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SUMMARY
• Twenty-six participants were purposively selected from a group who had previously
completed the ARC battery of psychometric measures at baseline and follow-up at 9
months.
• Participants identified themselves into one of four groups of adjustment (‘well adjusted
stable’; ‘distressed stable’; ‘improvement in adjustment’; or ‘deterioration in adjustment’).
• Individual questionnaire data were analysed to ascertain levels of adjustment according
to the quantitative measures and semi-structured interviews were conducted.
• Template analysis was used to explore and refine themes derived from the aims of the
research programme and the conceptual model used in Study 1: predisposing factors to
different levels of adjustment; intervening cognitive processes associated with different
levels of adjustment; and outcomes associated with different levels of adjustment
• There were discrepancies between the participants’ self reported perceptions of
adjustment and their scores on psychometric measures, particularly for the stable well
adjusted and improvement groups.
• Predisposing factors including experience of negative reactions from others and daily life
stressors were common across all groups.
• Those who identified themselves as well adjusted reported greater cognitive flexibility in
relation to their core views of themselves and of their appearance. They also reported
making external attributions (i.e. linking cause to others) and to have developed coping
skills that boosted self-efficacy.
• Those who identified themselves as well adjusted reported a high level of engagement in
social behaviour and not engaging in avoidance strategies, whereas the other groups
reported low levels of engagement and use of avoidance in coping. Maintaining stability
of positive adjustment was described as exerting an ongoing demand on resources.
• Improvement was associated with good aesthetic outcomes following treatment, greater
awareness of cognitive coping strategies, and social and professional support.
• Deterioration was associated with the occurrence of negative life events, and increase in
appearance salience due to a range of factors (i.e. others reactions, functional disability,
need for further treatment).
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