The aim of this programme of research was to investigate the differences between individuals in their psychological adjustment to perceived abnormalities of appearance. The first phase of the research was to refine and validate a measure of distress and dysfunction associated with having an appearance which is different from normal. Over 500 patients in plastic reconstructive surgery units were recruited as participants in a nationwide multi-centre trial. The resulting measure, the Derriford Appearance Scale 24r was shown to have good psychometric properties, and was used as a criterion measure of adjustment. A series of clinical interviews were conducted with contrasting groups of individuals identified as being either good or poor adjusters. Three analyses were carried out. The first took a grounded theory approach to the open ended section of the interviews. This produced an integrated phenomenological account of living with differences of appearance. It also demonstrated differences between the two groups - poor adjustment was associated with a more threatening and negative appraisal of situations and the self. The negative self view was more salient to the poor adjusters. The second analysis of the interview data was a hypothesis testing content analysis, designed to eliminate competing candidate hypotheses generated from the general psychology literature. From this study, it was shown that poor adjusters have a greater degree ofnegative appearance related thoughts, and a more negative appraisal of situations. They were both more pessimistic, and experienced more anticipatory anxiety. Using the interview sample, a third study was conducted, based on self-discrepancy theory. Poor adjusters were shown to place more value on their appearance, and have a greater discrepancy between their 'actual' and 'ideal appearance' selves than the good adjusters. On the basis of the interview studies, two further main empirical studies were carried out. The first tested comprehension of social cues. This did not differentiate the good and poor adjustment groups. Methodological, as well as theoretical reasons for this were proposed. The final study investigated the organisation of self-knowledge, using a sample of 70 participants recruited from a plastic and reconstructive surgery unit, and from two support groups. It was found that there were important differences between the adjustment groups. A high level of compartmentalisation of specific appearance information, greater levels of complexity of the self-concept, and an increased level of differential importance of aspects of the self concept containing specific appearance information were all related to poor adjustment. This set of findings was integrated with the earlier work, and is theoretically interpreted within a self-schema perspective. The contribution of this thesis is to develop the understanding of individual differences in adjustment from a relatively atheoretical field to a position where future research and clinical practice can progress in a theoretically integrated and meaningful way.

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