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More Than Just Skin Deep: The Psychological Impact of Acne

When people think of acne, they usually only think about the physical symptoms: red, inflamed skin, painful pimples that hurt when you smile. But acne goes deeper than that. Acne is not only physical, it’s emotional, psychological and affects every aspect of our lives. For those that have had or still have acne: IYKYK.

For years, my whole life was affected by my skin: I didn’t want to date. I avoided exercising around people. I stopped swimming. I never got snapchat because the thought of sending real-time photos of my make-up free skin was horrifying. I would avoid sitting under bright downlights that would showcase my acne. And I hated spontaneous plans because it took me so damn long to get ready (I envied those throw-on-a-dress-and-go type girls).

It ruined my confidence, my self-esteem, my relationships. I felt ashamed. Alone. Ugly. I felt like no one could ever want me.

You are not alone

As much as I felt like I was the only one with these thoughts, I discovered that it wasn’t just me. There is study after study showing the emotional impact acne has on both women and men.

It is well documented that people with acne have a tendency to suffer from depression, stress, low self-esteem, and negative body image [1, 2]. Even suicidal though patterns were found in 6-7% of people with acne [3]

Acne impacts how confidently people show up at work and how they behave in relationships with friends, family and romantic partners (especially romantic partners!) [4, 5].

One study showed that 75 percent of participants felt acne made them feel frustrated, embarrassed and more self-conscious around others. And without make-up, they would feel less confident and unattractive [6].

And it’s just getting worse

Our generation is becoming more emotionally triggered and more self-conscious about acne than ever before. And we can thank the rise of technology, social media and 24/7 accessibility to other people’s lives for that.

Whether we like it or not, we live in a society where we are judged based on first appearances – there’s literally whole dating apps based around this concept. We feel obligated to wear a face full of make-up or filter our skin to hide our acne. Because if we hide it, then we can feel beautiful. Then we are considered attractive by society’s standards. Today’s beauty standards are making us feel even worse about what we look like and adding gasoline to an already blazing fire of insecurity.

And unfortunately for those who’ve had acne for a while (I’d have gotten my long-service award in acne by now), the emotional hold on you still remains even after the acne is long gone. I still cannot look at myself in a hairdresser’s mirror to this day.

How to reduce acne’s PSYCHOLOGICAL real-estate?

Negative thought patterns about our skin and any aspect of our lives will always be there. Think of it like the bass line of a song – it’s the constant rhythmic tune playing in the background.

But it’s up to you whether you give the bass the spotlight or whether it will just keep humming away in the background. It’s up to you to determine how much attention you give to those negative thoughts. We have the power to re-frame how we see ourselves, our situation and our skin.

Evidence also shows the power of positive thinking not only impacts mental health but also physical health such as positive changes in the immune system, and a reduction in anxiety and stress [7,8,9]. This means lower levels of inflammation and a decrease in one of the key hormonal contributors of acne – cortisol.

I know you’re probably thinking: “when I look at my skin and see a face-full of acne it’s impossible to just think positive and feel better”. And you’re damn right! I mean if someone told me that back when my acne was at its worst, I’d probably want to slap them across the face. I will, however, tell you the exact things I did that helped me get through some of the worst times with my skin.

The “my skin is shit right now” Emotional Tool Box

1.) Positive Practice Commitment – Whether it’s writing down three things you’re grateful for in the evening, a high-5 in the mirror in the morning, post it notes all over your home, or saying loving affirmations to yourself. Whatever practise floats your boat, commit to it for the next 30 days and see if it changes the way you feel not only about yourself and your skin but the way you show up in life.

2. The Next Best ThoughtWhen you’re in one of those negative skin-talk spirals – you know the ones where you’re crying in front of the mirror at that new mega pimple on your already red face – I want you to take a moment, breathe and then think of the next best thought. And it doesn’t have to be about your skin at all. Just something as small as “My hair looks great today” or “I love that I got free coffee at work”. See how you can automatically shift your mood from a negative to positive feeling?

3. Feel the Feels – In saying the above, it’s not about pushing the thought away. The reason why you have those negative thoughts in the first place is valid and it’s important to process those emotions. You are allowed to have a cry. Full permission to go watch A Fault in our Stars or My Girl and let those tears roll (or maybe that’s just the emotional movie watcher in me). Whatever you do, just allow those emotions to flow through you and then you can pick yourself back up. I promise you’ll feel better after a good cry and wallow.

4. Talk It Out – Do you have a friend that’s had acne or skin issues that could relate? Or maybe a supportive partner, family member or therapist that you can trust to talk openly to? Getting everything off your chest about how you’re feeling can feel like a massive weight has lifted off your shoulders. It also helps the people around you understand what you’re going through and can help them be a bit more empathetic to the situation (most of the time the lucky non-acne-prone people don’t really understand all the shit that goes through your head on a daily basis).

5. Mirror Affirmations – My mirror is covered with positive thoughts, affirmations and quotes. It’s something I can visually see every day that reminds myself and puts me in a positive headspace for the day no matter what’s going on. Here’s a few I’ve used on rotation in my years:

You are enough. You are strong. Your skin is healing. Your skin is your body’s messages. I am proud how far I’ve come. I am worthy of feeling happy

From all of this I want you to know that you are not alone. The thoughts you have scrolling through your head on a daily basis are not just yours. They are mine. They are the thoughts of the 650 million people in this world who have acne (yes, nearly 10% of the global population).

But you are more than your thoughts. You are more than your skin. You have the power to reframe how you see yourself and your skin.

Yes, it’s a constant process. Yes, it’s a forever habit trying to reframe the way you see your skin (I still do it to this day). But overtime it will get easier. And I promise, there will be a day when you look at yourself in the mirror and hate your skin a little bit less. A day when you can sit under bad lighting and not feel self-conscious. A day when you can go on a date without worrying about whether they’re looking at your skin.

How would you feel then? *cue Freedom by Beyonce’*

References

1. Loney T, Standage M, Lewis S. Not Just `Skin Deep’: Psychosocial Effects of Dermatological-related Social Anxiety in a Sample of Acne Patients. Journal of Health Psychology. 2008;13(1):47-54. doi:10.1177/1359105307084311

2. Kellett, S., & Gilbert, P. (2001). Acne: A biopsychosocial and evolutionary perspective with a focus on shame. British Journal of Health Psychology, 6(1), 1–24. https://doi.org/10.1348/135910701169025

3.  Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420–6

4. Murray, C., & Rhodes, K. (2005). Nobody likes damaged goods: The experience of adult visible acne. British Journal of Health Psychology, 10(2), 183-202.

5. McNiven A. ‘Disease, illness, affliction? Don’t know’: Ambivalence and ambiguity in the narratives of young people about having acne. Health. 2019;23(3):273-288. doi:10.1177/1363459318762035

6. Tanghetti, E. A., Kawata, A. K., Daniels, S. R., Yeomans, K., Burk, C. T., & Callender, V. D. (2014). Understanding the burden of adult female acne. The Journal of clinical and aesthetic dermatology7(2), 22–30.

7. David C. McClelland & Carol Kirshnit (1988) The effect of motivational arousal through films on salivary immunoglobulin A, Psychology & Health, 2:1, 31-52, DOI: 10.1080/08870448808400343

8. University of Queensland (2014, September 28) A Positive Boost to the Immune System. UQ News: https://www.uq.edu.au/news/article/2014/09/positive-boost-immune-system

9. Eagleson, C., Hayes, S., Mathews, A., Perman, G., & Hirsch, C. R. (2016). The power of positive thinking: Pathological worry is reduced by thought replacement in Generalized Anxiety Disorder. Behaviour research and therapy78, 13–18. https://doi.org/10.1016/j.brat.2015.12.017

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