Saturday 17 March 2018

Parent: My son's acne is destroying his self-confidence

Ask the expert...

Illustration by Maisie McNeice
Illustration by Maisie McNeice
David Coleman

David Coleman

The clinical psychologist advises on the anxiety induced by acne for teenagers and how to deal with aggression in a child towards their baby sibling.

Question: My 14-year-old son is struggling with acne. I have given him cleansing products and we have visited the doctor who has advised against medication at this time. The acne is not bad compared to some cases but he has lost confidence and doesn't want to go out with his friends. I wonder if someone has said something to him? At least if he was in school he'd have to go out, but now that it's the summer he has become totally withdrawn. Before the acne erupted he was quite sociable but has become so self-conscious. How can I help him with this?

David replies: Even a single spot on the face of a teenager can feel, to them, like serious disfigurement. Their anxieties about standing out among their peers because of significant acne are very understandable.

Self-consciousness is the hallmark of early teenage life. Those years between 12 and 15 can be excruciatingly self-absorbed and self-doubting. Add into the mix any physical trait that they feel sets them apart and it can indeed become socially awkward for them.

Mostly, young teenagers just desperately want to fit in and be like everyone else. The creation of strong personal identity, particularly one that is different to the norm, usually comes later in teenage years. But, at your son's age, the aim is usually just to conform to the look and the style of all of your peers.

Your son, no doubt, wants to feel normal. I could imagine that he feels his spots make him look abnormal, especially if he is one of just a small few in his peer group who has a lot of acne.

So, it is very understandable that your son may be highly self-conscious of his spots. He may even feel that it makes him look ugly or unattractive in some way. Any self-doubt, like that, would be exacerbated if he was teased or slagged about his complexion.

In truth, though, his acne is actually a sign that he is highly normal and that he is developing healthily in terms of his overall pubertal development. Particularly in teenage acne, it is his testosterone production that is most likely to be affecting his skin's production of sebum, the oil that lubricates his skin.

It is good that you have taken him to the doctor as there are cases of acne that do need medical treatment. It is also good news that your son's acne is not so bad that it requires treatment.

Of course, this does mean that your son has no option now but to live with his skin complexion until such time as his testosterone production levels out and hopefully his skin returns to its pre-pubertal condition.

It is hard, as a parent, to actively influence your teenage child's social life. We can struggle to restrict access to unsuitable friends and we can struggle to increase access to potential friends if our children are reluctant.

However, I do think that you could talk with your son about what you are observing, in terms of his social withdrawal. It is really important that you are not critical of your son (nor that you even appear to be critical).

The tone of the conversation needs to be much more focused on your genuine concern for his happiness and his apparent self-consciousness. You need to be able to empathise with how awkward he may feel with his friends.

You can also, hopefully, draw him out in terms of his own feelings about his acne, or about how his friends may be treating him. It is always possible, after all, that his social withdrawal is not because of his skin complexion but because of some other issue between him and his friends.

It may be that his friends are experimenting, over the summer, with alcohol, other substances or other activities and it is just easier for him to avoid being with them than to explain why he doesn't want to take part in whatever they are doing.

Either way, talking with him will show him that you can understand his perspective and that you are willing to support him in any way.

With luck his acne and his self-imposed withdrawal will both be temporary and the return to school in September will get him back involved and engaged.

How can we stop our three-year-old son hitting out at his baby brother?

Question: My three-year-old son is very aggressive with his 11-month-old brother. He was very easy going about him when he was born. We were delighted he accepted him so well. But the older boy has started hitting or grabbing at the baby in the last few months. I find it so upsetting and feel very protective of the baby who can't defend himself. I slapped my older boy on the back of the hand the other day, just so he knew how much it hurt to be hit. I don't think it made any difference as I saw him pinching him later. How can we control our older boy?

David replies: Whatever else you choose to do, don't get into the habit of slapping your son. If you slap him you may reinforce a belief that when you get really cross, or if things don't go your way that it is okay to hit out.

By slapping your son you may, in fact, make it more likely that he will grow up to be physically aggressive with other children, and, in due course, even physically aggressive with you.

That said, you do have the current issue of his physicality with his baby brother. He may be jealous of his little brother and the attention that he gets for being the baby. Or, now that his little brother can be more active, he may just be reacting to the frustration of his little brother being around.

When his brother was born he may not have impacted too much on your older boy's life. He may have just been "the baby" who was passively there, but didn't interrupt his life too much. But, in recent months I could imagine that your younger son has become more mobile, crawling around and possibly getting into his older brother's "stuff".

It may only be in the last while that your younger son has been making his presence felt. He may have become much more disruptive to his older sibling. This might be why the friction between them is only emerging now.

If he feels frustrated by his little brother's disruption, the older boy's response actually makes sense.

He is responding to his annoyance or frustration in a very natural way by hitting out. Reactive aggression among two and three-year-olds is very common and easily understood. They feel annoyed and they simply act on that annoyance.

Our job is to help them learn other ways of reacting to their own frustration and to learn other ways of regulating that frustration so that it doesn't overwhelm them to the point of hitting out.

You can start this process with your son by empathising with him. This involves you recognising that your older boy might be cross or upset or frustrated (or whatever feeling you can identify). You then name that feeling for your son.

So you might say something like "oh you look really cross that your brother keeps crawling over to your toys", or, for example, "you seem quite upset that your brother wants to play with you, I think you prefer playing your game on your own".

You may also help him by verbalising for him that "little brothers can sometimes be fun and sometimes be annoying".

These kind of statements will help your son to realise what it is that he is feeling, and why he is feeling it. So he can begin to link his frustrations with his brother's behaviour (if that is indeed what is happening).

In tandem with helping him to be able to name his feelings you also have to explain to him what he needs to do when he feels those feelings. So you might suggest to him, "even if you feel cross you may not hit your brother. Be gentle with your hands".

Through all of this, it will really help if you are able to be present while the boys are in the same room, such that you can be ready to empathise (if you see your older son getting frustrated) and then to intervene.

Your interventions need to distract your younger son (so he doesn't disrupt his brother) or to help the two boys to play together more effectively.

By being present, you can also swoop in, if needed, to lift the older boy away before he can hit, empathising with his feelings but reminding him of what else to do rather than hitting out.


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