Either way, it’s reasonable to assume that this type of condition has an impact on mental well-being – the inability to use facial expression to communicate and the social stigma that accompanies the disorder make such an impact inevitable, according to new research.

This socioemotional impact was the topic of recent work by researcher Kathleen Bogart of Oregon State University’s College of Liberal Arts. Her survey of adults with either acquired (n=434) or congenital (n=112) facial paralysis revealed that those with facial paralysis are indeed more likely to experience depression or anxiety than the general population.

The research, published in Health Psychology, also revealed surprising differences between the congenital and acquired groups.

Bogart looked at the survey results to test two separate hypotheses. The first hypothesis is that those who have had facial paralysis since birth have a “congenital advantage”—since they went through their developmental years with the paralysis, they were able to develop ways of communicating that weren’t as reliant on facial expression. They also had no other experience to compare it with, so would presumably have the skills to cope better with social issues that arise.

The competing hypothesis is the “acquired advantage.” Since those who developed facial paralysis at a later age completed their development with range of motion and expression intact, they would theoretically have better tools to cope with the socioemotional effects of their disorder.

As Bogart studied emotional clarity – the ability to identify and understand one’s own emotions – as well as stigma, attachment, and psychological distress among the two groups, it became clear that the “congenital hypothesis” had the advantage.

For those who develop facial paralysis later in life, there is a sense of loss. Their appearance changes, they may have difficulty with eating and drinking, their disorder may be painful, and they may experience a stigma – even discrimination – for the first time in their lives. The prevalence of depression and anxiety was higher in this group, and they had more difficulty with emotional clarity and attachment.

On the contrary, those who were born with facial paralysis experienced their disability during early development, the period when their brain had the greatest plasticity. They were able to develop alternative ways of communicating and connecting with those around them, functioning more easily with the disability.

The stigma attached to facial paralysis is a real issue for both groups, however. Even compared with other groups with neurological conditions that are often stigmatized, the stigma attached to facial paralysis was greater, extending to employment opportunities – even in the face of the protections offered by the American with Disabilities Act. Worse, this stigma was the main predictor of anxiety and depression.

Bogart is calling for the development of therapies specific to those who experience psychological distress because of facial paralysis. For the neurologist who cares for patients with facial paralysis, it is important to evaluate mental well-being when caring for these patients, with appropriate referrals for mental health care. Until the disease is destigmatized and appropriate therapies available, this will remain an essential part of their healthcare.

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