Understanding the experiences of people with disfigurements: An integration of four models of social and psychological functioning.

Both psychological (Cash, 1996; Partridge, 1998; Leary et al ., 1998) and sociological (Goffman, 1968) models have been used to explain the personal and social consequences of cosmetic blemishes. In this study, people with the skin disease vitiligo were asked to describe a situation in which their condition had recently affected their lives. Consistent with theories of body image disturbance, incidents usually involved a triggering event when concerns about appearance were raised due to bodily exposure or enacted stigma. These events led respondents to be vigilant to others' behaviour, to be self-conscious and to attribute the cause of the event to their appearance. Theories of social anxiety could be used to account for how the respondents used impression management strategies such as avoidance and concealment. Respondents described how they could be uncertain as to how to deal with others' behaviour, illustrating the relevance of social skills models. In addition, avoidance/concealment had a number of social and personal costs, including the loss of valued activities, reluctance to develop intimate relationships and continuing anxiety. Thus, theories of body image, social anxiety, social skills and the sociology of stigma could be used to understand the respondents' experiences. It seems likely that therapeutic interventions based on different models are useful because they influence different aspects of the above process.