The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment

Although the role of the objectively and subjectively rated severity of appearance problems is often debated, the impact of severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to self-consciousness of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment. Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe objective severity was most related to poor adjustment.