Sadly, scientists haven’t studied the connection between stress, anxiety and acne in detail. But from what we know, it’s very likely that stress and emotional suffering can cause or aggravate acne. I also believe that they are the primary cause of acne for some people.

Stress and anxiety trigger the release of neurotransmitters. There’s evidence to show these neurotransmitters affect the skin in a way that increases the risk of acne; including an increase in sebum production, a release of inflammatory substances, and weakening of the skin barrier function. Stress can also affect acne indirectly by causing insulin resistance and boosting the levels of hormones linked to acne. Stress is also a known factor in many gut problems. In short, if there’s something that’s bad for your skin, stress will make it worse.

What I call emotional acne is probably similar to what psychologists call body dysmorphic disorder (BDD). Here’s what the Anxiety and Depression Association of America says about BDD:

People who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day. They can’t control their negative thoughts and don’t believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

Body Dysmorphic Disorder (BDD)
Anxiety and Depression Association of America

Emotional acne is one of the hardest nuts to crack, mostly because people with emotional acne often insist on doing exactly the wrong things.

Many people are going to have an immediate gut reaction against what I will say next. So please, take a deep breath and hear me out. Because this is really important.

You cannot get over emotional acne by fixing acne. Acne is not the main problem in emotional acne and focusing on getting over acne is not, in my opinion, the best thing to do.

I’m not saying that that getting over acne wouldn’t make you feel better. Of course, it would.

I’m saying that, paradoxically, trying to get over acne is probably not the best way to get over emotional-type acne – and that it may not even be possible.

This is not some weird Zen of Yoda speak; this will make perfect sense in a moment.

The root problem is usually dysfunctional self-image, -beliefs, and patterns of thinking. The pain that stems from self-image problems gets linked to acne. Acne becomes a channel for the pain, and it takes the blame for the pain. It’s much easier to say I’m ugly because of acne than to admit I’m ugly and just don’t like myself. Similarly, people often believe that, if they could only get over acne, then they would be happy/successful/rich/whatever.

They rarely realize that it’s their beliefs, and the way they think, not acne, that causes the suffering. They get into this cycle where they do everything they can to get over acne. But nothing they do has any real effect on their emotional pain, and acne refuses to budge. Lack of result, despite all the efforts, causes even more anxiety and desperation. They often feel they need to do more, cut out more bad foods, be even stricter with diet, take more supplements, to do more cleansing. And so the cycle goes on.

While nobody denies that acne is a factor in their emotional suffering, there’s evidence to show it’s not the main reason (more on that later).

Side note about severe acne

What I just said applies to mild and moderate acne cases. I’m not sitting here pretending that severe acne and scarring wouldn’t cause emotional suffering and low self-esteem by itself.

Signs of emotional acne

• Acne causes severe stress and anxiety.
• You spend a lot of time obsessing over acne.
• You are very sensitive to comments about your skin.
• Stress and anxiety acne causes are NOT linked to its severity. People with severe acne may experience less stress than someone with mild emotional acne.
• Friends and family don’t think your acne is as big of a problem as you think it is.
• You don’t want to leave the house, and you are becoming socially isolated, or acne otherwise interferes with your daily life.
• You are willing to do almost anything to get over acne, e.g., stick to an extremely restrictive diet; you fear that even small slip ups will cause acne; you are extremely healthy; you take all the supplements you can think of.
• You believe other people think less of you because of your acne. It may even seem like they are using body language to signal they don’t like you, for example by turning to face away from you or imperceptibly putting more distance between you and them.
• You believe you have to get over acne until you can be happy / successful / get a job / find love / whatever.

I want to make it clear that it’s normal for almost anyone with acne to show some of the signs. Someone with a severe acne may be reluctant to leave the house, which is completely understandable and doesn’t necessarily mean one has emotional acne.

My ‘diagnostic criteria’ for emotional acne is the combination of high levels of stress and willingness to go to extreme lengths to get over acne with little to no results to show for. The emails from people with emotional acne usually begin with something like this: “I’ve suffered from acne for years, and I’ve tried/ am doing [insert a very long list of diets, cleanses, supplements, meditation, etc.], but nothing seems to help. I’m desperate and stuck, what can I do?”

If you think you have emotional acne, you may also want to take this screening questionnaire for BDD (free and takes only a minute).

If the above rings true and the BDD screening questionnaire indicates you could have BDD, it’s critical to realize that your best bet for getting over acne is to deal with the emotional pain first; because it’s possible the pain itself perpetuates your acne. You have to break the acne > stress > more acne > more stress cycle. And that if you haven’t managed to deal with the acne part of the cycle before, it might be better to focus on the stress part.

Even if you disregard everything I just said

Let’s say you don’t buy what I just said. You know stress has little to do with your acne, and you can deal with it using diet and lifestyle.

Regardless of that, it still makes sense to deal with whatever is causing your emotional pain. Think about it; most people want to get over acne because they want to get over the emotional pain and stress it causes. They want to feel happy and be ok with themselves. They want to end the suffering.

My point is that it might be possible to feel happy and be ok with yourself even if you haven’t completely gotten over your acne. We’ll talk more how to do that later. And, if dealing with emotional pain also helps your skin, even better. But feeling happy is a worthy goal just by itself.