Bell’s Palsy and Mental Health

Bell’s palsy, or idiopathic facial paralysis, can have a significant impact on a person's quality of life, which can be compounded by the presence of underlying mental health conditions.

A recently published study by Rist et al. investigated the relationship between subclinical anxiety and depression on quality of life among patients with facial paralysis. They found that patients with facial paralysis have a much higher prevalence of both anxiety and depression when compared to the general population with increasing paralysis severity being associated with lower perceived quality of life.

To better interpret these findings, it’s important to understand the social impact of facial paralysis, the role of underlying depression and anxiety, and the resources available to this vulnerable population.

Facial features and routine dynamic movements of the face are intimately associated with identity and necessary for critical functions such as communication, expression, and feeding. For many people with facial paralysis, the inability to control the movement of their facial muscles can be distressing and lead to feelings of self-consciousness and embarrassment. This can affect their confidence and make it difficult to interact with others, leading to social isolation.

In addition, facial paralysis can make it difficult to eat normally or speak clearly, which can be physically and emotionally challenging. Unfortunately for many patients with Bell’s palsy, these difficulties can lead to anxiety and depression, and can further impact a person's quality of life.

In general, depression and anxiety have the ability to alter a patient’s ability to cope with their disease process. While these mental health conditions can lead to social isolation and difficulty carrying out everyday activities, the added impact of facial asymmetry and inability to express certain emotions have been shown to be just as distressing for patients with facial paralysis. This may explain the unusually high rates of depression and anxiety for these patients, with positive screens of 26 percent and 23 percent, respectively. These findings may be explained by the phenomenon of affective realism where an inability to effectively smile can increase one’s risk for anxiety and depression as the feedback loop for perceived happiness is disrupted. Overall, psychological distress from facial paralysis has been found to be the most significant predictor of social disability.

These findings emphasize the need to routinely screen patients with facial paralysis for psychological distress. Furthermore, it is important for individuals with facial paralysis to consider seeking treatment for anxiety and depression. Therapy and medication can help to improve quality of life and manage the emotional challenges of living with facial paralysis. Moreover, nonsurgical treatments, such as Botox and fillers have recently been shown to help decrease the psychosocial impact of facial paralysis by helping restore facial symmetry. Finally, surgery can provide long-lasting improvements in facial appearance.

Overall, the psychological distress from facial paralysis is thought to be a significant predictor of social disability and has a negative impact on quality of life. Prompt evaluation after symptoms of Bell’s palsy present and treatment by a facial paralysis expert can help improve the chances of recovery. Even for patients with long-standing facial dysfunction, seeking care from their health care teams can mitigate the symptoms of long-standing mental health conditions.