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Beyond Zits: Acne and Anxiety Disorders Part 1

by Mike on March 30, 2009 · 24 comments

mona-lisa-zits-smAcne 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]]

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