Each year, hundreds of thousands of Americans develop some form of facial paralysis from a variety of causes.
The loss of facial control and expression that follows can bring sometimes devastating stigma, depression and anxiety, a new study shows.
This seems especially true for people whose facial paralysis came later in life instead of from birth, researchers noted.
There are a number of conditions that can cause facial paralysis. Some are congenital, or present at birth. Others are acquired later in life. A common cause of facial paralysis is stroke.
Stigma major predictor
"We were interested in the psychosocial factors that people with facial paralysis might experience, and if there were differences in people born with a condition compared to people who acquired facial paralysis," said study author Kathleen Bogart. She's director of the Disability and Social Interaction Lab at Oregon State University.
"When we looked at the major predictors of depression and anxiety, stigma was the main one. A lot of these conditions look the same from the outside, but the stigma part doesn't change," Bogart said.
She said there is surprisingly little public awareness of facial paralysis. And sometimes the paralysis might not be easy to recognise.
"Peoples' faces may not be expressive, or their expressions may be unusual. The smile might look like a scowl," Bogart explained.
The researchers said about 225 000 Americans develop facial paralysis every year. Congenital conditions, such as Moebius syndrome or birth trauma, can cause facial paralysis. Injuries or conditions like Bell's palsy can cause acquired facial paralysis. Acquired paralysis is more common.
Highest depression and anxiety
The researchers surveyed 112 people with congenital facial paralysis and 434 people with acquired facial paralysis. The volunteers came from 37 different countries, but the majority of them were from the United States. The average age was 45 years old.
Both groups had higher rates of depression and anxiety than the general population. Those with acquired facial paralysis had the highest levels of depression and anxiety, the study found.
What might make it harder for those with acquired paralysis?
Bogart said it's possible that people with congenital paralysis may have developed adaptive or compensatory behaviours. Typically, children learn from an early age to use expressions as a form of nonverbal communication. Since that wasn't an option for children with facial paralysis, they found other ways to communicate. She likened it to the way young children are often adept at picking up new languages, while adults seem to struggle more.
"If you don't encounter a language when you're between one and three, it's more difficult later to pick up a new language. The same thing may be going on with nonverbal emotions," Bogart said.
Brittany LeMonda, a senior neuropsychologist at Lenox Hill Hospital in New York City, was not part of the study but reviewed the findings.
She said it makes sense that "someone born with this type of neurological presentation would learn to adjust and develop their social relationships. But if you don't have that ability, and you experience facial paralysis later in life, it could be more challenging to learn how to accommodate."
More tolerance is important
LeMonda noted that society is so focused on cosmetic beauty and outward appearances that acquiring paralysis later in life might make someone feel more self-conscious, as if people are staring at them even if they aren't.
She recommended that anyone who's having trouble with facial paralysis seek out a support group because it's helpful to talk to people who have dealt with the same concerns. LeMonda said it's also helpful to speak with a therapist, who can offer tools to cope.
Bogart added: "It's human nature to notice difference, but more tolerance of diversity in facial expressions and appearance is important. People with facial paralysis are not sad and anxious because they have paralysis, per se. They're sad and anxious because of the way society reacts to them."
The study was published recently in Health Psychology.
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