rare that you'll find somebody who loves everything about their skin and their body. Most of us, if we are asked to get undressed and look at ourselves in the mirror, [will] have plenty of complaints.

The problem is we look at these digitalized photographs that don't have pores, that don't have imperfections. And then we look in the mirror, and we've all got pores and imperfections, and by definition we feel ugly. When acne comes along, it is another blow to the imperfection that we see.

After acne clears do these feelings of shame, or problems with self-esteem, clear up as well?

Dr. Fried: You're probably aware that there is a thing in medicine called "phantom limb pain." People who have lost a hand, an arm, a leg, a foot, continue to feel that part. They actually have the sensation as if that limb still is a part of them.

There's something in my book, Healing Adult Acne, that I call "phantom acne." What we've found with acne is many, many acne sufferers will continue to experience the feeling that they still have active acne.

When people will go to touch their face, their chest, or their back, often they'll recoil as if they still have active lesions. They will look in the mirror and even though objectively they can say "I don't see any pimples," they will have a sense of experiencing the world as if they still have [acne].

So, to some extent, there is always some degree of pressure or so-called urgency to get reasonable control of the acne, because we just never know when it's been around long enough to do significant emotional damage.

Are there any warning signs that people should be on the lookout for?

Dr. Fried: Absolutely. It's the traditional warning signs we look for, for anyone who may be at psychological risk. One of them being a visible change in the so-called affective display, the emotion people have.

When people greet one another, there's usually some degree of animation. Some of us can light up a room. A change in that glow that people have, or the energy they have.

A change in their functional pattern. [Take for example someone] who used to be really active in church or temple, used to be very active in groups, go out, hang with friends -- suddenly they're not interested in going out anymore.

Changes in eye contact. Sometimes when people start to get depressed and anxious they have difficulty sustaining eye contact, glancing away and looking down.

Functional change. They're not doing as well at work. If they're in school, grades changing.

People who for as long as you've known them have always been really put together, they're not doing their nails, their hair just doesn't seem done, they're not doing their makeup. Some change in self-care.

Are they just not as talkative as they used to be? Do they seem to be quiet, cynical, negative. Talking about how they are so unhappy. And obviously, real extreme, talking about suicide.

If somebody sees themselves in that description, what should they do?

On the mild end of the continuum, they feel like their acne is owning more of their emotional and or physical time than it should, it's becoming intrusive, they're spending so much time in front of the mirror or so much time in the bathroom during the day to camouflage it, they should seek treatment.

When they seek treatment start with OTC products, benzoyl peroxide, salicylic acid products. If OTC products will work, then that's great.

If not, they should seek professional consultation. That might be the primary care doc, ideally with the dermatologist. And be frank. Don't go in there and make light of it.

Or if the dermatologist isn't taking it seriously, don't put up with that either. If the dermatologist dismisses it and says, "Ahh, it's just mild acne; it's really not a big deal." [Reply with how you feel.] "Well, excuse me, but this is a big deal to me." And make it very clear, "It's causing me a lot of stress and distress."

If they're seeing good, positive response in two to four weeks, great. If not, be proactive and say, "I really need more than this." Ask that the professional they're working with move things along in as safe and swift a pace as possible.

But people shouldn't think it's superficial. They're entitled.

Now regardless of the severity, if [it really has you stuck], then seek some professional help [from] either a psychologist, psychiatrist, or the family care doctor.

An emergency is an emergency when we really have diminished self-care, we're not functioning, and certainly if we're having thoughts of hurting ourselves or anybody else.

Next: Why We're Driven to Pop Pimples

Read the entire interview with Dr. Richard Fried:

Part 1: The Mind-Skin Connection

Part 2: The Stress Connection

You're Here >>> Part 3: The Emotional Impact of Acne

Part 4: Why We Pop Pimples

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