Adolescent Idiopathic Scoliosis and Emotional Health

Going through adolescence is hard for everyone as they experience body changes, surging hormones, and new peer pressures. Being diagnosed with adolescent idiopathic scoliosis—an abnormal sideways curvature of the spine without a known cause—can make things even tougher.

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It is common for medical professionals and parents to focus on finding and providing the right medical treatment for an adolescent who has scoliosis. However, all too often, little or no attention is paid to how scoliosis can affect self-esteem and emotional health. In order to successfully navigate this condition, it is important to offer adolescents emotional support and listen to their concerns. ¹ Reichel D, Schanz J. Developmental psychological aspects of scoliosis treatment. Pediatr Rehabil. 2003;6(3-4):221-5.

Factors That Can Affect Adolescents with Scoliosis

Adolescence is a time when children are especially concerned with fitting in. Anything that makes an adolescent appear different can potentially detract from that goal. Some common challenges for an adolescent with scoliosis could include:

• Sideways spinal curve and/or rib hump that is noticeable in the back when wearing a swimsuit or while changing in a locker room.
• Clothes that fit unevenly, such as one sleeve appearing too long while the other appears too short.
• Wearing a back brace that feels uncomfortable and requires activity to be limited, such as only being able to exercise, shower, or swim at set times during the day when it is taken off. Some back braces might be visible even while wearing clothes, which could potentially lead to questions or teasing.

See Types of Scoliosis Braces

Adolescents dealing with scoliosis are also at an increased risk for developing depression. ² Payne WK 3rd, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW. Does scoliosis have a psychological impact and does gender make a difference? Spine (Phila Pa 1976). 1997; 22(12):1380-4. ^{, 3} Chang WP, Lin Y, Huang HL, et al. Scoliosis and the subsequent risk of depression: a nationwide population-based cohort study in Taiwan. Spine (Phila Pa 1976). Feb; 41(3):253-8.

Relatively Mild Scoliosis Can Lower Self-Esteem

Scoliosis curves are traditionally measured by the Cobb angle, which is the angle between the most-tilted vertebra above the curve’s apex and most-tilted vertebra below the apex. Scoliosis curve sizes can vary—ranging from barely being considered scoliosis (10 degrees) and not noticeable to major curves that are easily seen when a swimsuit is worn.

Scoliosis in teens and young adults is linked to lowered self-esteem, but some studies suggest the findings are somewhat independent of curve size. ⁴ Freidel K, Reichel D, Steiner A, Warschburger P, Petermann F, Weiss HR. Stud Health Technol Inform. 2002; 88:24-9. ^{, 5} Kotwicki T, Kinel E, Stryla W, Szulc A. Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires. Scoliosis. 2007. 2: 1. ^{, 6} Durmala J, Blicharska I, Drosdzol-Cop A, Skrzypulec-Plinta V. The level of self-esteem and sexual functioning in women with idiopathic scoliosis: a preliminary study. Int J Environ Res Public Health. 2015 Aug; 12(8): 9444–9453. An adolescent who has a relatively mild case of scoliosis could still have serious emotional health challenges due to the condition.

The lack of a strong correlation between self-esteem and mild to moderate Cobb angles could potentially be because how someone feels about their scoliosis is subjective. One adolescent might have a relatively small curve but be bothered by the idea of having any type of spinal deformity, even if most people do not notice it. Another might have a relatively large curve, but adjusts to it well. Several other factors could also be involved, such as the possibility that someone with milder scoliosis could be teased or bullied for it more than someone who has a more severe case.

Offer Emotional Support to Adolescents with Scoliosis

When an adolescent has scoliosis, there can be a feeling of loss of control. Scoliosis cannot truly be cured—either a brace prevents the curve from getting worse or a major surgery straightens and fuses part of the spine. If a bracing treatment is recommended, it typically involves strict rules regarding how tight the brace must be, when it is to be worn, and what can and cannot be done while wearing the brace.

Anything family and friends can do to help empower the adolescent with scoliosis may be of benefit. Some examples include taking time to ask and listen to how he or she feels, offering supportive words or assistance with a task, and helping find ways to stay active and have fun. In addition, there are online scoliosis support groups for adolescents.

If an adolescent starts to show signs of depression—such as an unusual, long-lasting mood change or spending more time alone—it is important to seek help from a medical professional who can evaluate the situation.