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5.) Time Structures
What was striking about many of the responses was that people gave it a ‘whole life’ context,
stating how long they had had their condition and what had changed in their lives.
Duration: Respondents outlined since when, or for how long, they had their condition. This
illustrated the magnitude of their distress ‘spent half my life fighting this problem’ [man with RA];
it ‘[acne] still saps all my confidence, 40+ years later [female]. It could also stress that people
were ‘old hands’ at managing their condition and had learnt how to cope: ‘I am used to [psoriais]
and can hide affected areas’ [female].
Changes: This was relevant for many respondents, and was important for those with
conditions, especially skin conditions that could ‘flare up’ or change according to the seasons, or
the hormonal cycle. Some respondents wrote how their appearance, or coping strategies,
improved or worsened over time. Other respondents wrote about changes in coping with their
appearance, or life changes (divorce, changing jobs, children leaving home) had affected how
they coped with their appearance.
Milestones: Respondents mentioned especially relevant ‘milestone’ events, such as diagnosis
or beginning of conditions, years at school or childbirth.
COMMENTARY
Respondents wrote of a mix of appearance-related concerns, including those relating to
disfigurement, weight/shape and also the effects of ageing. This is an important point. Those
working in the area of disfigurement should note that the concerns of those affected are not
limited only to the consequences of their disfiguring condition and these should not be treated in
isolation.
The pressure exerted by socio-cultural standards and the resulting self-ought discrepancy are
widely evident in the responses. These are particularly salient in the responses to Theme I,
focusing on the sense of falling short of societal ideals. The second theme illustrates the
influence of appearance concerns on attributions for many aspects of the life course including
disruption to employment and relationships. Change was seen to exacerbate distress, including
the impact of life events, such as divorce and children leaving home, changes to social
groupings, and also changes in the status of their condition, for example, fluctuations in chronic
conditions. For some, there was a sense that significant proportions of their lives had been
dominated or given over to their appearance issue.
The impact of the responses of other people’s reactions and judgements is also highlighted, and
several respondents mentioned their concern about possible as well as actual responses.
There is also a reminder within this theme that partners, families and friends can offer both
positive support and be unhelpful.
A wide range of coping strategies are mentioned. Effective techniques include acceptance,
relegating the appearance concern to a low level of importance in the overall life experience,
and a sense of pragmatism. Others talked of coping less well, and of hiding the object of their
appearance concern to the best of their ability.
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