July 1st, 2010

Is excessive tanning a disorder?

You’ve perhaps known someone with a seemingly insatiable need to tan, no matter how bronzed he or (probably) she already is. And though these so-called “tanorexics” will probably never enter therapy for their sunbathing habit, there do indeed appear to be some psychological factors that entice people to ignore the well-publicized health risks.

Excessive tanning is nothing new. Yet when summer rolls around, efforts to get people to think twice about that “healthy,” sun-kissed glow are renewed. Although melanoma, the deadliest form of skin cancer, kills about one person an hour in the U.S., the threat pales in comparison to the aesthetic perks of a nice tan.

“Future outcomes have less psychological power than those more immediately down the road,” says Mark Leary, Ph.D., director of Duke University’s social psychology program, who conducted several studies on excessive tanning in the 1990s. His studies found the most devout sun worshippers placed a high value on being attractive and making favorable impressions on others.

“When you start thinking of tanning in terms of the value people place on being perceived positively and accepted by other people, it at least makes a little more sense,” Leary says. “Tanning is an extension of all the things people do to be liked and accepted. If you look it at that way, it doesn’t seem as vain or as irrational.”

Yet – as with anorexics – people who tan beyond a certain point may regard themselves differently from the way others see them.

“Someone who’s struggling may have a problem with their appearance, but not with their behavior,” says Chris Overtree, Ph.D., director of the Psychological Services Center at the University of Massachusetts-Amherst. “They may not have insight into the problem.”

Overtree likens excessive tanning to body dysmorphic disorder, which involves a distorted view of some aspect of one’s appearance, sometimes to the point that the person will have surgery.

One recent study by researchers at Memorial Sloan-Kettering Cancer Center and the University of Albany, State University of New York found a link between excessive tanning bed use and anxiety. Leary, in his research, found that the most “tan-insatiable” people showed signs of mild obsessive-compulsive disorder.

Other research has shown the desire to spend time in the sun might have a biological base. A protein linked to tanning may also be linked to the release of beta-endorphin, which binds to the body’s opiate receptors and may make sunbathing particularly pleasurable and relaxing.

“It’s very reasonable to wonder if UV radiation may trigger an addictive propensity through beta-endorphin release,” says David Fisher, M.D., Ph.D., chairman of the dermatology department at Massachusetts General Hospital.

The question of why people may have developed a propensity to seek the sun, even though it’s dangerous, is an interesting one, Fisher points out. He speculates the answer has to do with the need for Vitamin D – the lack of which could be fatal for children (through untreated rickets).

The production of Vitamin D in the body depends on sunlight touching the skin. During the course of evolution, as people migrated to colder northern latitudes, they may have evolved to be fair-skinned – fair-skinned people need less sunlight to produce vitamin D than darker-skinned people do. But people may also have lacked motivation to leave their caves, especially in winter and risk being food for predators in order to get the sunlight they needed, Fisher says.

“Maybe those who did leave their caves were at an advantage, since they got the Vitamin D they needed,” he says. “So, from an evolution standpoint, sun-seeking may truly have been part of the human species.”

People need to strike a balance between helping along their vitamin D production and avoiding skin cancer, Fisher acknowledges. Although people who tan easily are at less of a risk for skin cancer than are people who don’t, there’s no such thing as a safe tan.

“The act of developing a tan requires UV radiation to damage DNA in the skin,” he says. “The only way you could become tan is through some risky mutation-related process.”

DNA damage sounds like scary stuff, to be sure. Yet pronouncements on the adverse health effects of tanning might not be working as well as health officials would hope.

Leary says a more effective strategy might target appearance – perhaps an image of a 30-something who had to have a skin cancer lesion removed. In one study on young people, Leary found that having them read an article describing the appearance risks of excessive tanning (such as leathery skin and premature aging) was far more effective in changing their attitudes toward tanning than was having them read an article warning of skin cancer.

Leary says another public service approach could be to try to get people to compromise.

“Rather than say ‘don’t tan,’ you could try to get people to walk some middle ground that’s halfway healthy, halfway unhealthy,” he says. “You might tell them it’s okay to have a base tan, but don’t go overboard.”

By Ami Albernaz

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