I am petrified of being alone forever because of my acne

I struggle with relationships and am repulsed by my own skin

PROBLEM: I am a 20-year-old male and have just started college in the UK this year. All through my teenage years I have struggled with acne and chronically oily skin. When I turned 17 my acne got particularly severe and I developed cystic acne. After many months of medication the acne was dampened, but never eliminated.

Upon starting college, I noticed my acne flaring up and found myself spiralling downwards into depression and complete obsession. I have been attending a counsellor, which hasn’t helped me much so far. After being put on an unsuccessful course of antibiotics, the dermatologist put me on a controversial but effective drug. I am only two weeks in and am in the midst of an initial breakout, but despite the comfort of knowing my skin will improve, I can’t budge from the depression I feel.

My body image is catastrophic. I struggle with relationships and am repulsed by my own skin. Just today I heard my mum on the phone telling her friend about how greasy I was, and how my acne can be quite disfiguring.

I choose to stay at home whenever possible, despite having a large circle of friends. I feel as though I am isolating myself.

I am petrified of being alone forever because of the way I look, even though I am only 20. Although the drug has an almost 100 per cent success rate, pulling through these couples of months seems nearly too difficult. I feel hopeless.

ADVICE: What a tough time for you, and it has been going on for so long: all your teenage years have been hijacked. To go through such difficulty at such a vulnerable time in your life is having a very deep effect, and it is not surprising that you are suffering from depression and obsession. But you have taken action that you feel will work, and this is a sign that you have not given up.

Having acne is the lens through which you see the world, and this is having an effect on your identity and your confidence. You must decide that this is not who you really are, and you will discover the truth of this in the coming months. You must practise patience now and allow time for the drug to work.

You sound confident in the success rate of the drug, and so you must trust this and not fall into doubt for the next six months. Can you go into survival mode until your skin clears up? Do not make any judgments about your life or relationships for a while. You do not have enough information about what you are like without this condition to know what the real issues are in your life.

Your way of dealing with acne has been to hide away, and you say that you are isolating yourself at the moment. As your skin clears you will need to tackle this pattern of isolating yourself. Perhaps you could discuss and plan this re-engagement with the world with your counsellor. You have also developed a dangerous relationship with your body and skin, and this needs to be addressed so that you can discover what a source of pleasure your body can be.

You say you have a large group of friends, so you clearly have a capacity to connect with people and this augurs well for the future. All relationships require vulnerability as you take the risk of rejection on board.

Luckily, desire is so strong in us that it can push us over the fear and enable us to focus on the other person and not ourselves. Focusing your attention on the other person will help to pull you away from your negative self-commentary and begin to shed some of the awful self-criticism.

You perhaps need to have a conversation with your mother about the effect her conversations with her friends is having on you. If she could hold hope and belief in a recovery for you, it might help you when you are too low to see a successful end. In fact, asking for this support is in itself an act of self-confidence as you will be standing up for yourself.

It will take a long time for you to not hide your face, even when the acne has cleared, but there are lots of people who have been through this and will testify that your confidence can recover. This experience might offer you a sensitivity to others’ suffering that might be of benefit to you in the future. Have faith and be patient.