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Beyond Zits: Acne and Anxiety Disorders Part 1

by Mike on March 30, 2009 · 24 comments

mona lisa zits sm Beyond Zits: Acne and Anxiety Disorders Part 1Acne would seem to be a strange topic for a blog on the Anxiety Disorders.

But acne is one of the leading causes of Anxiety among adolescents and adults. A recent study published in the British Journal of Dermatology found that acne sufferers experienced social, psychological, and emotional consequences at the same level of those with chronic health problems, such as epilepsy, diabetes, and arthritis. 

Adults have acne, too, on into their 30′s and 40′s and beyond. And they are more likely than adolescents to feel that acne negatively affects their lives, regardless of how severe their acne is. This may be because there is a greater social stigma for adults with acne. It can lead to clinical Anxiety Disorders, depression, unemployment, and social isolation.

This post is part of a two-part series. Today’s post details who can have acne and how it affects their life under the following headings:

  • How many people have acne?
  • How acne affects your life
  • Acne and quality of life
  • Adult acne

Tomorrow’s post goes into the interaction of Anxiety, stress, and suicide, as well as getting help:

  • Acne and Anxiety
  • Acne and stress
  • Warning signs that your mental condition is getting out of control
  • Get help

How many people have acne?

Acne affects 85 percent of people

Acne vulgaris, more commonly known simply as acne, affects at least 85 percent of adolescents and young adults.{{1}}. That’s no surprise. But did you know that acne affects 25% of all adult men and 50% of adult women at some time in their adult lives? People can develop unpleasant acne or have an acne recurrence in their 20s, 30s, 40s and beyond.{{2}} It can be difficult to cope with no matter your age, and can cause Anxiety Disorders and depression in an adult the same way it can in a teen.

How acne affects your life

Acne can affect your whole life

Acne affects more than just your skin. It can affect your entire life in very real ways. Your family and friends may not fully understand or appreciate how acne influences your self-esteem, self-confidence, and your outlook in general. Even mild breakouts can negatively impact how you feel about yourself.{{3}}

Dr. Jerry K. L. Tan, Director of the Acne Research and Treatment Centre, Windsor, Canada, says:{{4}}

While the physical features of acne are readily apparent to us all, the emotional and social impact of acne is often underestimated by non-sufferers. This can be manifested as anxiety, depression, and social withdrawal. …[S]tudies have shown that those with acne are dissatisfied with their appearance, embarrassed, self-conscious and lack self-confidence. Problems with social interactions with the opposite gender, appearances in public, and with strangers have also been observed. 

44 percent of acne patients report severe anxiety

Of particular concern is the rate that acne sufferers of all ages go on to develop Anxiety Disorders, depression, and other mental disorders. One study showed that 44 percent of acne patients reported severe Anxiety, and 18 percent serious depression. To further illustrate the depth of despair experienced by those living with this condition, more than a third of patients in one study reported thinking about committing suicide.{{5}}

Acne severity does not seem to be a factor in the level of Anxiety or depression. Those with mild acne are just as likely to suffer from these conditions as those with more severe cases.{{6}} Some patients with only minor acne suffer from disturbed body image. Even in the absence of lesions, they consider they have severe acne and may suffer many of the psychological and social symptoms described above. They are said to have “dysmorphophobic acne.” Some severe cases of dysmorphophobia have a more global mental disorder similar to anorexia nervosa.{{7}}

Acne and quality of life

Acne sufferers report decline of quality of life as great as chronic diseases

Acne especially affects a person’s quality of life. That is no surprise, given the many corollary problems it introduces, such as depression, Anxiety, personality problems, emotions, self-concept, self-esteem, social isolation, social assertiveness, social anxiety, and body dissatisfaction.{{8}} Acne sufferers report deficits in quality of life are as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, or arthritis.{{9}}

Acne, most especially when found in the face, provokes cruel scoffs from other individuals. Also, acne sufferers may have a difficult time in building new relationships, particularly with the opposite gender. Consequently, such individuals will lack more confidence to meet new acquaintances and create bonds. They would even find it difficult to establish eye contact when communicating. They become introverted and withdrawn from the society.

Acne affects daily decisions

For some, acne influences daily decisions. A woman may be so self-conscious of her appearance that she won’t pose in family pictures during a reunion. A teenage boy might decline an invitation to go swimming with friends because his back acne embarrasses him.{{10}} Some sufferers have trouble looking others in the eye, while others completely avoid all social situations.{{11}}

Many people do not participate in exercise or sports because of their acne. Dr Martyn Standage, a lecturer in the School for Health at the University of Bath, states that:{{12}}

The skin is the most visible organ in the human body and, as such, is an important part of personal image. Fear of having one’s skin evaluated by others has implications for physical and social wellbeing. Sport and exercise activities provide many opportunities for the skin to be exposed to evaluation. Due to this, acne sufferers may become so anxious about their appearance that it prevents them from participating in physical activity.

Adult acne

Adults report greater quality of life deficits than teens

As mentioned, acne affects 25% of all adult men and 50% of adult women.  Older adults with acne reported greater overall effects in quality of life than their younger counterparts. This contradicts the prevailing perception of younger patients as being more susceptible to the psychosocial effects of acne.{{13}}

Adult patients with acne reported emotional effects of their skin condition that were similar in magnitude to those reported by patients with psoriasis, which is traditionally regarded as a skin condition causing significant disability.{{14}} This may be because of the duration of disease, poor response to treatment, or the social implications of acne in an adult population.

The majority of adults, when asked what bothered them the most about acne, say that they were bothered by acne’s appearance. Interestingly, appearance is most troublesome to patients aged 30 to 39 years. One explanation for this difference among age groups is that patients younger than 30 years are closer to adolescence and feel that acne is accepted by their peers, whereas those aged 40 years and older may have themselves accepted acne.{{15}}

High social sensitivity increases acne’s effect

Those adults with acne who suffer the most are women with high “social sensitivity,” or heightened concern about being judged and accepted by others. For both women and men, higher social sensitivity is associated with poorer social outcomes and quality of life. For men, it interacts with acne severity more than for women, who can be relatively free of acne and still have these problems. Dermatologist Jennifer Krejci-Manwaring at Wake Forest University School of Medicine in Winston-Salem, North Carolina, says:{{16}}

Men and women with severe acne have the most trouble in social interactions with both friends and strangers. However, women who are more sensitive even when their skin is clear have much more difficulty when they have outbreaks.

More troubling is how acne can affect employment. The unemployment rate for adults with acne is 7 percent higher than for those without.{{17}} Dr. Jerry K. L. Tan, Director of the Acne Research and Treatment Centre, Windsor, Canada, states:{{18}}

Acne can … affect one’s ability to earn a livelihood. A previous study has shown that those with acne were more likely to be unemployed than those unaffected. A recent Canadian study also observed that those with more severe acne were more likely to be unemployed than those with lesser involvement. It is uncertain whether these findings are due to the patient’s psychosocial impairment or the negative response by potential employers to those affected by acne.

Be sure to see tomorrow’s post!

Tomorrow’s post goes into the interaction of Anxiety, stress, and suicide, as well as getting help:

  • Acne and Anxiety
  • Acne and stress
  • Warning signs that your mental condition is getting out of control
  • Get help

As always, your comments are welcome!

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[[1]] Hanna, Shannon; Sharma, Jasdeep; Klotz, Jennifer. (2003). Acne vulgaris: More than skin deep. Retrieved March 21, 2009 from http://dermatology.cdlib.org/93/commentary/acne/hanna.html, abstract.[[1]]

[[2]]Kern, Daniel W. (2008). Adult acne. Retrieved March 26, 2009 from http://www.acne.org/adult-acne.html[[2]]

[[3]]Aktan, S.; Ozmen E.; Sanli, B. (2000). Anxiety, depression, and nature of acne vulgaris in adolescents. Retrieved March 21, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/10849125#_jmp0_[[3]]

[[4]]Tan, Jerry K.L. (2008). The Unseen Impact of Acne: There is help for those suffering. Retrieved March 21, 2009 from http://www.acneguide.ca/articles/unseen_impact_of_acne.html[[4]]

[[5]]Tan. (2008).[[5]]

[[6]]Palmer, Angela. (2008, December 5). Acne and Your Self Esteem. Retrieved March 21, 2009 from http://acne.about.com/od/livingwithacne/a/effectsofacne.htm [[6]]

[[7]]Staff of the New Zealand Dermatology Society. (2008, December 30). Psychological effects of acne. Retrieved March 21, 2009 from http://dermnetnz.org/acne/acne-psychological-effects.html[[7]]

[[8]]Lasek, Rebecca Jane; Chren, Mary-Margaret. (1998). Acne Vulgaris and the Quality of Life of Adult Dermatology Patients. Retrieved March 25, 2009 from http://archderm.ama-assn.org/cgi/reprint/134/4/454.pdf, introduction, ¶2.[[8]]

[[9]]Hanna. (2003). Quality of life, ¶2.[[9]]

[[10]]Loney, Tom; Standage, Martyn; Lewis, Stephen. (2008). Not Just ‘Skin Deep.’ Retrieved March 21, 2009 from the Journal of Health Psychology http://hpq.sagepub.com/cgi/content/abstract/13/1/47[[10]]

[[11]]Palmer. (2008)[[11]]

[[12]]Staff of Medindia.com. (2008, March 9). Social Anxiety Prevents Acne Patients from Participating in Sports, Exercise. Retrieved March 21, 2009 from http://www.medindia.net/News/Social-Anxiety-Prevents-Acne-Patients-from-Participating-in-Sports-Exercise-33952-1.htm[[12]]

[[13]]Lasek. (1998). Comment, ¶2.[[13]]

[[14]]Lasek. (1998). Comment, ¶4.[[14]]

[[15]]Lasek. (1998). Comment, ¶5.[[15]]

[[16]]Krejci-Manwaring, Jennifer; Kerchner, Katherine; Feldman, Steven R.; Rapp, Derek A.; Rapp, Stephen R. (2006). Social sensitivity and acne: the role personality in negative social consequences and quality of life. Retrieved March 25, 2009 from http://www.biomedexperts.com/Abstract.bme/16927583/Social_sensitivity_and_acne_the_role_of_personality_in_negative_social_consequences_and_quality_of_life [[16]]

[[17]]Lasek. (1998). Comment, ¶4.[[17]]

[[18]]Tan. (2008).[[18]]

{ 22 comments… read them below or add one }

Tracy March 31, 2009 at 10:02 pm

Interesting post – I am in the 30-40 age group and I know many of my peers are very concerned about acne and there are a lot of self deprecating jokes about it and unwanted facial hair (which tends to crop up in the mid 30s!). I imagine that people who are more deeply affected wouldn’t be inclined to be so social and joke about it.

Tracy’s last blog post..I am grumpy and grumbling this April Fool’s Day

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Mike April 1, 2009 at 12:17 am

@Tracy, thanks for the comment!

People of all ages can be brutal with their comments about acne. It hurts many adolescents, and it hurts many adults, too.

And for those whose acne has pushed them into Anxiety and depression, those comments can be especially hurtful.

There’s no cure for this except for becoming — and helping others to become — more sensitive to those around us, especially when joking. Of course, this applies to all situations where there are those that could be hurt by an unguarded jest.

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Mike April 1, 2009 at 1:31 am

A reader named Evelyn sent me a comment by email that I thought would be valuable here. I am showing an extract, since it contained a commercial message.

Evelyn’s comment
Of all the skin afflictions, Acne is the most ubiquitous and is commonly associated with adolescence. Surprisingly, Adult acne is prevalent in 25% of men and 50% of women at various stages of adult life. Scientists at NY University College of Medicine have shown that Niacinamide is superior to antibiotics such as Clindamycin in controlling acne. Niacinamide (Vitamin B3), applied topically, is beneficial for reducing Acne, skin hyper-pigmentation (acne scars), increasing skin moisture and reducing fine wrinkles. Niacinamide is generally recognized as safe during pregnancy (always consult a doctor).

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Kim Woodbridge April 6, 2009 at 11:24 am

I was lucky in that I never had too much of a problem with acne. I didn’t, however, get it until I was over 30. I had no idea that it had such an impact on employment and emotional well-being.

I wish people would just stop being cruel about other’s physical appearance.

Kim Woodbridge’s last blog post..WordPress Flash Uploader Fix for the HTTP Error

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Sophie April 25, 2009 at 1:42 pm

I came across your blog on the google search engine and saw a few of your earlier posts that you did previously . I just added you to my Google News Reader. Keep up the great work. i will Look forward to reading more from you again.

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Mike April 25, 2009 at 5:14 pm

Thank you, Sophie, for your comment!

You can browse through the site a number of ways. Perhaps the easiest is to check out the “Most Popular Posts’ column in the sidebar. Then check the “Categories” tab and do a search for particular topics.

Thanks for looking!

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shannon April 23, 2010 at 9:28 am

I wish more people were aware of what a negative impact acne can have on the sufferer.I started getting pimples at 9 which steadily worsened until at 14 I was getting cystic acne.This led to severe depression and now at 28 even though my skin is pretty good I still suffer from Social Anxiety Disorder.This is a disease which is on your face for all to see,comment on and critisice,you are often looked at as someone who is unclean and slobbish and are either pitied or ignored.I would not wish acne on my worst enemy

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mitesser May 10, 2010 at 5:58 am

Acne and similar skin diseases can be so indredibly disturbing. Unclear skin makes me usually feel ashamed and insecure, I then usually avoid being out amongst people. I personally belief acne and stress are related to each other!

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Paco July 25, 2010 at 10:59 am

I’ve suffered from severe acne since I was 14 years old – I’ll be 29 in August. A lot can happen to a person who has experienced bad acne for 15 years. I’ve had to go through intense periods of anxiety and depression, which still persist to this day. It has resulted in me underachieving in various aspects of my life. Similar to what other people have stated in previous posts, I’ve had to quit jobs and drop out of numerous courses due to anxiety which acne has contributed to enormously.

I’ve been on about 4 courses of Roacutane, suffering bad side affects along the way. Every time my acne cleared but unfortunately, it kept coming back. After spending a fortune on dermatologists, medications, treatments etc., with no lasting results, I just became so disillusioned with what I regarded as the ‘acne industry’ that I just stopped caring for my skin. It made me so angry to hear so called aspects say that people don’t have to suffer from acne any more due to the ‘fantastic’ new treatments now available. I became convinced that the ‘industry’ would lose an absolute fortune on numerous products if a major breakthrough in acne treatment was in fact made and as such, were not interested in investing too much in possible miracle cures.

While I have no intention of ever paying a private dermatologist again, I have been seeing a public consultant lately, free of charge. I’m currently waiting to use light treatment on my skin. This may or may not make a difference but at least I won’t pay a penny.

After reading the above article and subsequent posts, I did something I haven’t done for a long time – I patted myself on the back. Acne has contributed to so many set backs in my life but during the dark years I did manage quite a few achievements which now appear all the more impressive, given what I was going through at the time. Having the detrimental affects of acne spelt out in such a way puts a lot of the self loathing I’ve inflicted on myself over the years into perspective. I’m obviously quite a resourceful person to be where I am today in spite of the crippling condition I’ve had to endure for so long so hopefully I can use that in the future in terms of how I treat my skin and my life in general. People need to be made aware that acne is anything but trivial. Many thanks for the article and posts.

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Acne April 7, 2011 at 8:13 am

Acne is a much more serious medical condition than many people realize. It’s not just some bumps on your skin, to some people it has a MAJOR psychological impact. I actually wrote an article about the effects acne has on self esteem on my website, because I think that not enough people realize how significant acne can be to a persons mental health and well being.
Acne´s last blog post ..Acne Vs Eczema – How To Tell The Difference

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Melodie Pennie August 25, 2011 at 8:25 am

David T. Wolf~ Idealism is what precedes experience cynicism is what follows.

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Bruce Johnson November 7, 2011 at 9:15 pm

Great advice. Watching my sons battled acne problems for years they both finally conquered it by using Acnezine. A clinically tested, FDA approved, natural acne treatment which easily help them to prevent further acne breakouts and keep it off without any side effects!Natural Acne Treatment that Works

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Pat May 14, 2012 at 5:25 pm

Those employment numbers are crazy! I can’t believe acne has this big of an impact on people. No wonder there is such a giant industry in acne medication. Very interesting article.

-P

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skin clear October 14, 2012 at 11:50 am

Thanks for this its genuinely great, have you got any other content ?

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PerryK April 13, 2013 at 6:11 pm

Well i am in the same boat as the rest of you. I used to have mild to moderate acne for about the last 4 years. back then, my social life was in shambles. I have started college and it is very hard making freinds with acne back then. My skin has started to improve when I started using the Citrus Clear Wash – I guess I just have sensitive skin. I am hoping that it will continue so at least i can have a fun summer. SO far NO ZITS OR ACNE! I just use the Citrus Clear Face Wash, but Im going to try the moisturizer also. Will let you know how it goes!

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Bo April 22, 2013 at 2:12 pm

Feels both good and bad to say this, but I’m glad to see that there are other people with this issue out there. It is difficult to live with, but reading comments from people who are making it through life with acne is incredible and gives me strength.

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Karen April 27, 2013 at 3:44 pm

I had severe acne from 5th grade on. Two rounds of Accutane didn’t help–and worsened my emotional state. My husband had cystic acne as a teen, and the drugs didn’t help him either.

After years of infertility (drugs didn’t really help that either), I was diagnosed with a gluten problem. Within a month of fixing my diet, I was pregnant–and my face cleared up. A few years later, my son was diagnosed with a dairy allergy–and we discovered my husband had never “outgrown” the dairy allergy he’d had as an infant. (30% of people don’t outgrow a dairy allergy–and those cases tend to run in families.) In researching dairy allergies, I discovered that if someone has one but continues to consume it, that can exacerbate any mild acne.

I am very curious to see if our children, who because of allergies have to be on a gluten- (both) and/or dairy (son) -free diet, have the kind of acne my husband and I had.

Whether it’s food allergies, or endocrine disruptors in pesticides and toiletries, the effects on our delicate hormones are very real. If hair care products can induce menarche in little black girls at 7 or 8, why not trigger or exacerbate acne? There’s a great database tool online for finding safe personal products: skin deep by the environmental working group.

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dermatologist toronto July 27, 2013 at 2:13 pm

When I originally commented I clicked the “Notify me when new comments are added” checkbox and now each time a comment is added I get
several e-mails with the same comment. Is there any way you
can remove people from that service? Thanks a lot!
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Mike Nichols July 27, 2013 at 4:42 pm

I tried to find your email on the list but couldn’t. I need the exact email you used when you signed up for comments.

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how to treat acne August 7, 2013 at 7:34 am

I want to to thank you for this excellent read!! I certainly enjoyed every bit of it.
I’ve got you saved as a favorite to look at new stuff you post…
how to treat acne´s last blog post ..how to treat acne

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Dr. Lawrence Kindo September 14, 2013 at 11:27 pm

Excellent article. I am a physician and I can commend the author for the effort put in to write this article.

Good read for any person wanting to know the association between anxiety and acne.
Dr. Lawrence Kindo´s last blog post ..The Food Pyramid Fallacy: Why We Have Been Receiving The Wrong Nutrition Advice

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Steve September 30, 2013 at 3:02 pm

Thanks Mike! I really appreciate this article. When my anxiety got triggered and led to panic attacks with agoraphobia, I did not initially treat my health condition with anti-anxiety medication. I tried to wade it out with my inner will, thinking I could outsmart my anxiety with my head, but finally, I just let go of my pride, and took medication. During my panic episode which lasted several months, without the use of medication (specifically a SSRI antidepressant), I formed a long line of pus, or acne, down corresponding with the line of veins down my left leg. Likewise I started forming skin outbreaks around my upper arms, like facial acne. After staying on the medication for two months, the acne around my arms faded away. The acne around my leg, which goes down my blood artery, is also going away, as I have placed a skin antibiotic on it. It should clear up within a month, as I continue to stay on the anti-anxiety medication. I’ve read that serotonin gets produced in the gut and flowed through the blood. Personally I know my untreated anxiety caused the skin outbursts, due (from my understanding) the excessive serotonin that was flowing through my body. There is definitely a correlation between anxiety and skin problems. Panic Disorder (PD) is most definitely a medical problem for me if I don’t seek treatment in managing it. Again, great article!

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