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Socio-cultural factors
These factors provide the context for adjustment, and include age and developmental stage,
gender, race, social class & cultural milieu. Also included in this category are parental and peer
group influences. In addition, many writers have pointed to the role played by the media in
creating and exacerbating the pressures on those distressed by their appearance – although the
impact of media and other socio-cultural factors has been shown to vary between individuals
(Tiggemann, 2004).
Psychological factors and processes
Factors in this category include the structure of a person’s self esteem and self-image (e.g. the
weight given to the opinions of others and to broader societal standards), a person’s
personality/disposition, coping repertoire, perceptions of social support, levels of psychological
well-being (e.g. anxiety, depression) and social anxiety, feelings of shame, and the perceived
noticeability of their visible difference to others. These factors can be broadly categorised as
affective (relating to feelings), cognitive (relating to thoughts) or related to behaviour, and are on
the whole more amenable to change than physical, treatment-related or socio-cultural factors
(Thompson & Kent, 2001; Rumsey & Harcourt, 2005). Fagervik-Morton’s (in preparation)
systematic review of the literature relating to adults with visible differences (which initially
examined 1191 potentially relevant articles, and a final inclusion of 12 studies) concluded that
the evidence was not sufficiently strong to draw firm conclusions about which factors exacerbate
distress/promote adjustment and whether variation is related to the structure and organisation of
appearance-related information. This review confirmed the existing conviction of this research
collaboration that an elucidation of these factors and processes should be a priority in this
programme.
Previous research has focused on the problems and difficulties associated with visible
difference. In addition, the large majority of participants in previous research have been
recruited from a population seeking treatment for their condition. In order to understand the
breadth of adjustment, it is also crucial to gather information from those who are not seeking
treatment and/or perceive treatment to be irrelevant in addressing their needs. Accordingly, this
research has also focused considerable recruitment effort on a sample drawn from the
community.
For the researchers and clinicians in this collaboration, the key priorities were, first, to clarify
those factors and processes that exacerbate distress and/or promote successful psychological
adjustment in people with visible differences, and second, by focusing on those factors which
are amenable to change, to use the resulting knowledge to inform the development and
refinement of a comprehensive range of methods of support and intervention designed to
promote positive adjustment.
Theoretical underpinning
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