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The GHQ-12 has been recommended as a reliable screening instrument for psychological distress in all clinical groups. The usefulness of the GHQ-12 was evaluated in individuals with significant facial disfigurement by examination of the impact of alternative scoring methods on case detection rates. The type of scoring method used had a significant impact on the relative prevalence of `cases'. However, examination of the receiver operating characteristics (ROC) of the alternative scoring methods revealed a good fit between methods. The use of the GHQ-12 as a screening instrument to determine psychological distress in individuals with facial disfigurement may be enhanced by inclusion of an appearance-specific measure in the screening schedule and by the adoption of one scoring method; the GHQ method.

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The face is an integral part of one’s self-concept and unquestionably the most important attribute used to distinguish one's identity. A growing body of literature demonstrates that any condition that results in facial disfigurement can have a profound adverse impact on one's psychological and social functioning. In this respect, patients with facial disfigurements are at higher risk to experience psychosocial difficulties than others. Owing to injuries or illnesses such as cancer, patients undergo reconstructive surgeries both to recover their facial function and to reduce the adverse impact of facial disfigurements on their psychosocial functioning. However, since surgical planning and evaluation of reconstructive outcomes still relies heavily on surgeons' qualitative assessments, it is challenging to measure surgery outcomes and, therefore, difficult to improve surgical practice. Thus, this dissertation research aims to help patients suffering from facial disfigurement by developing quantitative measures that are 1) related to human perception of faces, and 2) that account for patient's internal status (i.e., psychosocial functioning). Such measures can be used to improve surgical practice and assist patients with disfigurement to be psychosocially adjusted. Specifically, this dissertation proposes quantitative measures of facial morphology and expression that are closely related to overall facial attractiveness and a patient's psychosocial functioning. Such measures will allow surgeons to quantitatively plan and evaluate reconstructive surgeries. In addition, this dissertation introduces a modeling technique to simulate disfigurement on novel faces with control on the type, location, and severity of disfigurement. This modeling technique is important since it can help patients with facial disfigurement gain a more accurate understanding of how they are viewed in society, which has a strong potential to facilitate their psychosocial adjustment. This dissertation provides a new perspective on how to help patients with facial disfigurement address challenging problems in facial reconstruction, aesthetic understanding, and psychosocial actualization. It is hoped that this work has shown that multiple benefits could be realized from future studies utilizing the modeling technique to understand human perception of facial disfigurement and thereby to develop quantitative measures that are closely associated with human perception. / text

No / The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool.

yes / The face is not the property of an individual; it is a key part of our communicating body. It is performed, in social interaction (Goffman, 1982) and seen and responded to within historicised and gendered ideals of the normal and of beauty. The normal and the beautiful have a particular resonance in a visually mediated consumer society, “looks matter”. But more than half-a million people in the UK have a significant disfigurement to their face (Changing Faces, 2007). This chapter explores the way facial difference illuminates debates on bodily representation. It explores how people living with visible facial difference invoke discursive formations of disfigurement (Garland-Thomson, 2009). It asks how we encounter and respond to facial difference and examines how close personal relationships can offer a source of support. The chapter contextualises the relevance of the face for communication and then examines implications for social selves in personal communities. Seventeen people living with visible facial difference were interviewed as part of a PhD study and interview extracts illuminate different aspects of the aesthetics of inclusion.

Objective: This systematic review explored how “adjustment” is generally defined in adults with an acquired visible difference (AVD) and what positive psychological factors have been evidence to be associated with positive coping and processes of adjustment in AVD. Method: A systematic search for peer reviewed journal articles from 1980 to February 2016 was conducted using: PyschINFO, Medline, EMBASE and CINAHL. Studies were appraised according to eligibility criteria and evaluated against a quality criterion to assess risk of bias. Results: Fourteen studies were included and were in the areas of head and neck cancer, burns and amputation. Selected studies demonstrated inconsistent conceptualisations of adjustment ranging from: lack of psychopathology, resilience, post-traumatic growth and quality of life. Psychological factors identified were; social functioning (social support, social self-efficacy), coping strategies (emotion, problem-focused, active coping) and dispositional optimism. Studies were considered to be of moderate methodological quality with weaknesses including; a lack of control/comparison groups, lack of measure sensitive to the unique challenges of living with AVD and minimal account for confounding variables. Results are discussed in the context of future research implications. Objective: This study aimed to explore the relationship between two dimensions of attachment insecurity (avoidance and anxiety), body image dissatisfaction and perfectionism using theoretically driven multiple mediation models that included emotion dysregulation and interpersonal problems as hypothesised mediators. Method: Fifty female outpatients seeking cosmetic surgery on the National Health Service (NHS) and 26 females interested in seeking cosmetic surgery within the public domain participated in this cross-sectional study (N=76). Participants completed measures of attachment avoidance and anxiety, body image dissatisfaction, perfectionism, emotion dysregulation and interpersonal problems. Results: Attachment insecurity was significantly associated with body image dissatisfaction and perfectionism. Interpersonal problems and emotion dysregulation also significantly partially mediated the relationship between attachment insecurity and body image dissatisfaction, specifically satisfaction with discrete aspects of body parts. Emotion dysregulation was also found to significantly partially mediate the relationship between avoidant attachment and perfectionism, but not anxiety. The clinical implications of this research are discussed.

People with visible facial difference often experience other people reacting negatively to their appearance. For many, this is part of everyday life. Research has identified social support as critical in adaptation processes. This is the case both for those whose facial difference was apparent at birth, and those who experienced injury or illness. There is a lack of a comprehensive theoretical construct for exploring how personal communities provide resources needed by adults to live well with visible facial difference. The combination of semi-structured interviews and creation of personal community maps provided opportunities to explore the interplay between respondent accounts and patterns of relationships people are embedded within. Seventeen adults with visible facial difference and two unaffected ‘significant others’ were interviewed. The findings provide evidence that personal communities are important social spaces for negotiation of resources that enable adults to feel connected, valued and safer within wider communities. Social support was not described as a property of the individual, but as experienced with combinations of people that change according to situation, place, or time. A diversity of personal community patterns were found, largely consistent with findings from Spencer and Pahl (2006), with one variation which increased intimate support. Some personal communities were less supportive and consequently people were at risk of isolation. Processes within personal communities were helpful both in dealing with negative social environments and in helping establish different versions of ‘normal’ life. The importance of focussing on social contexts, when seeking to understand how people live with visible facial differences, is highlighted.

Made available in DSpace on 2016-12-08T16:51:59Z (GMT). No. of bitstreams: 1 113756.pdf: 38138045 bytes, checksum: d9aec6e3e795b4971f260ca0c70a1063 (MD5) Previous issue date: 2013-03-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This text seeks to create a procedural thinking unbound from systematic reflections commonly developed in the academy. To achieve this, I chose to study the artist Olivier De Sagazan, who was not very known until the beginning of this research in Brazil. I establish reflections on his works, with an approach focus on Transfiguração [Transfiguration] and the disentangled overflow of languages from his study, permeating aspects between performance, drawing, sculpture, theater and photography. The disfigurement is the central thread that provides dialogues between De Sagazan, Francis Bacon, Samuel Beckett and Antonin Artaud, as it is understood as a strategy of destabilization of the subject and his form, a characteristic that binds the interlocutors chosen in the discussion. The violent destabilization of the meaning, of language and form are problematized as violence necessary to the creation of art, as well as a source of political and religious discussion of current society, permeating anachronistically relationships with ancestry. / Este texto procura criar um pensamento processual desvinculado das reflexões sistemáticas comumente desenvolvidas na academia. Para isso, escolhi estudar o artista Olivier De Sagazan, pouco conhecido até o início dessa pesquisa no Brasil. Estabeleço reflexões sobre suas obras, tendo como foco de abordagem a Transfiguração e os transbordamentos de linguagens desenlaçados a partir do seu estudo, permeando aspectos entre a performance, o desenho, a escultura, o teatro e a fotografia. A desfiguração é o fio condutor que proporciona diálogos entre De Sagazan, Francis Bacon, Samuel Beckett e Antonin Artaud, uma vez que é entendida como estratégia de desestabilização do sujeito e sua figura, característica que une os interlocutores escolhidos na discussão. A desestabilização violenta do sentido, da língua e da forma são problematizadas como uma violência necessária à criação em arte, assim como fonte de discussão política e religiosa da sociedade atual, permeando anacronicamente relações com a ancestralidade.