Acne can cause Anxiety and can lead to Anxiety Disorders and depression.
Up to 60 percent of acne sufferers show significant levels of Anxiety. Some researchers even think that acne can cause these mental disorders. It is certain that stress can cause acne and exacerbate existing Anxiety Disorders and depression.
What is not apparent is how many suicides are attributable to acne. Thirty-five percent of teenagers with bad acne have suicidal thoughts, and more than 10 percent have tried to kill themselves. The numbers are not available for adult suicide ideation and attempts, but there is reason to believe that they are similar.
The first post in this series described how acne affects the lives of both adolescents and adults. This post discusses the interrelation of acne and the Anxiety Disorders and stress, as well as getting help. The headings are:
- Acne and Anxiety
- Acne and stress
- Warning signs that your mental condition is getting out of control
- Get help
The first part of this series details how acne can affect people psychologically and emotionally under the following headings:
- How many people have acne?
- How acne affects your life
- Acne and quality of life
- Adult acne
Acne and Anxiety
Acne often leads to the Anxiety Disorders
Acne often leads to mental disorders, especially the Anxiety Disorders.[1] Acne is associated with a greater psychological burden than a variety of other disparate chronic disorders.[2] Some researchers believe that acne can actually cause psychological problems, rather than just exacerbating them among those with susceptibility.[3] Shannon Hanna, of Dalhousie University Medical School Halifax, Nova Scotia, Canada, says:[4]
Acne vulgaris has the potential to cause significant psychiatric and psychological complications, while negatively affect[ing] quality of life. Many factors influence the nondermatological aspects of acne including personality, perceptions, age, and social and cultural factors, as well as disease characteristics (duration, severity, scarring).
The Anxiety Disorders, especially Social Phobia, are the most prominent among acne patients. Up to 60 percent of acne sufferers show significant levels of Anxiety. As might be expected, people with a more severe degree of acne show higher Anxiety values in studies.[5] Women with acne have a higher level of Anxiety, and are more vulnerable than males to the negative psychological effects of acne.[6] The rates of Anxiety increase among those with a higher education.[7]
Acne and stress
Stress causes acne to get worse
Stress is a constant in our lives, but for the acne sufferer it can be especially troubling. It has been found that stress can actually cause acne to get worse and can make any psychological conditions worse, as well. Dr. Jerry K. L. Tan, Director of the Acne Research and Treatment Centre, Windsor, Canada, says:[8]
The mental stress of sufferers with acne can be greater than that associated with other chronic diseases such as asthma, epilepsy, diabetes, back pain, arthritis, and heart disease.
There seems to be a two-way street with acne and stress; Acne can cause stress and negative emotions, and stress and negatives can cause and worsen acne. Any effective acne treatment should address both the acne and the emotional state of the person with acne.[9] (See “Get Help,” below.)
For those who have mental disorders, the stress caused by acne can exacerbate the condition. And for those who are predisposed to psychological factors, acne’s stress can cause mental disorders to become active.[10]
Dr. John Koo, of the University of California, San Francisco’s Psoriasis Treatment Center and Phototherapy Unit, states that psychological factors may play a significant role in acne in at least three ways:[11]
- Emotional stress can exacerbate acne.
- It is common for patients to develop psychiatric problems as a consequence of acne, such as those related to low self-esteem, Social Phobias, or depression.
- Primary psychiatric illnesses such as Obsessive-Compulsive Disorder and psychosis may be based on a complaint that is focused on acne.
It is obvious that to properly control acne, a sufferer’s stress must be addressed as well, especially if the stress is making their Anxiety Disorders or depression worse. A professional mental health practitioner is the best source of help, and should be considered as essential as a good dermatologist.
Warning signs that your mental condition is getting out of control
Warning: Avoidance and social withdrawal
In a society that places great emphasis on appearance, acne sufferers often feel uncomfortable or embarrassed. The prevalence of myths regarding acne development may even lead some to feel a sense of guilt or shame, as if they are somehow responsible for their acne.[12]
These feelings lead to social withdrawal and to avoiding social situations. This avoidance is a primary reason that Anxiety Disorders get a toe-hold in your life, and avoidance is the main way that Anxiety Disorders grow and flourish. Avoiding going out with friends, finding excuses to not attend family functions or generally having little interest in socializing with others may be warning signs that acne is seriously affecting your life.[13]
But the danger of acne goes beyond just Anxiety Disorders and depression. Many people, especially adolescents, contemplate or actually attempt suicide due to their acne.
Thirty-five percent of teenagers with bad acne have suicidal thoughts, and more than 10 percent have tried to kill themselves.[14] I have not seen any studies about suicide among adult acne sufferers, but it is logical that there is some degree of these numbers holding true in adults.
Get help
Anxiety Disorders and depression often mixed with acne
The treatment of acne should involve more than addressing skin problems. Disturbance of the psychological state with signs of Anxiety Disorders or depression, as well as mixed depression and Anxiety Disorders, is frequently associated with acne.[15]
It stands to reason that any treatment plan should include both physical and psychological care. Shannon Hanna, of the Dalhousie University Medical School in Nova Scotia, says that the treating physician should consider all factors when treating acne. She continues:[16]
Addressing nondermatological effects of acne allows the physician to treat the whole patient and not solely the skin condition. Acne vulgaris is a common skin disease with potential complications that are more than skin deep.
And Dr. Peter Watson of the University of Auckland states that:[17]
Our data suggest that doctors who see … people with problematic acne have a particularly important role to play in screening these … people for depression, anxiety and suicidal thoughts and behaviour.
Patient education is very important, as well. Too many people have misguided notions of why acne occurs, which can further exacerbate emotional and mental problems. In a study of acne patients in a dermatologists care, almost 30 percent believed that poor skin hygiene was a causative factor of acne. If this belief exists among a patient population who has had some degree of education by their physicians, similar beliefs must also exist in the general population.[18]
Here are some suggestions for getting help with your acne:[19]
- At a minimum, find a dermatologist who is sympathetic and willing to address the emotional issues that go along with acne. Be honest with your doctor. Let her know if acne is considerably affecting your self-esteem, interfering with social interactions, or causing depression or anxiety.
- Ideally, acne should be treated early, before damage to the self-esteem has begun. People who have chronic, long-lasting acne are more likely to have psychological ramifications. If you believe you may be anxious or depressed, you may benefit from psychological counseling.
- Seek out a support system. Having a compassionate person, or group of people, who understand what you are going through can help dispel feelings of isolation and hopelessness that are common to acne sufferers
What do you think?
Too often, acne is brushed off as just something that teenagers have, and that goes away quietly. The psychological, emotional, and social effects of acne never enter the mind. However, as these posts show, acne often leads to deeper problems that can linger a person’s whole life.
I had the usual adolescent acne, but never very badly. I did have friends who had severe acne, and I remember the suffering and social isolation they experienced. And I have known many adults who had acne whose lives and psyche were impaired by it. How about you?
- If you had or have acne, how does it affect your life?
- Do you know someone with acne who may be experiencing Anxiety Disorders or depression?
As always, your comments are welcome!
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FOOTNOTES
1. Srivastava, S.; Bhatia, M.S.; Das, P.; Bhattacharya, S.N. (2008). A Cross-sectional study of quality of life and psychiatric morbidity in patients with Acne Vulgaris. Retrieved March 21, 2009 from http://www.jpps.com.pk/display_articles.asp?d=199&p=art ↑
2. Tan, J.K.L. (2004). Psychosocial Impact of Acne Vulgaris: Evaluating the Evidence. Retrieved March 21, 2009 from http://www.skintherapyletter.com/2004/9.7/1.html#_jmp0_ ↑
3. Fried, Richard; Wechsler, Amy. (2006, September 27). Psychological problems in the acne patient. Retrieved March 25, 2009 from http://www3.interscience.wiley.com/journal/118599090/abstract ↑
4. 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, Conclusions.↑
5. Asad, Faria; Qadir, Altaf; Ahmed, Lugman. (2002). Anxiety and Depression in patients with Acne Vulgaris. Retrieved March 21, 2009 from http://www.pakmedinet.com/3517 ↑
6. 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_ ↑
7. Datuashvili, M.G.; Chitashvili, M.D.; Katsitadze, A.G. (2002). Psychological Particularity in Acne Vulgaris. Retrieved March 21, 2009 from http://content.karger.com/ProdukteDB/produkte.asp?Doi=64500 ↑
8. 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 ↑
9. Fried, Richard. Healing Adult Acne. Oakland, CA: 2005 ↑
10. Kenyon, F.E. (1966). Psychosomatic Aspects of Acne. Retrieved March 25, 2009 from the British Journal of Dermatology, http://www3.interscience.wiley.com/journal/119756413/abstract?SRETRY=0 ↑
11. Koo, John; Smith, Laura. (2008, March 20). Psychologic Aspects of Acne. Retrieved March 25, 2009 from http://www3.interscience.wiley.com/journal/119356624/abstract?CRETRY=1&SRETRY=0 ↑
12. Palmer, Angela. (2008, December 5). Acne and Your Self Esteem. Retrieved March 21, 2009 from http://acne.about.com/od/livingwithacne/a/effectsofacne.htm ↑
13. Palmer, Angela. (2009, January 2). Is Acne Negatively Impacting Your Life?. Retrieved March 21, 2009 from http://acne.about.com/od/livingwithacne/tp/3WarningSigns.htm ↑
14. Purvis, D,; Robinson, E.; Merry, S.; Watson, P. (2006). Acne, anxiety, depression and suicide in teenagers. Retrieved March 21, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/17096715 ↑
15. Datuashvili. (2002).↑
16. Hanna. (2003), Conclusions↑
17. Purvis. (2006).↑
18. Hanna. (2003), Introduction↑
19. 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 ↑
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Thanks for the very informative post, I’m looking forward to the rest of the series.
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It seems like a terrible cycle. Acne intensifies the emotional stress which makes the acne worse etc…
I haven’t actually known anyone who suffered emotionally because of it – or maybe I just wasn’t aware …
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I do like your website i read some others that are on similar subjets, but they do not put new posts in very often, thanks.
Thank you, Sue, for your comment!
I try to have 2 or 3 new posts each week. Since so much research goes into each post, that’s about all I can do!
While you’re here, take a look around: check out the “Most Popular Posts” sidebar, click the “Categories” tab, and look for your favorite subjects with the “Search” function.
Welcome!
Tracy, thanks for dropping by!
Fortunately, I haven’t been plagued by acne as an adult, so I have been spared the anxieties suffered by many who have. That’s a good thing, too, seeing as how I have a laundry list of other Anxiety Disorders!
Kim, thanks for your observations!
I have known several people with adult acne, but at the time I was too thick and obtuse to empathize with their suffering. If I had just stopped and thought a little, I would have realized that they were experiencing emotional pain due to their skin condition. Oh well. At least I’m doing something about it years later!
Finally! An article that explains what i’ve gone through these past 5 years. Im so glad people are now realising how much damage acne can do, and not just brushing the subject off.
I am a 23 year old male and have had chronic, persistent acne everyday of my life since age 13. At times it has been very severe. I have widespread scarring across my entire face. My back and chest have finally cleared up on there own, but were severely broken out for several years. After 10′s of thousands of dollars on treatments that have failed I am very frustrated. My face is much better now than in the peak years of severity but I still wake up everyday to more zits on my face. I feel like there is nothing left for me to do.
Acne has been a major part of my life. It has caused me so much pain and suffering and has negatively influenced every aspect of my life. I too, have contemplated suicide. Have struggled for years with depression and anxiety while no one seems to think that having acne is a reason for me to be depressed. I want to not care. I wish I could have no emotion towards acne at all. But the fact is, my emotional ability to deal with acne has been steadily declining every year for the last 10 years. Every year I think, This is it, soon, you won’t have to deal with this bullshit anymore, but of course I have been saying this to myself for a LONG LONG time. Acne is much harder for me to deal with the older I get.
When I was 17-18 my acne was worse than it is now, but emotionally, it affected me less. I think because I still had hope that it would go away soon, and that acne is more acceptable, or at least more common for 17 year olds. But when you are 23…it is a constant embarrassment. When I tell people my age, they usually don’t believe me. Probably because its so uncommon to see a 23 year old with a face full of zits. Slowly but surely, as I get older but still have acne I am rejected by more and more girls. I guess I have to accept the fact the no one wants to date the 23 year old guy still breaking out everyday.
Acne is a constant drain on my life. Acne alone, has caused me severe depression and anxiety. Caused me to quit jobs, drop out of school multiple times. It has basically made me lose all interest in trying to meet girls because I have been rejected to many times and eventually you don’t want to get back on the horse cause it just hurts too much. I withdraw from friends and family. Don’t like being social because of the anxiety it causes me, but not being social causes depression because of the lack of stimulation which is a never ending cycle.
Basically, I don’t want to get out of bed in the morning. I wake up, and the first thing that comes to mind everyday is, God damnit, I have to go look in the mirror right now and I still have acne. 10 years is much to long, I would do anything, or change any aspect of my life to not have to wake up to an infection on my face 1 more time.
Wow, this is the best researched and written article I have seen since college. Very good work!
It seems like a vicious circle the stress causes the acne, which builds the stress which triggers more acne and so on…
I have read that changing ones lifestyle is very important to clearing up acne and that is nutritionally sound. Though, one can clean up the diet, exercise, and hygiene…but if the psychological makeup of the individual needs cleaned up too. Well, the acne still will not go away if I am understanding your post correctly.
Thank you, I am going to bookmark your site and return for more education.
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I’m 29 almost 30 and I Read this and thought I wish everyone I new could realize the affect this has on my life.. Even my husband thinks its crazy to break down and cry because I have a huge cyst on my face. I realize I am part of the problem with my cysitc acne being so severe by picking which is an absolute obsession for over 15 years now, like an tweeker I can not stop myself just hope I can take one cyst at a time and try not to pick. It causes me such anxiety, social isolation, panic attacks, sleepless nights, sadness, outburst, failure feelings, and on and on. YOu name it I’ve felt it my current derm has me on doxy and some topical but yet to see hope… keep hoping for a miracle
Wow this article is exactly what i deal with on an everyday bases too. The thing is i know i prolly need help but i dont like to classify myself in that category so i dont. I too have withdrawn myself from family and friends. I use to get txts and phone calls everyday from friends wanting to do stuff or girls wanting to still date or talk to me, but since this huge social draw i made to everyone, it doesnt happen anymore. Just another sign of how things are getting.
I too never want to get up in the morning to look in the mirror, i just want to sleep forever, thats all i ever want to do is just sleep, even then thou i will have dreams of horrible breakouts at times which sux. There is so much i want to do but i dont, i go to work because i have to (in military) and i know i have to make a living and i refuse to be a total dependent loser. At least i need my independence and i do have nice things, just not a nice face. I started getting it at 27 and now i am turning 30 this year.
No treatment seems to work and doctors seem not to really care, they just spit out more pills or topicals and that makes it even worse. I wish the fn disease on my face would just end already. Derms say what causes it so easily yet we can not figure out how to keep it away for everyone.
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 of 15 years. I’ve had to go through intense periods of anxiety and depression, which still persists 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.
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 in 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.
that really nice post thanks
So I have been on doxycycline (pill) and now just Aczone (topical) and to be honest the doxy just made my cyst heal faster and me sick to my stomach. I’d rather just use the Aczone to treat and help prevent my cyst. I am now 31 and at the end of my pregnancy which I thought would make my skin awful but surprisingly pregnancy has made my skin better. I am hoping that after I deliver my skin will not be a nightmare and maybe the change of hormones will correct my skin issue (crossing my fingers). It’s nice to see that other people have been so affected by the anxiety acne causes and still have accomplishments in there life.
I agree with you. Acne can definitely lead to some serious anxiety. Teenagers especially are obsessed with their looks. A small pimple appears and they start panicking. Worst is, they overdo chemical treatments that they find which can sometimes only make things worse (let’s not forget benzoyl peroxide can react with sensitive skin).
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