My research at Hull University looks at emotional impact of skin disease, in particular, acne. In my clinical practice I see all spectrum of acne – from a few spots on the chin to scarring and pigmentation after being treated for a year or so and discharged by a dermatologist. I understand the impact acne/spots/blemishes have on my clients’ private lives.
Skin – Stress – Emotions.
- Already 20 years ago, it was suggested that skin could form a channel of communication for unexpressed feelings (Koblenzer, 1983) and nowadays research shows that skin disease and emotional lability may be connected. Arnetz, et al. (1991) lists the psychosocial stressors that are related to onset/relapse of acne – these include marriage, divorce, bereavement, excess of minor life-events and multiple daily hassles.
- New line of dermatology research seeks to reduce stress in skin diseases. Already Hughes, et al. (1983) found that relaxation with cognitive imagery and physical treatment produced significantly greater reduction in facial acne (compared to a matched physical treatment alone). Furthermore, patients who failed to continue with the psychological therapies experienced a relapse.
Acceptance in the Society.
- The desire to appear attractive goes beyond the sexual domain – attractive people have advantages in the society (Etcoff, 1999). Attractiveness is related to social approval and we have evolved with strategies to attract others and elicit their approach behaviour. These strategies have become central in many domains of social life; sexual attraction, alliance formation, in-group acceptance and leadership.
- In acne, feeling stigma and shame can be very acute, emotionally painful and socially debilitating. The psychosocial impact of acne lies in its ability to disrupt – at least in the eyes of the sufferer – signals of social acceptability to peers and potential sexual partners. The blemished skin “acts as a signal of disease” eliciting rejection and avoidance from others. Culturally, skin clarity is commonly enhanced in media-generated images of idealized, desirable people. People with acne may not be able to induce positive feelings about themselves in others. They fear inducing negative feelings – anxiety, anger, or disgust – that are likely to reduce the chances of being seen as desirable (Porter, et al., 1990) and prevent mutually rewarding relationships. Research suggests that believing that others think negatively of you leads to changes in behaviour that can result in self-fulfilling prophecies (Crocker & Major, 1989).
Evolutionary Links
- There are evolutionary reasons explaining why those who “appear ill with acne” are avoided through natural aversion to avoid possible contamination. Skin clarity is perceived as a sign of “good genes” and often, unfairly, negative personal characteristics are attributed to people with acne – thinking of them as dirty, lazy – and making them appear doubly unattractive.
- Social comparison is an old social cognition and salient in judging one’s own attractiveness to others (Gilbert, 1995). Negative social comparison and the negative emotional states are linked. Women, and even more so older women, are particularly prone to acne-related embarrassment (Krowchuk, et al., 1991). It is because they have hightened levels of self-consciousness and also physical attractiveness is a more central part of female sexual strategies.
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