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patient populations, but in contrast pose significant difficulties for those presenting to surgical
clinics.
Further, this shows that people with visible differences have pronounced and sometimes
debilitating concerns about their appearance which impact on their engagement in intimate
behaviours. Socialising with potential partners and hugging were self-reported as problematic
for a large proportion of this sample of patients seeking surgery. This supports the limited
previous research with condition specific groups (e.g. Porter et al 1990) and is in line with the
high levels of social anxiety experienced by this group. Future research considering the impact
of appearance concerns on intimacy with people with visible differences is required in order to
develop the scale further. The ceiling effects on responses to the questions by the clinic sample
indicate that future versions of the scale need to include more non-sexual intimate behaviours
(e.g. touch, dating, talking to potential partners, exposure of body parts) and their anticipatory
cognitions about performing these behaviours (worry about dating, looking attractive to others).
CONCLUSION
The role of appearance concerns in intimacy and sexual relationships is an under-researched
but important issue to consider when seeking to understand the adjustment of people with
visible differences. Developing a more robust scale would allow the measurement of early
avoidance behaviour and the opportunity to offer appropriate intervention sooner. It would also
provide an important outcome measure for both psychosocial and surgical interventions for
people with appearance-related concerns. This remains a priority for future research in this
area.
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