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appearance-related issues. The salience of appearance concerns, the value attached to
appearance, appearance-related self-ideal discrepancies and appearance-related social
comparison processes correlated significantly with all outcome measures. Their effects were
particularly apparent in relation to scores relating to social anxiety and social avoidance
(DAS24) but their role also impacted on levels of anxiety, depression, aggression, positive and
negative affect.
The results indicate that appearance concerns are complex and can be debilitating. However,
an important positive aspect is that they involve factors which are amenable to intervention,
offering a strong endorsement of the potential of cognitive behavioural approaches to address
the needs of those affected. The results of this study support the tentative conclusion drawn
from previous research that the appearance concerns of people both with and without
disfigurements contribute to a range of processes including beliefs about the impressions
formed by others on the basis of appearance, and perceptions of the self (Thompson & Kent,
2001; Moss & Carr, 2004; Rumsey & Harcourt, 2005). The current results further indicate that
the way people process appearance-related information contributes to their level of adjustment.
These mechanisms are not new in the psychological literature, but until now have not been
demonstrated so clearly in people with disfiguring conditions. Associations between processing
styles and psychological distress including anxiety (Bar-Haim et al, 2007) and depression (Mogg
& Bradley, 2005; Strunk & Adler 2009) have been demonstrated in general population samples,
and there has been some evidence of appearance-related cognitive biases resulting in
increased recall of appearance-related information (Altabe & Thompson, 1996) in people with
high levels of body image concern. An increased likelihood of interpreting ambiguous situations
as appearance-related and negative has been shown in people who are obese (Jansen et al,
2007) and in those with eating disorders (Cooper 1997) compared to those without. Rosser,
Moss & Rumsey (in submission) found in a sample of people without disfigurements that
appearance concerns appear to include a propensity to interpret ambiguous stimuli as
appearance-related and negative (without any priming), and that those with high levels of
concern have a tendency to attend preferentially to stimuli they believe to be appearancerelated
when given a choice.
Taken with the results of the current study, a picture is emerging of people (with or without
disfigurements) in whom higher levels of appearance concern result in attentional biases.
These are people who perceive the world in a way that reinforces and exacerbates their
distress. Their processing biases (for example, preferential attention to and interpretation of
ambiguous information as negative) may lead to a perception of the world that is dominated by
the appearance issue(s) of concern, perhaps resulting in hyper-vigilance towards threatening
stimuli and self-reinforcing perceptions regardless of the actual environment (Matthews, 1990;
Rosser, 2008).
Social comparison processes help us contextualise and understand ourselves in relation to
others. Rosser (2008), for example, highlighted that people placing a higher value on
appearance in their self definition are more vulnerable to making negative (upward)
comparisons with others. The more frequently people engage in social comparisons the more
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