[Meta description: Spending more than an hour a day trying to fix your acne in the mirror or avoiding social situations because of your acne are signs that you may benefit from working with a therapist.]
For most of us, acne is unpleasant. It can even be stressful. A big pimple that seemingly arrives out of nowhere overnight right when you have something important going on; another breakout across your chin when the last one was just clearing up; acne spots that linger for weeks. The majority of people are familiar with acne distress: 85 percent of young people have experienced acne, which can persist into adulthood.
We know there are many things you can do about your acne, from topical to prescription medication. Some people, however, become fixated on their acne to the point where it’s difficult to look at their own reflection in a mirror or leave home for school or work. They feel as if they don’t really see themselves—all they see is their acne.
If you fixate and obsess about your acne, your problem is probably more psychological than dermatological. But because society tells you that acne is bad and it’s something worth fixing, it can be difficult to know when obsessing over your acne is a true problem or not, and what you can do to get help.
There can be quite a few things at play behind your distress over your acne, including anxiety, dermatillomania, and body dysmorphic disorder. You might also want to know if this type of obsession can be a form of obsessive-compulsive disorder (OCD).
Read on to learn more about when a fixation on acne is a mental health concern, what could be going on, and how to get the help you need.
Signs that your acne obsession is a mental health issue
It’s normal and understandable if you’re concerned about your acne—whether it’s the occasional pimple, a breakout, or cystic acne. And if you can’t keep your hands off of a zit, you’re certainly not alone.
Where this moves into worrisome territory is when your focus on acne impacts your ability to function normally in life and causes extreme anxiety. Signs that an acne obsession may be a mental health issue include:
- You put your makeup on in a tiny mirror to avoid seeing your full face with acne.
- You won’t go swimming because you don’t want to be seen without makeup.
- You stay home rather than going out and being seen with acne.
- You spend an extreme amount of time applying makeup to hide your acne.
- You spend lots of time per day examining your skin.
Do these experiences sound familiar? Learn how you can overcome them.
Here at NOCD, we know how overwhelming OCD symptoms can be—and how hard it is to open up about your experience. You’re not on your own, and you can talk to a specialist who has experience treating OCD.
Learn moreHow obsessing about acne impacts your life
Unfortunately, the extreme measures you may try to take to hide your acne can severely limit your life, says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. The consequences can include distress, isolation, and being consumed with thoughts about your skin and acne. This may make you more likely to stay home agonizing over your skin; when acne consumes your thoughts, it can make it difficult to enjoy your life and spend it doing the things you love with the people you love, or even fulfilling the obligations you need to take care of.
Acne obsession and BDD: What’s the connection?
An obsession with your acne may indeed be body dysmorphic disorder, or BDD. BDD is defined as a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others,” according to diagnostic criteria.
Putting it in more plain language: “In BDD, there’s a perceived flaw, and the person spends a lot of time and attention on investigating and trying to fix it, even though most outsiders wouldn’t care about their ‘flaw,’” Dr. McGrath says. “BDD is done with the purpose of wanting the perceived physical flaw to be better or more beautiful. For someone with BDD, they believe their flaws are the center of attention for everyone,” he says.
The idea that most outsiders aren’t actually concerned or disgusted by your appearance doesn’t mean the anxiety surrounding the “flaw” isn’t real. It is very real to the person who feels it and is very important to address. But for another person looking in, this person is blowing their own “flaw” way out of proportion.
It’s important to point out that it doesn’t matter how “bad” the flaw—in this case, acne—is in reality. It’s possible to fixate on your face when you have a bad breakout, but it’s just as possible to get lost in this fixation when you have a single spot on your skin that you desperately want to get rid of.
BDD often occurs alongside skin conditions, particularly acne—in a study on 245 people with acne throughout several dermatology centers in Spain, more than 10% were found to meet the criteria for BDD. On average, they spent two hours a day worrying about their appearance, spending a lot of time mirror checking and applying makeup.
In general, signs and symptoms of BDD include:
- Performing repetitive behaviors, which may include mirror checking, excessive grooming, skin picking, and reassurance-seeking. These repetitions can also be mental, such as comparing one’s appearance with others.
- This preoccupation is distressing and affects one’s life.
It’s possible to develop BDD surrounding any type of physical concern—it’s not limited to acne. Someone can be preoccupied with the appearance of their calves, assume they’re losing hair, or think their butt is too small or their face isn’t symmetrical enough.
Overtime, BDD can cause longer-term health problems. In one case study, published in Advances in Dermatology and Allergology in 2022, a young man who had BDD because of his struggle with acne in the past described how his skin condition triggered severe anxiety about leaving the house: he would have panic attacks, developed social phobia, and misused both anti-anxiety medication and alcohol. It was difficult for him to even attend therapy sessions because it required him to leave his home and be around others.
The connections between acne fixation and OCD or BFRBs
Though it involves obsessive thinking and behaviors that are tough to resist, acne “obsession” is usually not a form of OCD, says Dr. McGrath. “I’m wary of saying that acne is an obsession. If it is a true obsession, it would require a compulsion to neutralize. Popping zits is usually not a compulsion,” he explains. Just because you spend a lot of time doing something—including popping zits or picking at your face—does not mean this is a true obsession or compulsion in the context of OCD.
Acne obsession is more likely BDD, says Dr. McGrath. While BDD falls under the category of OCD-related disorders and shares similar characteristics with OCD, it is its own condition.
Depending on your symptoms, there are other mental health disorders that may be going on, such as dermatillomania, or excoriation disorder, which are body-focused repetitive behaviors (BFRBs). People who have excoriation disorder may excessively pick their skin to the point where they cause damage but don’t feel as if they can stop the behavior. While picking may bring relief in the moment, overall it causes serious distress, according to the International OCD Foundation. Often, skin picking occurs with anxiety and depression, and it’s far more common than you think, affecting 5% of people.
While skin picking might be done to cope with anxious thoughts, as a distraction technique, or for a small endorphin rush, “BDD is singularly focused on a flaw you believe is gross and disgusting and you need to ‘fix,’” Dr. McGrath says. “Skin picking need not have any of that whatsoever,” he says. In addition, though someone with BDD may also pick at their skin, their main symptom is excessive focus on a flaw they fear is repulsive to others. For excoriation disorder, skin picking is the main symptom; most of their time is spent actively picking.
What can I do to cope with my obsession about my acne?
It’s difficult to say if you have BDD, excoriation, or even OCD or anxiety, which is why a proper evaluation is the first step. There can be a lot of shame surrounding both BDD and excoriation, which is why both conditions tend to be undertreated.
For BDD, treatment can be challenging. After all, “a patient with BDD will typically want to pursue physical changes,” says McGrath. Unfortunately, physical changes will never be enough. With acne, your skin will never be clear enough, the acne scars will never be smooth enough. Yet, it’s tough to truly realize that seeing one more dermatologist or finding that exact right product will not be the solution.
In short, the answer is not found in your dermatologist’s office. “Most patients will say that they haven’t had an issue getting help for their acne, but after treatment—even if the acne is significantly better—they complain that there’s still a spot, and they have to keep going back for more appointments,” says Dr. McGrath. “In BDD, nothing is 100% good enough,” he says. Earlier research found that BDD improved with acne treatment in only 3% of cases—very few people are actually helped by efforts to fix their flaw; instead, they need psychological support.
What’s more, OCD can exist together with BDD or excoriation, so it’s not uncommon to be diagnosed with both, especially if you experience similar themes about other parts of your life.
That’s why you should seek out help from a clinician who is qualified to work with OCD and related disorders like BDD or skin picking. People with BDD respond well to CBT techniques, including exposure and response prevention (ERP) therapy, cognitive restructuring, and perceptual training techniques, and these approaches may also be supplemented with medication.
For skin-picking symptoms in excoriation, habit reversal training (HRT) is the most likely first-line treatment. They’ll work with their therapist to gain awareness of their behaviors and develop competing responses they can engage in whenever they feel the urge to pick their skin, allowing them to accept the way they feel about their skin over time.
For OCD, treatment may look a bit different. For example, Dr. McGrath says, someone with acne BDD may actively practice not looking in a mirror when they have the urge to, decrease the amount of time they spend in front of the mirror, or go out with fewer layers of clothing, accessories, or makeup covering their skin. Over time, they gain a greater ability to live the way they want to, without being ruled by their fixation on acne.
If you believe your acne obsession may be a sign of a skin-picking disorder or OCD,I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. All NOCD Therapists are specialty-trained in HRT for BFRBs like dermatillomania, as well as ERP for all themes of OCD.
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