Gloria was 9 years old when she got her first pimple. It popped up right before her inaugural period, immediately exacerbated by the red, blotchy rashes she was particularly prone to in the dry California heat. Her acne only worsened from there, with the mild cocktail of whiteheads and blackheads standing in stark contrast to her classmates' crystal-clear complexions.
"Nobody else was breaking out in fifth grade," she says. "There must have been a secret water fountain bestowing beautiful skin that I didn't know about. Some guys eventually broke out in high school, but I felt very much alone. The only thing people would say to me was that it’ll go away when I get older, but it didn’t."
Instead, it got worse. Gloria was bullied extensively in school (one classmate even "created a caricature and bobble head of me, with a face-full of zits, and continued to taunt me with them when we were in college," she tells us); she lost her friends; she stopped going to class. "It made me feel like I was disgusting and ugly, like I was this blob of pimples who didn't deserve to be loved," she says.
The psychological effects of acne are a lot like the symptoms at the bottom of a Celebrex ad: You can become irritable, angry, depressed, ashamed, defeated, insecure, withdrawn, lonely, and desperate. So it follows that even after your skin clears — which, for Gloria, happened in her mid-20s — you can experience something of an acne identity crisis.
"When I look in the mirror, I still think it’s there," she says. "My skin looks bumpy and red in the reflection, and I see red angry pimples on my cheek while [my dermatologist] tells me it's just one whitehead. I worked part-time at Sephora and people would compliment my skin, and I would think they’re crazy. I couldn’t help but point to my chin and say, 'No no, look! I have a lot of acne!'"
Gloria, like many others who once struggled with acne, suffers from acne dysmorphia. A relatively unknown struggle, clinical psychotherapist Matthew Traube, MFT, tells us it's a form of body dysmorphic disorder, in which "people become preoccupied with an imaginary physical issue," he says.
Some might assume that when acne clears, the burden that comes along with it does, too. But that's not always the case: "In my practice, I often see patients who have objectively very little acne and catastrophize it," Traube says. "They are aware that others don’t see it, but for them it’s debilitating. It can cause limited social interactions, occupational issues, or prevent people from pursuing relationships."
Kind of like how you get an unsettling feeling whenever you hear someone creeping up behind you, acne dysmorphia sufferers live in a constant state of fear that the condition will return. "When people believe that acne was holding them back from finding love or being successful, the idea of acne returning is very scary," he says. "They may believe that they will lose everything they achieved when their skin was clear."
That's something Gloria experienced first-hand: "I was scared that I would never find a boyfriend, so when I started dating someone at 14, I stayed with him until I was 26 despite us not being a good match," she explains. "I just didn’t feel pretty or attractive enough."
Beyond the psychological, there's also a physical component, too: Treating these newfound foreign challenges like scars, dark marks, or unevenness can be exhausting and time-consuming. It's not like there's a post-acne tab on the dropdown menu of Sephora.com to help you through the process, after all. "I see the ghost of my acne's past all over my face every day," Gloria says. "The scars from my dad’s exuberant popping and from my picking at them, plus hyperpigmentation all around my chin and my mouth from old acne spots. My worst fear is deep pitted scars, and I’m still afraid all my acne will come back if I change up my routine."
As for treating the acne dysmorphia itself? Well, that requires challenging your thinking patterns. "You want to identify and question any negative thoughts you have about your acne," Traube says. "If you're feeling too insecure to go on a date, ask yourself why. 'Is it really true that no one will like me if I have pimples on my face?'" That way, he explains, you'll be inclined to remember of a time that contrasts your point. "If we continue to do this, over time we'll be able to create a mindset that prepares us to manage the negativity."
Gloria is now in her early 30s, working as a successful publicist in L.A. and managing the breakouts that pop up every now and again. (She swears that lasers have significantly reduced her post-acne scars.) She'll never not be afraid of the skin condition returning, and that's okay. For now, she'll relish in the fact that she no longer ducks from the mirrors she walks by — because even if her reflection doesn't always look "perfect" to her, she's learning to love it anyway.
This story was originally published on August 4.