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anxiety was in the low to mild range, the level for positive affect was quite high, and negative
affect quite low compared with normative values. The mean level for aggression fell in the low to
moderate range. However, the variance in the sample was high, and substantial numbers of
participants showed significant levels of distress.
The data from clinic attendees was examined for any notable patterns of adjustment or distress.
There are many difficulties inherent in classifying the various conditions which result in
disfigurement (for example, patients attending a dermatology or plastics clinic will have
disfigurements resulting from a large number of different aetiologies). Accordingly our analysis
was limited to differences in the type of clinic attended. The overall impression resulting from
this analysis was the similarity in profiles from the various clinics – once again adding to the
impression that individual psychological factors and processes were a bigger determinant of
adjustment. Taken on its own however, the lack of differences between clinics in this data set
should be treated with caution. Despite minimum recruitment targets for every clinic, the
challenges of recruitment and the resulting sample sizes varied considerably. The profile for
participants with a cleft of the lip and/or palate is one of greater distress for negative affect,
aggression and anxiety than for participants from other clinics. However, the sample is also the
smallest (n=11), reflecting the low preponderance of patients of 18 years and over attending this
particular out-patient clinic. In addition, adjustment profiles may vary as a result of the age
profiles of attendees (for example, the preponderance of older adults attending melanoma and
Rheumatoid Arthritis clinics).
Demographic variables
The mean age of participants was 47 years, with a range of 18-91 years. The respondents in
this study represent a sample with an older profile than in the majority of previous research,
offering a useful insight into the appearance concerns in middle and older adulthood. There
were negative correlations between increasing age and scores for social anxiety and social
avoidance, aggression, negative affect, depression and anxiety. So, bearing in mind the
limitations of a cross-sectional sample, the picture in this study is one of positive adjustment
increasing with age. However the relationships are not dramatic and many older participants
were concerned and distressed about their appearance. These results are consistent with
previous research, and should not be taken as indicating that appearance concerns are the
preserve only of the young.
The importance of appearance in late adolescence and early adulthood has been highlighted by
many (Harris & Carr 2001; Liossi 2003; Lovegrove & Rumsey, 2005), and Cash et al’s (1986)
survey of 15-74 years found that body image concerns diminished with age. However, Rosser
(2008) has also pointed out that the role of age in appearance adjustment is not straightforward,
and Lansdown, Lloyd and Hunter (1991) pointed to the crucial role of appearance concerns
throughout the lifespan. Rumsey and Harcourt (2005) reported data from older people (over 60
years) with skin conditions which indicated that although fewer people in this age group
expressed significant concerns, a sizable proportion were distressed about aspects of their
appearance. Rather than a reduction in levels of concern compared with younger people, the
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