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BACKGROUND
To date, the majority of research in the field of visible difference has focused on the experiences
of people who report having problems such as difficulties in social situations, and on negative
outcomes, such as anxiety and depression. However, many people living with a visible
difference do not report such problems. For example, whilst 30-50% of participants in a study of
650 people with a visible difference reported significant levels of distress (Rumsey et al 2004),
the majority (50-70%) did not. Furthermore, more than 70% of respondents to a survey by the
Cleft Lip and Palate Association reported positive consequences of having their cleft. Moreover,
Thompson et al. (2002) reported that some people with vitiligo spontaneously developed coping
strategies not unlike those used within treatment. More, recently, Saradijian et al. (2008)
reported that some people using a prosthesis were using a variety of strategies to minimise their
distress. Faulkner and Thompson (2006) purposively selected people whom identified
themselves as coping well with a disfigurement and found a range of naturalistic coping
strategies being used.
Clearly many people do adapt positively to the challenges they face, and succeed in minimising
the impact of their visible difference (Rumsey, 2002). It has been suggested (Eisermann, 2001)
that it is unethical to focus on pathology and not to consider positive aspects and outcomes of
visible difference. Whilst some research has examined positive aspects of chronic illness
including benefit finding and adversarial growth (e.g. Petrie et al, 1999; Sodergren & Hyland,
2000; Sodergren, Hyland, Crawford & Partridge, 2004), there is currently very limited research
focussing on visible difference. That which has been conducted has shown that humour, a good
sense of self, family support and faith all contributed to resilience and success amongst
individuals with Moebius syndrome (Meyerson, 2001) and inner strength and a valued social
circle were identified in those with a craniofacial difference (Eiserman, 2001). These studies,
and others (e.g. Fortune et al, 2005) have focussed on specific conditions as opposed to visible
difference more generally.
The current study was conducted with people with a variety of visible differences. It aimed:
• To investigate positive consequences of living with a visible difference. Specifically, what
are they? Why are they considered positive and what facilitates them?
• To inform the development of psychosocial interventions intended for those individuals
who report problems associated with having a visible difference.
METHOD
A review of available quantitative measures (e.g. The Silver Linings Questionnaire; Satisfaction
with Illness Scale) failed to identify any standardised scales that would give a sufficiently indepth
understanding of the issues relevant to people with a visible difference. Instead, a
qualitative methodology was felt more appropriate to capture rich, personal accounts of
participants’ positive experiences and perceptions of living with a visible difference.
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