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Facial Paralysis Takes Emotional Toll, Especially When Acquired Later in Life

Individuals with facial paralysis are more likely to experience depression and anxiety compared to the general population, especially if the paralysis occurs later in life rather than at birth, according to a new study published in the journal Health Psychology.

Approximately 225,000 people each year develop facial paralysis in the U.S., whether from injury or illness like Bell’s palsy, or from congenital issues like Moebius syndrome or birth trauma.

Facial paralysis can affect people in a variety of ways, including difficulty with facial expressions, vision, speech, eating and drinking. It can also cause physical discomfort and pain.

And since people with facial paralysis have visibly different faces, regardless of when they acquired the paralysis, they also deal with stigma and discrimination.

For the study, researcher Dr. Kathleen Bogart from Oregon State University (OSU) surveyed people around the world with different forms of facial paralysis, both congenital and acquired, to gain a better understanding of the socioemotional issues they face.

Bogart focused on peripheral facial paralysis, which affects only the face and is caused by facial nerve problems, rather than paralysis from other cognitive conditions that affect multiple parts of the body.

After contacting participants through facial paralysis organizations and social media, Bogart surveyed 112 adults (average age 45) with congenital paralysis and 434 people with acquired paralysis, which is much more common. Participants were from 37 countries, with the majority in the U.S., and the vast majority were white women.

Bogart looked at emotional clarity — the ability to identify and understand one’s own emotions — as well as stigma, attachment and psychological distress. She also tested two competing ideas: the “acquired” advantage and the “congenital” advantage.

The acquired advantage hypothesis states that people who acquire paralysis later in life would fare better on emotional clarity, as they completed their early developmental stages with a full range of motion and expression.

The congenital advantage hypothesis asserts that people born with paralysis have been able to adapt from a young age and thus develop their own alternative ways of expressing themselves, such as body language and tone of voice.

Surprisingly, the findings show that it’s people who acquire paralysis later in life that struggle the most.

“It seemed that people assumed that people who went through their initial development not having facial paralysis would be doing better; like ‘having a so-called normal early childhood would give you the emotional fundamentals,'” Bogart said.

“But these findings are actually really neat, because lots of people have disabilities, and this suggests the ones who have them from birth actually seem to have an advantage. They’re learning how to function in the world for the first time, alongside that disability, at a time of great cognitive flexibility. People with congenital disabilities have a lot to teach us about adaptation.”

When people acquire paralysis later in life, she said, there’s a real sense of loss or a change in identity that those born with paralysis don’t experience.

The shock of suddenly experiencing stigma, or experiencing stigma in that way, also contributes to the challenges faced by people with acquired paralysis, she said.

The findings show that people with acquired paralysis had higher rates of depression and anxiety, as well as more problems with emotional clarity and attachment, likely stemming from the newfound difficulty in conveying emotions to other people.

But both groups still experienced greater stigma than the norm, even though the norms for this question were calculated from people with other stigmatized neurological conditions, just without visible facial paralysis.

To address these issues and alleviate psychological distress, Bogart says, there should be greater protections against discrimination and bullying toward people with visibly different faces.

Source: Oregon State University

Facial Paralysis Takes Emotional Toll, Especially When Acquired Later in Life

Traci Pedersen

Traci Pedersen is a professional writer with over a decade of experience. Her work consists of writing for both print and online publishers in a variety of genres including science chapter books, college and career articles, and elementary school curriculum.

APA Reference
Pedersen, T. (2020). Facial Paralysis Takes Emotional Toll, Especially When Acquired Later in Life. Psych Central. Retrieved on November 27, 2020, from
Scientifically Reviewed
Last updated: 26 Jan 2020 (Originally: 26 Jan 2020)
Last reviewed: By a member of our scientific advisory board on 26 Jan 2020
Published on Psych All rights reserved.