Background Acne vulgaris (AV) imposes psychosocial burden beyond lesion severity, yet the specific psychological profiles it produces remain incompletely characterized. Objective To examine emotion dysregulation (DER) and binge-eating disorder (BED) psychopathology in AV patients, and evaluate whether subjective quality of life (QoL) mediates the association between objective severity and psychological outcomes. Methods This cross-sectional study enrolled 100 AV patients and 105 matched controls. Objective severity (GAGS), QoL (AQLS), DER (DERS-16), and eating psychopathology (EDE-Q-13/BED subscale) were assessed. Bootstrapped mediation analyses and multivariate regression were performed. Results AV patients demonstrated significantly higher DERS-16 (d = 1.82) and BED subscale scores (p = 0.005) than controls. Group membership predicted DERS-16 and EDE-Q-13-BED scores independently of sociodemographic covariates. GAGS severity showed no direct association with DERS-16 or EDE-Q-13. Crucially, AQLS significantly mediated the effect of GAGS on both DERS-16 (β = 2.747, 95% CI [0.164, 5.837]) and EDE-Q-13 (β = 0.336, 95% CI [0.036, 0.836]); these indirect effects remained robust after adjustment for education, occupation, and income. Study limitations Cross-sectional design limits causal inference. Significant sociodemographic differences existed between groups (controlled via regression). Statistical power for GAGS subgroup comparisons was limited. No structured psychiatric interviews were conducted. Conclusions Subjective QoL impairment, rather than objective lesion burden, is associated with significant indirect effects on both emotion dysregulation and affect-driven eating pathology in AV patients. Routine dermatological care should integrate QoL assessment and psychological screening, irrespective of clinical severity.
