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Adjustment and distress are multi-factorial. A synthesis of findings from all the studies indicates
that the psychological characteristics of those who were positively adjusted included higher
levels of optimism, greater feelings of social acceptance and satisfaction with social support, a
lack of concern about negative evaluations by others, and a self-system with lower levels of
salience and valence afforded to appearance related information. Levels of social anxiety and
social avoidance were low, as were levels of negative affect, general anxiety and depression.
These people felt their disfigurement was reasonably easy to disguise, and tended to be older
than people with higher levels of distress.
By contrast, those experiencing high levels of distress were characterised by a more pessimistic
outlook on life, higher levels of fear about negative evaluations by others and perceptions and
lower levels of satisfaction with levels of social support. The discrepancy between how they
perceived their appearance to be, and how they thought it should be was considerable. They
believed their disfigurement was visible to others, and hard to disguise. Appearance concerns
occupied a more central position in their cognitive architecture and in the way they process
information from their social environment.
These findings have consequences for the wellbeing of people with visible difference, as many
of the characteristics of those with higher levels of distress are amenable to intervention for
which there is a growing evidence base. Accordingly, the results of this programme of research
have been used to inform the development of an intervention manual which is included in this
report. This manual will form the basis of a training package to be piloted in November 2009.
Summarised recommendations
Intervention
Packages of support and intervention tailored to individual need should be developed, trialled
and refined.
Support and intervention should address the socio-cognitive and appearance specific cognitions
identified in this and earlier studies.
Support and intervention should be offered in a timely way according to a tiered model from
generalist to specialist interventions.
Screening and referral pathways to facilitate this approach should be developed.
Interventions should have regard for the cultural context of different groups of people with visible
difference.
Training and education
Training packages for health professionals should be developed emphasising screening, tiered
treatment and referral.
Public education initiatives should be developed to reduce the pressure from the media and
society on those vulnerable to appearance concerns.
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