The psychological effects of acne can be considerable. The psychological morbidity is complex and often does not conform to standard psychiatric disease criteria. Recognition and management of the psychological squeals of acne by general practitioners is of considerable importance.
Self-image and self-esteem
The link between appearance and subjects' self-image or self-concept and self-esteem was explicit and gave rise to much of the psychological morbidity in acne patients. Not surprisingly,
the effect of an acne-related self-image on their self-esteem was considerable for many subjects. The effect was global and pervasive and colored most aspects of many subjects' lives. Some older, more self-reflective, subjects noted that acne effect was particularly acute because of its peak prevalence during the teenage years, a time of psychosocial and sexual maturation and development of adult identity. A prominent element of self-image in the teenage years was acne's effect on self-perceived sexual attractiveness.
Embarrassment and self - consciousness
Embarrassment and self-consciousness were directly linked to self-image and self-esteem. The theme of embarrassment was prominent in all subjects' responses and was seemingly easier for many subjects to articulate than, for example, dysphoria or depression or anxiety.
Taunting and being judged.
Two important exacerbating factors in the relationship between acne and embarrassment and self-consciousness were taunting or teasing and a perception of being judged by others. Teasing could be psychologically damaging. Many participants were uneasy that they would be judged not only as unattractive but as less worthwhile people. They even feared being thought unhealthy, unhygienic, or in the case of the subject quoted here (a nursing student), not fit to be a health professional. The word "stigma" was used infrequently, but the theme of stigmatization was apparent in discussions of judgment.
Depression and anxiety
Mood and anxiety symptoms were common in this study, but depression and anxiety were somewhat peripheral in the map of psychological morbidity. A striking finding was that symptoms of anxiety related temporally to experiences of acne tended to be milder and less obvious than would be required for a clinical diagnosis of major depression. At times, emotions described as depression by subjects were more consistent with frustration and anger than with clinical depression. Another notable finding was that anxiety tended to arise in anticipation of, rather than during, episodes of being on show.
Consequences of the effects of acne
Consistent with findings regarding reduced self-confidence and fear of being on show were indications of avoidance behavior.
Permanent effects on personality
Contrary to the common perception that acne is a minor and temporary affliction of adolescence, many subjects thought that acne had had a permanent effect on them. Some subjects reported avoidance behavior in response to their acne, and some bore evidence of avoidant personality traits.
Moderating factors
Some factors moderated the relationship between acne and psychological squeals. Age and sex were relevant; women with late-onset acne were seen as especially likely to have squeals. Supportive family and peer groups were generally seen as buffering the psychosocial effects of acne. Women found camouflaging their acne with makeup was effective in decreasing embarrassment and self-consciousness, while men tended to try to rationalize acne as a normal accompaniment to adolescence. Subjects of both sexes employed "compensation," which is pursuit of endeavours that compensated for their acne-affected appearance.
