How facial palsy may affect mental health

Research shows that people who develop facial palsy are more likely to become anxious and/or depressed compared to the normal population.  This is completely understandable as facial palsy can impact on many aspects of daily living.  It is a complex condition which can present the person with physical and psychosocial challenges.

A person’s level of anxiety or depression does not necessarily relate to the degree of their facial paralysis.  It is natural to want to try and hide the changes that have happened to your face and people with facial palsy can become socially withdrawn and isolated.  You may feel unable to relax and laugh without being stared at which can have a big impact on day to day living. You may find it hard to be confident and may fear or avoid new situations or meeting new people.

Your facial palsy may make it difficult to smile as you used to without even having to think about it.  Feeling unable to smile in a normal way can have a negative effect on how you feel. To make matters worse people with facial palsy are often criticised for not looking cheerful enough.  Looking friendly is important in all spheres of life both personal and professional so without it, you may feel lost.  Smiling expresses friendliness and without it you may lose confidence around other people.  This may cause you to feel quite low and anxious about participating in everyday life.

Factors which may trigger feelings of anxiety or low mood/depression in people with facial palsy

    • Occupations which are public-facing or entail high levels of face to face communication, for example, training/lecturing/teaching/presenting/selling.
    • Lack of support from employers/colleagues/family/friends/community
    • Poor access to help/advice/treatment for facial palsy
    • Not being listened to by health professionals or health professionals who dismiss facial palsy as just a cosmetic problem
    • Bullying
    • Facial pain/eye pain/headaches
    • Context, for example, contracting facial palsy during pregnancy when there is great concern over the health of the mother and unborn child.
    • Social isolation
    • Feeling lack of support from a partner or a breakdown in interpersonal relationships
    • Multiple health problems

This list is not exhaustive and there may be many factors which contribute to feeling anxious or depressed.  You may have experienced problems with anxiety in the past or you may describe yourself as being vulnerable to such feelings which may return in response to developing a facial palsy. This is why some of the questionnaires that you will complete ask about how you feel as well as how your face is functioning.  Your responses will help identify the type of information that will be useful to you and allow a more bespoke approach to your rehabilitation programme.  The information which follows explains what anxiety is, how it can present itself, and how it can have a negative impact on the facial muscles as the nerve recovers.

Physical symptoms of anxiety

    • Faster or irregular heartbeat which you can feel
    • Dizziness
    • Headaches
    • Chest pain
    • Loss of appetite
    • Muscle tension
    • Digestive disorders
    • Tingling of the extremities

Psychological symptoms

    • Feeling tense or nervous
    • Unable to relax
    • Worrying
    • A sense of doom
    • Feeling tearful

Behavioural symptoms

    • Inability to enjoy leisure pursuits/time
    • Loss of concentration
    • Lack of attention to personal care
    • Unable to relax
    • Difficulty sleeping or poor sleep patterns
    • Avoidance of anxiety-provoking situations

The recovering facial nerve, muscle tension and anxiety

The main concern is two-fold, firstly, that anxiety and stress can have a negative impact on the health of recovering facial muscles.  Feelings of anxiety both acute and chronic can cause raised levels of muscle tension.  Secondly, the recovering facial nerve finds it difficult to moderate the number of electric signals it sends to the muscles. This causes the muscles to become thicker and tighter.  Eventually, the muscles will shorten and become immobile.  As good muscle health is essential for maximising the potential for recovery, it is important to minimise tension whether it is caused by anxiety or abnormalities in the recovering nerve.  A relaxed face is an essential prerequisite in the rehabilitation process.  Good muscle health is the ultimate goal because muscles which are elastic and mobile will be able to respond effectively to the recovering/recovered facial nerve.

Read more

Reasons to start smiling

How family and friends can help

Photo by Melanie Kreutz on Unsplash