Psychosocial Impact of Facial Palsy

Introduction

“Societal interest in appearance has a long history,” and today this seems more important than ever. Social media, the importance of “the perfect picture,” and the desire and possibilities to change and enhance the body create more unrest and discomfort. Older studies show that physical attraction is an important predictor in entering relations and dating. Physical attraction is also associated with success, happiness, and better job prospects.

Rojas et al. believed that the face plays a crucial role in social interaction. People with facial palsy feel that their face is no longer “right” due to asymmetry and negative physical side effects such as incomplete eye closure, limited mouth movement, and synkinesis. Additionally, facial palsy is mentally burdening; patients often indicate they prefer not to look in the mirror because their face startles them. Moreover, they find it difficult when other people look at them and they cannot express their emotions. Because of the latter, emotions can often be misunderstood, resulting in miscommunication. For example, patients want to show their happiness, but due to asymmetric and paradoxical facial movements they may seem sad or angry.

It is of great importance that clinicians take into account the impact of facial palsy. Research has been performed on facial palsy patients concerning self-perception, difficulties with social encounters, and depressive disorders. Although facial palsy has been recognized to influence patient-perceived quality of life, the psychosocial disability may not be related to the severity of the condition. In 2000, evidence was found of a large individual variation in adaptation to facial palsy. At the same time, a strong relation between the degree and severity of the limitations and levels of stress was not found. Recently, the literature has shown that even a condition we qualify as minor may have severe psychosocial consequences, and that a patient with severe facial palsy or disfiguring synkinesis may not necessarily experience any problems. Health care providers need to be aware of the fact that patients are distressed but that it may not correlate with the severity of the palsy. Patients with low self-esteem, younger patients, and women suffer more from distress.

According to several studies, facial palsy is significantly correlated with not only reduced quality of life but also significant rates of depression and psychological distress. ^, Significant correlations have also been found between perception of facial palsy and level of psychological distress. The authors also found that female patients with facial palsy were more severely impacted with depression. Etiology of the facial paralysis also appears to play a part in the degree of depressive disorders. For instance, patients who develop facial paralysis secondary to a tumor are simply glad to be alive and often accept the paralysis more readily.

Coulson et al. also showed that 50% of facial palsy patients are unable to accurately express one or several emotions (happiness, anger, fear, sadness, disgust, surprise). The partners of these patients also considered their expressions more difficult to read. There were also some significant correlations between the duration and the timeline and emotional representation subscales of the Illness Perception Questionnaire-Revised (IPQ-R), as well as the Hospital Anxiety and Depression Scale. ^, This indicated that the duration of the facial palsy affected participants’ levels of distress. In a sample of patients with facial palsy, Bradbury et al. also found distress levels of 11.4% for depression and 35% for fear.

Psychosocial Consequences of Facial Palsy

The face is where all social interactions begin. Within a fraction of a second assumptions are made concerning age, gender, status, health, mood, and intentions—all by looking at a person’s face for just nanoseconds. In general, this is an efficient way of processing information, as we learn to “read” complex social stimuli from a very early age.

Facial palsy disturbs this process and changes the position of both the patient and the conversational partner in the interaction. In the literature, it is mentioned that damage to the face may also cause damage to “the self.” Various psychological mechanisms are triggered, and patients and their partners in conversation need to look for a new balance.

As described earlier, the responses of patients vary widely. Two factors play an important role: circumstances that caused the facial palsy and the existing personality traits such as self-esteem and intrinsic self-worth. Factors surrounding the facial palsy such as the etiology, age, gender, the manner in which the situation has been explained to them, and social support also have significant influence in outcome. The overall impact of a new appearance therefore is extremely diverse and the most important consequences are depression and anxiety ( Fig. 3.1 ).