To those who’ve followed my journey, you know I’ve battled acne for over a decade. For some, that might seem insignificant – ‘oh, it’s just acne, people have much worse things going on’ or ‘it doesn’t even look bad, no one cares’.
I acknowledge that my situation isn’t as severe as many others. However, that doesn’t diminish the impact acne has had on my mental health. Skin conditions can significantly impact self-esteem. It’s frustrating to face constant dismissal and invalidating comments from those who’ve never experienced acne firsthand. But, that’s a topic for another day.
Anyway. Studies show that acne does impact mental health. Majorly. The British Journal of Dermatology published the review ‘Is it really ever ‘just acne’ back in 2023, which shared some shocking statistics:
- The prevalence of anxiety in patients with acne is estimated to be as high as 68.3%.
- People with a range of common dermatological diagnoses (including acne) had a sixfold increased chance of experiencing symptoms of body dysmorphic disorder (BDD).
- 22.3% of 2166 respondents to an online survey had considered taking their own life as a result of their acne.
My experience of acne & mental health
For years, my acne has taken a toll on my mental health.
For years, I haven’t been able to leave the house without spending at least an hour on my makeup and truly believed people would be disgusted at the state of my natural skin.
For years, social events due to my skin have caused me intense anxiety, with weeks of worry, planning and preparation in the lead-up to the event ruining any chance of actually having a good time.
For years, I’ve restricted my diet and felt guilty after eating anything even slightly unhealthy, monitoring my nutrition and quite literally becoming obsessed with drinking copious amounts of water and taking a long list of expensive supplements.
For years, I’ve believed that my acne made me ugly and unlikable. Hell, I’ve even convinced myself that it must mean I’m unhealthy and unhygienic, even though the daily rituals I’ve developed would suggest the complete opposite.
But I just got on with it. I wasn’t okay, but I was okay – if that makes any sense. I’d developed so many coping mechanisms and routines to manage my acne and push how it made me feel to the back of my mind. I was also really good at appearing outwardly put together and chilled, whilst my life behind the scenes was kinda chaotic and anxiety-riddled.
Why it all went downhill in 2024
2024, the year when pushing how I felt to the back of my mind (life lesson: don’t do that) finally, truly, bit me in the butt. That anxiety I’d always felt about my appearance spiralled into depression and, later, a diagnosis of body dysmorphic disorder (BDD).
I understand that sharing such a personal experience might sound intense. I’m not seeking sympathy, but rather aiming to raise awareness and offer support to others who may be going through similar struggles.
So what started it all off? In 2023, I’d managed to get semi-clear skin naturally, through diet and lifestyle changes, after years of intensive acne medications. It took a lot of dedication and sticking to a strict diet and routine, but I legitimately thought my years of acne were over and was so pleased to just be dealing with one or two spots at a time.
When my skin flared up majorly earlier this year, I felt heartbroken. I hadn’t changed anything in my diet or lifestyle, other than letting go a tiny bit over the Christmas period (which is pretty normal, right?!) and couldn’t afford another £1,000+ to get all the tests I’d previously gotten to figure out what was going on internally.
I quickly went into panic mode, spending all my spare time researching what could be the cause, restricting my diet even more, buying more supplements and skincare, analysing my skin in the mirror 24/7 and going into meltdown every time I felt another lump beginning to swell up on my chin or jaw.
When nothing seemed to be helping, the obsession became more and more intense. I was crying daily and picking at my skin obsessively and compulsively until it bled, in a bid to expel all the infection (which only made things worse). I stopped going to the gym in fear the sweat would make my skin worse and cancelled on lots of social events because I worried people would think I was gross.
I believe the milestone of turning thirty might have had something to do with my intensified feelings. I’d spent much of my teens and most of my twenties trying to manage this damn skin condition and feeling embarrassed about my damaged skin. My thirties, I thought, would be a fresh start and a chance to put all the energy I’d used on trying to manage my skin, into other things, like work, friendships or this blog – ha, nope.
The worst two weeks of my life (and trying Sertraline)
My mental health had got so bad that I finally plucked up the courage to see the doctor. She signed me off work for a month, citing ‘mixed depression and anxiety’ as the reason, and gave me a prescription for Sertraline.
The first two weeks on Sertraline were absolute hell. All my feelings were amplified. I couldn’t look in the mirror without bursting into tears or having a panic attack, I could barely get out of bed in the mornings, barely ate, ended up calling crisis hotlines multiple times per day and had my parents on speed dial trying to get me through each day. I thought I understood mental health but until these particular two weeks, I don’t think I truly did.
I’m glad to say I’m feeling a lot better now (more on that later), but god, it scares me to know I can feel that bad. And, just an FYI, if you ever need to start anti-depressants, be prepared to feel worse before you feel better.
Getting diagnosed with body dysmorphic disorder
The mental health nurse at my GP decided (and, tbh, I agree) that I needed high-intensity ‘level 3’ therapy, rather than the 30-minute ‘level 2’ phone-based therapy they also offer, and that I’d had before. The problem? The waiting list is 9 months or so.
Thankfully, my parents offered to pay for private therapy for me. It makes me sad to know that so many people out there feel just as bad as me – or worse – and have to wait almost an entire year for help. In fact, it’s not just sad, it’s dangerous. But again, that’s a blog for another day.
I went in for my assessment, where I spoke through everything that had happened, how I felt and how it was impacting me now. The therapist’s instant conclusion? “You’re suffering from body dysmorphic disorder”.
Honestly, this confused me at first. I thought body dysmorphic disorder was when you were imagining that something was wrong – or saw something completely different to reality – but I did have acne. Like, it was right there on my face, so how could I have BDD?
What is BDD?
According to Mind, BDD is an anxiety disorder related to body image, which is closely related to obsessive-compulsive disorder (OCD). People with BDD often:
- Deal with obsessive, intrusive and negative thoughts about their body or face, or a particular perceived flaw.
- Spend several hours a day thinking about the area or areas of concern and become preoccupied with negative thoughts about their general appearance.
- Develop compulsive and repetitive behaviours and routines – such as mirror checking, camouflaging, overexercising, skin picking, researching, and shopping for treatments, products and supplements – to deal with the anxiety they feel about their appearance.
- Spend hours each day carrying out these behaviours to try to reduce the anxiety.
- Experience significant disruption to your daily life as a result of these worries and behaviours, such as avoiding social situations.
This explanation clarified my understanding. BDD didn’t mean I was delusional; it meant my preoccupation with my acne had spiralled into obsessive thoughts and compulsive behaviours that worsened my anxiety.
People with BDD, like myself, often struggle with the misconception that we’re simply vain. In reality, we’re plagued by crippling self-doubt and anxiety about our appearance. An example of this, for me, is my chronic lateness. To others, might appear rude, lazy, vain or high maintenance, but really, it has always stemmed from the fear of not looking ‘acceptable’ enough to leave the house.
As the BDD Foundation explains, “People with Body Dysmorphic Disorder aren’t vain – quite the contrary. They believe themselves to be ugly or defective. BDD is a serious disorder that shares similarities with obsessive-compulsive disorder, health anxiety, and social phobia.”
What I’m doing to treat my BDD (and acne)
I plan to do a series all about what I learn in therapy for my BDD, to help people who don’t have access to therapy right now. But as this blog has gotten pretty damn long, I’ll quickly wrap up with a quick summary what I’m doing now.
For me, therapy, and a lot of hard work, are key to getting better.
Early on, my therapist (who’s fantastic, by the way, and based in Chester) explained a common BDD pattern: we use ‘safety behaviours’ – like excessive mirror-checking, online research, or skin-picking – to try and manage our anxiety.
But these behaviours, while temporarily soothing, actually worsen the condition, trapping us in a vicious cycle. Therapy, on the other hand, provides the tools and strategies to break free from this cycle, offering a path to recovery.
A huge part of the therapy is stopping said safety behaviours – which, if you’ve relied on them as much as I have for several years, is far from easy. It’s gonna take time, but I’m so glad I’m at least aware of what’s happening in my brain and am on a path to fix it.
So, I hope that if you’re experiencing similar feelings, you know that you’re not alone. You’re note weird, crazy, strange or vain (like I felt for so long) – you’re suffering from a mental health condition and can get better.
Keep an eye out for my ‘what I learnt in therapy’ series, where I’ll be sharing everything I learn to recover from BDD – we’re in this together 🙂
3 responses to “How acne led to a body dysmorphic disorder (BDD) diagnosis”
Hi Alice,
I’m a 32 year old woman. I am currently in the thirty day waiting period to start accutane again (second time). I really resonate with everything you are saying. I have BDD and just started an antidepressant because the compulsions (obsessive mirror checking) have gotten so bad. Thank you for sharing your story.
Did you ever do the “what I learned in therapy?” Posts?
I didn’t – but, you’ve just made me remember that I need to, and definitely should. I’ll write something soon!