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Visibility and areas of concern
The findings relating to the visibility or otherwise of a disfigurement to others are mixed.
Approximately 65% indicated that their main concern related to the appearance of their face or
head, and 12.3% indicated their hands, mirroring earlier research about the greater impact of
visible disfigurements, compared with those which are more easily camouflaged or covered up
(see for example, Kent & Keohane, 2001). In addition, increasing levels of distress were
associated with perceptions of increasing difficulty in being able to disguise the aspect of
appearance in question. However, in the regression analyses, a lack of visibility to others in
everyday situations was associated with greater distress (higher levels of depression, anxiety,
aggression and negative affect, lower positive affect and higher levels of fear of negative
evaluation by others). It should be noted, however, that the effect sizes were small, and other
appearance-related cognitions had a much greater impact on adjustment. This mixed picture of
the effects of the visibility or otherwise to others may have resulted from shortcomings in our
measures. However, Moss (2005) and Rosser (2008) have also highlighted the complex nature
of the relationship between visibility and adjustment. Rosser (2008) noted the likelihood of an
effect of ease of concealment and also that the personal salience and valence attached to a
particular body part may further complicate matters. Major & Granzow (1999) and Smart &
Wegner (1999), raised the possibility of the ‘Preoccupational Model of Secrecy’ which discusses
the possible negative impact of concealment associated with the threat of the stigma being
discovered and/or fear of revealing the stigma. Those with a difference which is routinely visible
to others may be forced to develop strategies to deal with the reactions of others (for example,
using camouflage, or developing ‘stock’ answers to common questions), and may perceive this
to be effective. Avoidance of the need to develop these strategies may increase fears of
negative evaluation by others and may feed insecurity in more intimate situations when the
disfigurement will become visible. This interpretation is also supported by recent data derived
from patients seeking plastic surgery (Clarke, Hansen, White and Butler, in preparation). Further
research is warranted in this area.
Previous research has consistently shown a lack of linear relationship between severity and
concern/distress. In the light of these findings, and as the focus of this research related to
subjective psychological factors and processes, there was no objective assessment of the
severity of the participants’ disfigurement in this study. Various explanations for the lack of
relationship between severity and adjustment/distress have been put forward. Lansdown et al
(1997) suggested that those with ‘minor’ differences have to face a variability in responses that
inhibits the ability to predict with any certainty, and this can act as a deterrent to developing self
efficacy in responding effectively. For those with more severe (and visible to others)
disfigurements, there is a more consistent reaction (and most react), thus prediction is relatively
easy. Moss (2004) illustrated the complexities of the severity and the disguisability of
disfigurement and adjustment in reporting a U shaped parabola in a sample of 400 people with
a variety of disfigurements for visible disfigurements, with no such relationship for those able to
routinely conceal their difference. Moss refined Lansdown’s explanation in speculating that both
minor and severe disfigurements produce consistent and more easily predictable responses
from others, with those in the mid range provoking more variety.
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