Difficulties in emotion regulation and quality of life in patients with acne

  • Gül Ferda CengizEmail author
  • Gülhan Gürel



The psychological factors associated with the impairment of the quality of life (QoL) in acne vulgaris have not been fully elucidated, yet. The aim of the present study was to evaluate the performance of the difficulties in emotion regulation (DER) in predicting the QoL of patients with acne vulgaris and to examine the relationship between acne vulgaris and common psychopathologies, such as anxiety and depression.


A total of 141 patients were administered the difficulties in emotion regulation scale (DERS-Brief Form) (DERS-16), Hospital Anxiety and Depression Scale (HADS), and Acne Quality of Life (AQOL) Scale, while the control group including 102 participants was administered all scales other than the AQOL.


The patients with acne vulgaris had significantly higher DERS scores than the control group. DER were found to predict quality of life more than acne severity. A strong positive correlation was found between the DERS and anxiety and depressive symptoms. There was no significant correlation between the acne severity and HADS and DERS scores, although only a weak correlation was found with the AQOL scores. The duration of acne showed no correlation with any of the variables.


Our study results showed the relationship between the DER and acne vulgaris. The ignorance of this relationship while evaluating patients with acne may result in anxiety and depression symptoms and impairment in the QoL in the future. Hence, psychopathologies should be considered in acne treatment and patients should gain the ability of regulating their emotions through appropriate therapeutic approaches.


Acne vulgaris Emotion regulation Quality of life Anxiety Depression Skin disease 


Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Dreno, B., & Poli, F. (2003). Epidemiology of acne. Dermatology, 206, 7–10.PubMedGoogle Scholar
  2. 2.
    Polenghi, M. M., Zizak, S., & Molinari, E. (2002). Emotions and acne. Dermatology and Psychosomatics, 3(1), 20–25.Google Scholar
  3. 3.
    Mallon, E., Newton, J. N., Klassen, A., Stewart-Brown, S. L., Ryan, T. J., & Finlay, A. Y. (1999). The quality of life in acne: A comparison with general medical conditions using generic questionnaires. The British Journal of Dermatology, 140(4), 672–676.PubMedGoogle Scholar
  4. 4.
    Gupta, M. A., & Gupta, A. K. (1998). Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. The British Journal of Dermatology, 139(5), 846–850.PubMedGoogle Scholar
  5. 5.
    Halvorsen, J. A., Stern, R. S., Dalgard, F., Thoresen, M., Bjertness, E., & Lien, L. (2011). Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: A population-based study. Journal of Investigative Dermatology, 131(2), 363–370.PubMedGoogle Scholar
  6. 6.
    Jain, N., Bukharia, A., Khess, C. R. J., & Munda, S. K. (2017). Psychiatric morbidity among patients with psoriasis and acne: A comparative study. Journal of Pakistan Association of Dermatology, 26(4), 337–346.Google Scholar
  7. 7.
    Yang, Y. C., Tu, H. P., Hong, C. H., Chang, W. C., Fu, H. C., & Ho, J. C. (2014). Female gender and acne disease are jointly and independently associated with the risk of major depression and suicide: A national population-based study. BioMed Research International, 2014, 504279.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Eyüboglu, M., Kalay, I., & Eyüboglu, D. (2018). Evaluation of adolescents diagnosed with acne vulgaris for quality of life and psychosocial challenges. Indian Journal of Dermatology, 63(2), 131.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Unal, D., Emiroğlu, N., & Cengiz, F. P. (2016). Evaluation of social anxiety, self-esteem, life quality in adolescents with acne vulgaris. International Journal of Adolescent Medicine and Health. Scholar
  10. 10.
    Siener, S., & Kerns, K. A. (2012). Emotion regulation and depressive symptoms in preadolescence. Child Psychiatry and Human Development, 43(3), 414–430.PubMedGoogle Scholar
  11. 11.
    Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., & Znoj, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy. Behaviour Research and Therapy, 46(11), 1230–1237.PubMedGoogle Scholar
  12. 12.
    Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy, 40(2), 142–154.PubMedGoogle Scholar
  13. 13.
    Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: İmplications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348.PubMedGoogle Scholar
  14. 14.
    Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2–3), 25–52.PubMedGoogle Scholar
  15. 15.
    Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: Linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28(1), 73–86.PubMedGoogle Scholar
  16. 16.
    Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.Google Scholar
  17. 17.
    Sarkar, S., Patra, P., Mridha, K., Ghosh, S. K., Mukhopadhyay, A., & Thakurta, R. G. (2016). Personality disorders and its association with anxiety and depression among patients of severe acne: A cross-sectional study from Eastern India. Indian Journal of Psychiatry, 58(4), 378.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Lucas, C. J. (1961). Personality of students with acne vulgaris. BMJ, 5, 354–356.Google Scholar
  19. 19.
    Gül, Aİ., & Çölgeçen, E. (2015). Personality traits and common psychiatric conditions in adult patients with acne vulgaris. Annals of Dermatology, 27(1), 48–52.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Pollock, N. C., McCabe, G. A., Southard, A. C., & Zeigler-Hill, V. (2016). Pathological personality traits and emotion regulation difficulties. Personality and Individual Differences, 95, 168–177.Google Scholar
  21. 21.
    Ciuluvica, C., Amerio, P., & Fulcheri, M. (2014). Emotion regulation strategies and quality of life in dermatologic patients. Procedia-Social and Behavioral Sciences, 127, 661–665.Google Scholar
  22. 22.
    Innamorati, M., Quinto, R. M., Imperatori, C., Lora, V., Graceffa, D., Fabbricatore, M., et al. (2016). Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis. Comprehensive Psychiatry, 70, 200–208.PubMedGoogle Scholar
  23. 23.
    Almeida, V., Taveira, S., Teixeira, M., Almeida, I., Rocha, J., & Teixeira, A. (2017). Emotion regulation in patients with psoriasis: Correlates of disability, clinical dimensions, and psychopathology symptoms. International Journal of Behavioral Medicine, 24(4), 563–570.PubMedGoogle Scholar
  24. 24.
    Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2(2), 151–164.Google Scholar
  25. 25.
    Hazarika, N., & Archana, M. (2016). The psychosocial impact of acne vulgaris. Indian Journal of Dermatology, 61(5), 515.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Singh, A., Agrawal, P., Chaudhary, S. V., & Jain, D. (2013). Disability in acne patients–A hospital based study in rural population of central India. Global Journal of Dermatology & Venereology, 1(2), 21–24.Google Scholar
  27. 27.
    Doshi, A., Zaheer, A., & Stiller, M. J. (1997). A comparison of current acne grading system: And proposal of novel system. International Journal of Dermatology, 36, 416–418.PubMedGoogle Scholar
  28. 28.
    Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., et al. (2016). Development and validation of a brief version of the difficulties in emotion regulation scale: the DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284–296.PubMedGoogle Scholar
  29. 29.
    Yiğit, İ., & Yiğit, M. G. (2017). Psychometric properties of Turkish version of difficulties in emotion regulation scale-brief form (DERS-16). Current Psychology. Scholar
  30. 30.
    Gupta, M. A., Johnson, A. M., & Gupta, A. K. (1998). The development of an Acne Quality of Life scale: Reliability, validity, and relation to subjective acne severity in mild to moderate acne vulgaris. Acta Dermato-Venereologica, 78(6), 451–456.PubMedGoogle Scholar
  31. 31.
    Demirçay, Z., Şenol, A., Seçkin, D., & Demir, F. (2006). Akne Vulgarisli Hastalarda Akne Yaşam Kalite Ölçeğinin Türkçe Güvenilirlik Çalışması (Reliability of Turkish Version of Acne Quality of Life Scale in Patients with Acne Vulgaris). Türkderm, 40, 94–97.Google Scholar
  32. 32.
    Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.PubMedGoogle Scholar
  33. 33.
    Aydemir, Ö., Güvenir, T., Küey, L., & Kültür, S. (1997). The validity and reliability of the Turkish version of hospital anxiety and depression scale. Turkish Journal of Psychiatry, 8, 280–287.Google Scholar
  34. 34.
    Yazici, K., Baz, K., Yazici, A. E., Köktürk, A., Tot, S., Demirseren, D., et al. (2004). Disease-specific quality of life is associated with anxiety and depression in patients with acne. Journal of the European Academy of Dermatology and Venereology, 18(4), 435–439.PubMedGoogle Scholar
  35. 35.
    Golchai, J., Khani, S. H., Heidarzadeh, A., Eshkevari, S. S., Alizade, N., & Eftekhari, H. (2010). Comparison of anxiety and depression in patients with acne vulgaris and healthy individuals. Indian Journal of Dermatology, 55(4), 352.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43(10), 1281–1310.PubMedGoogle Scholar
  37. 37.
    Jafferany, M. (2011). Psychodermatology: When the mind and skin interact. Psychiatric Times, 28(12), 1–2.Google Scholar
  38. 38.
    Rao, T. S., Basavaraj, K. H., & Das, K. (2013). Psychosomatic paradigms in psoriasis: Psoriasis, stress and mental health. Indian Journal of Psychiatry, 55(4), 313.Google Scholar
  39. 39.
    Folks, D. G., & Warnock, J. K. (2001). Psychocutaneous disorders. Current Psychiatry Reports, 3, 219–225.PubMedGoogle Scholar
  40. 40.
    Aktan, Ş., Özmen, E., & Şanli, B. (1998). Psychiatric disorders in patients attending a dermatology outpatient clinic. Dermatology, 197(3), 230–234.PubMedGoogle Scholar
  41. 41.
    Fried, R. G., & Wechsler, A. (2006). Psychological problems in the acne patient. Dermatologic Therapy, 19(4), 237–240.PubMedGoogle Scholar
  42. 42.
    Lukaviciute, L., Navickas, P., Navickas, A., Grigaitiene, J., Ganceviciene, R., et al. (2017). Quality of life, anxiety prevalence, depression symptomatology and suicidal ideation among acne patients in Lithuania. Journal of the European Academy of Dermatology and Venereology, 31(11), 1900–1906.PubMedGoogle Scholar
  43. 43.
    Salman, A., Kurt, E., Topcuoglu, V., & Demircay, Z. (2016). Social anxiety and quality of life in vitiligo and acne patients with facial involvement: A cross-sectional controlled study. American Journal of Clinical Dermatology, 17(3), 305–311.PubMedGoogle Scholar
  44. 44.
    Snorrason, Í., Smari, J., & Olafsson, R. P. (2010). Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample. Journal of Behavior Therapy and Experimental Psychiatry, 41(3), 238–245.PubMedGoogle Scholar
  45. 45.
    Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572.PubMedGoogle Scholar
  46. 46.
    Blackledge, J. T., & Hayes, S. C. (2001). Emotion regulation in acceptance and commitment therapy. Journal of Clinical Psychology, 57(2), 243–255.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Psychiatry DepartmentBozok University School of MedicineYozgatTurkey
  2. 2.Dermatology DepartmentBozok University School of MedicineYozgatTurkey

Personalised recommendations