They say beauty is only skin deep, but anyone who has had acne begs to differ. How we look on the outside has a huge impact on our confidence and self-esteem.
It may seem strange to think that something as small as a clogged pore can change our decision to go out with our friends, to join an activity, or to talk to a new person, but the fact is, it does. By affecting how we feel about ourselves, acne changes how we relate to others.
But a pimple does not have to dictate your life decisions. You can learn to let go of this kind of thinking, but first you need to understand the complex ways that acne affects mental health.
The struggle is real
And by “real”, we mean scientifically proven. The effect of acne on self-esteem is not “all in your head”, it’s a phenomenon that has been observed across cultures and ages.
Studies conducted on Brazilian students, Malaysian students, adolescents and adults from the UK, Italy and Germany all found the same thing: that acne-ridden individuals are plagued with a lot more anxieties than their clear-faced counterparts. They hate looking at the mirror, shy away from having their photos taken, and feel uncomfortable making new friends. Many reported deciding not to go out with friends or go to school during bad breakouts out of fear of being made fun of. Acne has caused people to refuse to do sports or join social activities that they are interested in. Some even feel like their pimples cost them a potential job.
Even among skin disorders that also contribute to uneven and rough skin, acne appears to present more psychological issues. Compared to those who are diagnosed with seborrheic dermatitis, acne sufferers are more likely to experience depression and social anxiety.
A paper published by the International Journal of Women’s Dermatology reviewed 13 scientific articles and found overwhelming evidence that acne contributes strongly to low self-esteem, especially on female patients.
We could go on and on about the research conducted and studies published, but all of them validate what we already know: that mental health and acne are issues that come hand in hand, but are rarely treated together.
Body dysmorphic disorder
The implicit understanding is that once acne is cured, the feelings of shame and self-hate are cured along with it. However, that is not the case for those who suffer from body dysmorphic disorder (BDD).
Body dysmorphic disorder is a psychiatric condition that is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is characterized by debilitating preoccupation with a perceived physical deformity, even in the absence of such.
In layman’s terms, this refers to people who cannot function normally because they think they’re disgustingly, embarrassingly ugly, when the truth is, they look fine. In the context of acne, people spend hours worrying about their pimply skin, even when they’ve already gotten their skin cleared up.
Research shows that BDD is much more common among those who suffer from acne compared with those who do not. It’s highly likely that it remains underdiagnosed as many are dismissive of the turmoil we go through “just because” of pimples.
BDD represents the most extreme manifestation of insecurities stemming from acne, but the spectrum is wide. If you feel that the anxiety about your skin condition is crippling your ability to make decisions, we strongly encourage you to seek the professional help of both a dermatologist and therapist.
Your problem is valid and deserves attention. There should be no shame in seeking help for acne and for how it makes you feel.
Tips to help lessen acne anxiety
Though not all people who struggle with acne have BDD, it’s safe to say that their quality of life is still very much affected by the skin condition.
So if your decision-making process is not dictated by a breakout, but you still can’t help but feel self-conscious and embarrassed when you go out, here are some tips you can use to hold your chin a little higher.
Normalize acne through choosing social media content
We are constantly bombarded by airbrushed and filter-laden pictures that tell us smooth skin is the norm, when it is not. A staggering 85% of people aged 12 to 24 have experienced pimples, blackheads and whiteheads, but you couldn’t tell based on what you see on mainstream media and social media.
But the one saving grace of social media and the internet is the ability to choose content. It will take a while (or maybe never) for mainstream media to have acne representation on the TV or big screen. So find inspirations in real life.
You can join online support groups for those suffering from acne and find people who relate to your struggle. You understand that you’re not alone and your feelings of shame and loneliness are valid. At the same time, you find support in people who have gone through what you’re going through, and can share with each others tips on skincare, makeup, and ways to deal with the stress of a breakout.
Follow hashtags like #normalizeacne and #acnepositivity on Instagram, Twitter, and Tiktok so your feed reflects reality rather than the alternate world of clear-skinned, airbrushed models. You’ll see real life people with real life skin who are still able to celebrate who they are and how they look.
Search for celebrities who have shared their struggles with acne. A shortlist includes the likes of Lili Reinhart, Justin Beiber, and Kylie Jenner. Blemished people tend to hide from the limelight in shame, but these people are living proof that it doesn’t have to be that way.
Separate self-worth from skin condition
This is a lot easier said than done. We live in an age when businesses benefit from self-esteem issues, so this message is reinforced in both subtle and overt ways. But we have to challenge this thinking if we want to lessen the anxiety we feel about our acne.
We tend to hyperfixate on our acne when it’s not what defines us. There is so much more to you than your pimples, and realizing that can help you seize control of your life rather than handing over the reigns to your insecurities.
Yes, you have pimples. But what else do you have? Maybe you have a cute butt, or a talent for web design, or the ability to make people laugh. Yes, you had a breakout this week. But what else happened? Maybe you made a mouth-watering batch of cookies, or got a good score in the test you were so nervous about, or taught your dog a new trick.
While you cannot deny the reality of your skin, it isn’t the basis of your identity. There is so, so much more to you than the acne on your face. And the sooner you start recognizing that, the sooner you’ll stop letting it control your decisions.
But real talk: This is not an overnight solution, it’s a lifelong process. You will always have to battle with your issues, but it does get easier with practice. So whenever you find yourself obsessing about things about yourself you don’t like, take a step back and find things about yourself that you do like.
With enough practice, it’ll be easier to spot the good in yourself rather than fixating on the bad.
Get your acne information from reputable source
In this age of social media, you are bombarded with ads, influencers, and clickbait articles promising a cure to acne. We see amazing before-and-after pictures, and imagine us submitting our own. So we buy that product or do this regimen, and more often than not, end up failing.
The cycle begins again, and with every failed attempt, we start to think that this skin condition will never go away and that there is nothing we can do about it. This is where a lot of the anxiety roots from: the feeling of helplessness.
But maybe, just maybe, the problem may not be that we are helpless, but that we seek help from the wrong places. A study published in the Pediatric Dermatology scientific journal that 69% of those who take acne advice from social media sources make skin care changes that do not align by the guidelines set by the American Association of Dermatologists. This means that the effort and time these people put into changing their skin is not backed by medical science.
One way of empowering yourself is learning more about acne from reputable sources. Remember that the skin is an organ and acne is essentially a disease of that organ. Let that approach guide you when looking for advice online.
By learning more acne from a scientific perspective, you may be able to understand why that product didn’t work or why that regimen was ineffective. You begin to make skin care choices based on science-backed evidence rather than fancy advertising and marketing schemes. And the possibilities for improvement are much higher.
They say knowledge is power, and that rings true for acne as for anything else.
This content is for general information only and is not a substitute for medical advice.
Resources:
Yousaf, Ahmed & Hagen, Rachael & Delaney, Emily & Davis, Stephen & Zinn, Zachary. (2020). The influence of social media on acne treatment: A cross‐sectional survey. Pediatric Dermatology. 37. 10.1111/pde.14091.
Fabbrocini, G., Cacciapuoti, S., & Monfrecola, G. (2018). A Qualitative Investigation of the Impact of Acne on Health-Related Quality of Life (HRQL): Development of a Conceptual Model. Dermatology and therapy, 8(1), 85–99. https://doi.org/10.1007/s13555-018-0224-7
Bowe, Whitney & Leyden, James & Crerand, Canice & Sarwer, David & Margolis, David. (2007). Body dysmorphic disorder symptoms among patients with acne vulgaris. Journal of the American Academy of Dermatology. 57. 222-30. 10.1016/j.jaad.2007.03.030.
El, Mahaabd & Mohamed, Sayeda & Mohammed, Radwa. (2019). Impact of Acne on Self-Esteem and Body Dysmorphic Disorder Symptoms among Adolescents with Acne. 163. 204-229.
P, A., Gengatharan, R., Zulkiflee, S., Ganisan, P., Arumugam, S., & Kumar, N. (2018). Acne and One‘s Self Confidence: Cross-sectional study on Malaysian Student population. Bangladesh Journal of Medical Science, 18(1), 83-86. https://doi.org/10.3329/bjms.v18i1.39555
Gallitano, S. M., & Berson, D. S. (2017). How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem. International journal of women's dermatology, 4(1), 12–17. https://doi.org/10.1016/j.ijwd.2017.10.004
Khan, M. Z., Naeem, A., & Mufti, K. A. (2001). Prevalence of mental health problems in acne patients. Journal of Ayub Medical College, Abbottabad : JAMC, 13(4), 7–8.
Behnam, B., Taheri, R., Ghorbani, R., & Allameh, P. (2013). Psychological impairments in the patients with acne. Indian journal of dermatology, 58(1), 26–29. https://doi.org/10.4103/0019-5154.105281
