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Several studies, however, have highlighted the importance of subjective assessments of
severity. Moss (2004) and Rumsey et al (2004) found a linear relationship between subjectively
assessed severity of appearance and adjustment, highlighting the importance of personal
evaluation of a problem. Our results showed a striking relationship between increasing
numbers of areas of concern and growing levels of distress, particularly in relation to social
anxiety and social avoidance around appearance (DAS24). Participants in the community were
more likely to report multiple areas of concern than those recruited in hospital settings, and
women had greater numbers of areas of concern than men.
Only 25.7% of the sample reported being concerned about only one area. It is important to note
that people with a disfiguring condition affecting one body part may also have significant
appearance concerns about other aspects of appearance. Twenty seven percent reported
concern about their abdomens, 22% in relation to the appearance of their thighs & 14% re
buttocks. These results may reflect concerns about weight, and it is possible that these worries
may over-ride issues about a disfiguring condition. Weight related concerns were greater in the
community sample. The prevalence of weight concerns in the general population comes as no
surprise in the current context of rising levels of obesity. However, more research is needed to
unpick the similarities and differences in the different types of concern.
The multivariate nature of adjustment
The measures chosen as the outcomes in our conceptual framework were significantly
correlated, supporting the view that adjustment is multi-factorial (see for example, Rumsey et al,
2004; Rumsey and Harcourt, 2005). 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.
An identical regression model was used to interrogate the data for each outcome variable. In
relation to social anxiety and social avoidance, an impressive 66.2% of the variance was
explained by the model. This was anticipated, as the measure in question (the DAS24) is
designed specifically to assess levels of distress in people with disfigurements. In this
regression model, there were no effects of living status, method of recruitment, or of
appearance-related social comparisons. There was a small gender effect, with women more
distressed than men, and strong negative effects of age (older people were less distressed),
optimism and social acceptance. As levels of fear of negative evaluation, salience and valence
increased, so did distress.
Similar pictures emerged when applying the regression model to the other outcome measures.
The model predicted approximately 30% of the variance for positive affect, 45% for negative
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