Psychological Effects of Acne
The social and psychological effects of acne cannot be underestimated. Acne vulgaris is an incredibly common skin condition, with far reaching consequences if treatment is delayed. Approximately more than 80% of adolescent will develop acne. Acne is also more common in adults than what was initially perceived. An epidemiological study estimates that 20% of adults over the age of 35 suffer from acne.
During the adolescent stage, it can be a vulnerable time for many individuals who are coping with school, relationships with family and friends and body image. It is not uncommon for patients to grow long hair to hide their acne, or even put on excessive make up. Back acne may prohibit individuals from taking part in enjoyable and meaningful sporting activities such as swimming for the fear of embarrassment in the public. In a recent survey, 70% of adolescent report that shyness and lower self confidence as an effect of having acne.
Does Acne Cause Depression?
Different individuals cope and react to having acne differently. For example, a male patient with moderate to severe acne may not be too bothered by it at all, while on the other hand, a female patient with mild acne may cause her greater distress and anxiety.
Depression often accompanies acne. In a recent study on the psychological burden of acne in women aged 25 to 45, 43% had scores indicative of moderate to severe depression or anxiety. Depression is twice more common in women with acne compared to man. Depression in the adolesecent group may be manifested as a withdrawal from social events, isolation and poor academic performance.
The American Psychiatric Association defines Depression as having the below symptoms for more than 2 weeks:
- Depressed mood or feeling sad
- Poor sleep or excessive sleeping
- Changes in appetite
- Loss of interests in activities previously one finds enjoyable
- Feeling worthlessness or guilt
- Poor concentration and decision making process
- Feelings of fatigue and loss of energy
- Increase in purposeless activities, and slowness in speech and action
- Suicidal thoughts
Depression is a treatable medical condition. If you think you or someone may be suffering from depression, please see a doctor for advice. Alternatively, if you need someone to talk to, you can call Samaritans of Singapore.
It is common for individuals with acne to pick at their skin from time to time to try to remove the acne. This in itself may cause scarring, pigmentation or even infection.
Acne Excoriée is a condition where there is excessive, and habitual repetitive picking of the skin. Although more commonly seen in women, few individuals have difficulty acknowledging that a problem actually exists. Upon examination, there may indeed by very few active acne on the skin, and what is seen are fresh excoriations (scratch marks) and hyperpigmentation.
Even with effective acne treatments, the compulsive picking may be difficult to break. Treatment in the form of psychological therapy and medication may help break this cycle.
Body Dysmorphic Disorder
Body dysmorphic disorder is a condition that affects 2-3% of the population, and starts to manifest from the age of 12-13. It is characterised by intrusive and persistent thoughts and preoccupation with an imagined or slight defect in one’s appearance. The obsession with one’s appearance may lasts several hours of a day, and interferes with daily life. The persistent and intrusive thoughts make it difficult to form relationships, and many experience difficulties in school and/or work. There is often associated social withdrawal, anxiety, depression and eating disorders.
Acne Dysmorphobic Disorder is a subset of Body Dysmorphic Disorder. In this condition, individuals may suffer from a disturbed body image disproportionate to their acne condition. Some may perceive their acne to be severe even when there is few or absent acne lesions.
Effective treatments to improve outlook and quality fo life are available to help with the symptoms of this condition. In consultation with a psychiatrist, treatment options include cognitive behavioural therapy and/or medications.
Why Treat Acne
Acne is more than just a skin condition. It can cause social and psychological effects in both the adolescent and adults alike. These effects may appear mild or subtle to the outsider, but may in fact cause significant distress, frustration and anxiety to the individual. It may even masks clinical depression which is a treatable condition.
In a recent survey report on acne, social media behaviour and teenager’s self esteem, 72% of teens polled say that most people their age who use social media are conscious about their acne. 50% of teenagers with acne on social media may choose to edit pictures, delete pictures, or even avoid having their picture taken altogether. It can really be difficult living with acne especially when it affects self-esteem, fuels anxiety and interferes with meaningful relationships.
Acne is a treatable condition, where effective treatments have allowed many individuals to lead full and productive lives. Successful treatment of acne no doubt increases confidence, self-esteem and performance in work and school. Improving appearance, self perception and perception of control enhances the quality of life for many individuals.
- Yentzer BA, Hick J, Reese EL, Uhas A, Feldman SR, Balkrishnan R. Acne vulgaris in the United States: a descriptive epidemiology. Cutis. 2010;86:94-99.
- Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the burden of adult female acne. J Clin Aesthet Dermatol. 2014;7:22-30.
- Ritvo E, Del Rosso JQ, Stillman MA, La Riche C. Psychosocial judgements and perceptions of adolescents with acne vulgaris: A blinded, controlled comparison of adult and peer evaluations. BioPsychoSocial Med. 2011;5:11.
- Skaggs RL et al. Characterization of Patient’s quality of life and experience on the course of acne treatment. SkinMed 2017;15(6):431-435.