Tanning dependence or tanorexia (a portmanteau of tanning and anorexia ) [1] is a syndrome where an individual appears to have a physical or psychological dependence on sunbathing or the use of ultraviolet (UV) tanning beds to darken the complexion of the skin. [2] Compulsive tanning may satisfy the definition of a behavioral addiction as well. [3] [4] [5]
Tanning dependence may have a physiological basis involving endogenous opioids. There is evidence that UV exposure produces beta-endorphin in the epidermis and conflicting evidence of this opioid being released into the blood system, a pathway to the brain. [6] A small study also found the opioid antagonist naltrexone reduced preference for UV tanning beds and at higher doses produced withdraw symptoms in frequent tanners. [6] Better understanding of tanning dependence requires further controlled studies, especially in imaging and neurobiology. [7]
The finding that excessive tanning can lead to dependence is based upon "the observations of many dermatologists." Dermatologists tell researchers that although they advise their patients not to visit tanning beds because of the risk of melanoma, patients still do. In a 2014 literature review, researchers wrote that many people who tan excessively meet psychiatry's symptom criteria for substance abuse. [7] In a case where ten studies provided data for the assessment of melanoma risk among subjects who reported “ever” being exposed compared with those “never” exposed; a positive association was found between exposure and risk. [8]
The effects of tanning dependence include but are not limited to skin cancer, skin burns, premature skin aging, and eye damage (both short and long-term). [9]
Extreme instances may be an indication of body dysmorphic disorder (BDD), [10] a mental disorder in which one is extremely critical of his or her physique or self-image to an obsessive and compulsive degree. As it is with anorexia, a person with BDD is said to show signs of a characteristic called distorted body image. In layman's terms, anorexia sufferers commonly believe they are overweight, many times claiming they see themselves as "fat", when in reality, they are often, but not always, nutritionally underweight and physically much thinner than the average person. In the same way, a sufferer of "tanorexia" may believe him or herself to have a much lighter – even a pale – complexion when he or she is actually quite dark-skinned.
Neither tanning dependence nor tanorexia are covered under the latest edition of the Diagnostic and Statistical Manual of Mental Disorders . However, a 2005 article in The Archives of Dermatology presents a case for UV light tanning dependence to be viewed as a type of substance abuse disorder. [11]
In 2012, New Jersey mother Patricia Krentcil received national media attention amid accusations that she had brought her five-year-old daughter with her to a tanning salon in order for the child to receive a tan. The child's school nurse had expressed concern over her sunburn, at which point the daughter claimed she had gone "tanning with Mommy". This prompted the school to call Division of Youth and Family Services, as New Jersey law bans children under 14 from tanning booths. [12] Initial media coverage of the event resulted in widespread attention given to Patricia Krentcil's unusually bronzed image, leading many to speculate that she was tanorexic. [13] She was subsequently charged with second-degree child endangerment, [14] and she was banned from over 60 tanning salons in the tri-state area. [15] Patricia claimed that it was all a misunderstanding, saying her daughter was never exposed to the tanning booth's UV rays and instead got slightly sunburned while playing outside on a warm day. [16] She was later cleared of the charge. [17] At one point, she was challenged to stop tanning for one month, which she did, greatly changing her appearance. She claimed it made her feel "weird and pale", and that she would cut back on tanning, but not eliminate it from her hobbies. A Connecticut-based business also attempted to seize and capitalize on the "tan mom" craze by creating an action figure doll of Patricia. [18]
Excessive tanning increases the risk of developing certain types of skin cancer. People that are addicted to tanning are dealing with a body dysmorphic disorder (BDD). [19] People with tanorexia dislike the color of their skin but in reality the perceived defect may be only a slight imperfection or non-existent. Commonly, people who are suffering from tanorexia also suffer from anxiety disorders such as obsessive compulsive disorder, depression and eating disorders.
To get the right treatment for tanorexia, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. Effective treatments that are available at the moment are cognitive behavioral therapy, antidepressant medications, hypnosis and addiction treatment centers. [19] Antidepressant medications include selective serotonin reuptake inhibitors and can help relieve the obsessive and compulsive symptoms of tanorexia. The third treatment, is an audio hypnosis session which is developed by psychologists with a wide experience in helping people beat all kinds of addictive behaviour patterns. [20] [ unreliable source? ] Lastly, people with an extreme tanning addiction can look for help at specific addiction centres that are spread throughout the United States. [21] [ unreliable source? ]
In Western European culture, pale skin has indicated high status. A tan signified that you had to work outdoors as a manual laborer, while pale skin announced that you could afford to stay out of the sun and spend time and money cultivating your appearance. In the 1920s, pioneering fashion designer Coco Chanel popularized the idea of tanning. She made it so the sun represented pleasure and relaxation as well as wealth. [22] Post Industrial Revolution, tanning gained popularity because at this time it was easier to be employed, and therefore there was less outdoor manual labor, and more indoor labor. Due to more indoor jobs, a tan began to mean that you had the leisure time to bronze your skin and the money to travel to places where it could be acquired. A tan also represented enthusiasm for outdoor activities, as well as physical fitness and good health. [23]
When tanning bed became implemented the concept of tanning changed yet again. The first self tanner, Tan-Man, was introduced in 1959, and UV tanning beds started to appear in the United States in 1978. [24] A study conducted at Pepperdine University in 2005 found that 25 percent of beach-goers showed signs of tanning addiction or tanorexia. [25] Since the implementation of tanning beds in the United States, nearly 30 million people tan indoors every year. [26]
There have been health issues related to tanning trends. In 2014 most Australian states put a ban on all commercial tanning beds. It is the second nation after Brazil to impose restrictions. In 2011 over 2000 people died from skin cancer in Australia. Several European counties and American States have banned the use of tanning beds by minors. [27] Scientists have also suspected that frequent exposure to UVs has the potential to become addictive. Researchers have found that several parts of the brain that play a role in addiction are active when people are exposed to UV rays. [28]
In the mid-1990s, a new type of tanning trend appeared in Japan called Ganguro. It was a way for Japanese women to resist traditional roles for women in Japan. [29] The style is described as having deep tans and blond, orange, or silver gray hair. Many of these women were shunned by the public and media. [30]
Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.
Trichotillomania (TTM), also known as hair-pulling disorder or compulsive hair pulling, is a mental disorder characterized by a long-term urge that results in the pulling out of one's own hair. A brief positive feeling may occur as hair is removed. Efforts to stop pulling hair typically fail. Hair removal may occur anywhere; however, the head and around the eyes are most common. The hair pulling is to such a degree that it results in distress and hair loss can be seen.
Body dysmorphic disorder (BDD), also known in some contexts as dysmorphophobia, is a mental disorder defined by an overwhelming preoccupation with a perceived flaw in one's physical appearance. In BDD's delusional variant, the flaw is imagined. When an actual visible difference exists, its importance is disproportionately magnified in the mind of the individual. Whether the physical issue is real or imagined, ruminations concerning this perceived defect become pervasive and intrusive, consuming substantial mental bandwidth for extended periods each day. This excessive preoccupation not only induces severe emotional distress but also disrupts daily functioning and activities. The DSM-5 places BDD within the obsessive–compulsive spectrum, distinguishing it from disorders such as anorexia nervosa.
Sun tanning or tanning is the process whereby skin color is darkened or tanned. It is most often a result of exposure to ultraviolet (UV) radiation from sunlight or from artificial sources, such as a tanning lamp found in indoor tanning beds. People who deliberately tan their skin by exposure to the sun engage in a passive recreational activity of sun bathing. Some people use chemical products which can produce a tanning effect without exposure to ultraviolet radiation, known as sunless tanning.
Indoor tanning involves using a device that emits ultraviolet radiation to produce a cosmetic tan. Typically found in tanning salons, gyms, spas, hotels, and sporting facilities, and less often in private residences, the most common device is a horizontal tanning bed, also known as a sunbed or solarium. Vertical devices are known as tanning booths or stand-up sunbeds.
Ultraviolet light therapy or ultraviolet phototherapy is a treatment for psoriasis, atopic skin disorder, vitiligo and other skin diseases.
A food addiction or eating addiction is any behavioral addiction that is primarily characterized by the compulsive consumption of palatable food items which markedly activate the reward system in humans and other animals despite adverse consequences.
Sunless tanning, also known as UV filled tanning, self tanning, spray tanning, or fake tanning, refers to the effect of a suntan without exposure to the Sun. Sunless tanning involves the use of oral agents (carotenids), or creams, lotions or sprays applied to the skin. Skin-applied products may be skin-reactive agents or temporary bronzers (colorants).
Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, autism spectrum disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.
According to proponents of the concept, sexual addiction, also known as sex addiction, is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; neither of the two major mainstream medical categorization systems recognise sex addiction as a real medical condition, instead categorizing such behavior under labels such as compulsive sexual behavior.
Excoriation disorder, more commonly known as dermatillomania, is a mental disorder on the obsessive–compulsive spectrum that is characterized by the repeated urge or impulse to pick at one's own skin, to the extent that either psychological or physical damage is caused.
An addictive behavior is a behavior, or a stimulus related to a behavior, that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders and behavioral addiction. The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.
Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.
UV-B lamps are lamps that emit a spectrum of ultraviolet light with wavelengths ranging from 290–320 nanometers. This spectrum is also commonly called the biological spectrum due to the human body's sensitivity to light of such a wavelength. UV-B light does not tan the skin very much, compared to the UV-A lamps that are used in tanning beds.
Pseudoporphyria is a bullous photosensitivity that clinically and histologically mimics porphyria cutanea tarda. The difference is that no abnormalities in urine or serum porphyrin is noted on laboratories. Pseudoporphyria has been reported in patients with chronic kidney failure treated with hemodialysis and in those with excessive exposure to ultraviolet A (UV-A) by tanning beds.
Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet (UV) radiation, usually from the Sun. Common symptoms in humans and other animals include red or reddish skin that is hot to the touch or painful, general fatigue, and mild dizziness. Other symptoms include blistering, peeling skin, swelling, itching, and nausea. Excessive UV radiation is the leading cause of (primarily) non-malignant skin tumors, which in extreme cases can be life-threatening. Sunburn is an inflammatory response in the tissue triggered by direct DNA damage by UV radiation. When the cells' DNA is overly damaged by UV radiation, type I cell-death is triggered and the tissue is replaced.
Exercise addiction is a state characterized by a compulsive engagement in any form of physical exercise, despite negative consequences. While regular exercise is generally a healthy activity, exercise addiction generally involves performing excessive amounts of exercise to the detriment of physical health, spending too much time exercising to the detriment of personal and professional life, and exercising regardless of physical injury. It may also involve a state of dependence upon regular exercise which involves the occurrence of severe withdrawal symptoms when the individual is unable to exercise. Differentiating between addictive and healthy exercise behaviors is difficult but there are key factors in determining which category a person may fall into. Exercise addiction shows a high comorbidity with eating disorders.
Skin cancer in Australia kills over 2,000 each year, with more than 750,000 diagnosed and treated. Tanning became embedded in Australian culture and proved to be a controversial issue because of its popularity among teens and solarium users, despite correlations between tanning and an increased risk of developing melanoma. Australia experienced relative success through skin cancer prevention campaigns started in the 1980s and continued to invest and promote awareness through government-funded mass media strategies. Although Australia has one of the highest national rates of skin cancer, mortality trends in melanoma stabilized.
Sherry Pagoto is a professor in the Department of Allied Health Sciences at the University of Connecticut and director of the UConn Center for mHealth and Social Media. A behavioural scientist and licensed clinical psychologist, she is an expert in leveraging technology, especially social media, to promote health behavior change with extensive research on the topics of obesity management and cancer prevention. She is the President of the Society of Behavioral Medicine.
June K. Robinson is an American dermatologist, academic and researcher. She is a Research Professor of Dermatology at Northwestern University’s Feinberg School of Medicine.
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