Recognizing acne as a feature of emotional disorders

When self-esteem and self-image become an overwhelming preoccupation in some
people, they may show signs and symptoms of types of acne that have severe
underlying emotional and psychiatric underpinnings.
 Acne excorieé. This is a self-inflicted skin condition in which the sufferer has a
compulsive, irresistible urge to manipulate their skin and to pick real, as well as
imagined, acne lesions. This results in a worsening of acne and sometimes scar-
ring of the face. Also known as acne excorieé des jeunes filles, this type of acne
is almost invariably seen in young females. Jeunes filles means “young girls” in
French, but this condition is also seen in adult women (and males aren’t immune).
Many of these females deny that they manipulate their skin, but it’s rather obvi-
ous when you can see scabs that are almost always present on their faces. It’s
assumed that they have an underlying obsessive-compulsive disorder, a type
of emotional problem characterized by persistent thoughts and ideas and repet-
itive behavior.
 Body Dysmorphic Disorder (BDD). This psychiatric condition is characterized
by a fixation and chronic complaining about a nonexistent or minimal cosmetic
defect or minor flaw in one’s physical appearance. The “flaw” can be wrinkles,
large pores, or just a few pimples. The person with BDD exhibits an unreason-
able amount of anguish about them. BDD occurs equally in males and females.
BDD often results in significant suffering and social difficulties. Individuals with
BDD have variable degrees of awareness concerning the psychiatric nature of
the illness. Many people continue to agonize about an imagined defect although
they’re aware that their concerns are excessive, while other folks have no insight
into their unusual preoccupation with their appearance. Some people with BDD
frequently develop major depressive episodes and are at risk for suicide.
Treating acne excoriée and BDD is a major challenge. Certain medications and
cognitive-behavior therapies can complement each other and be helpful for some
people. Cognitive-behavior therapy involves discovering, challenging, and changing
the underlying negative thoughts and beliefs that the people with these conditions
repetitively dwell upon.
In addition to these treatments, family education and counseling, to help family
members understand what’s going on and how to help the sufferer, and group ther-
apy may be of benefit. Unfortunately, individuals with acne excoriée and BDD often
refuse psychiatric referral because of their poor insight into the underlying psychi-
atric illness.