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Visible facial differences (VFDs) can pose a number of psychosocial challenges for those affected past them. In particular, the feel of being stigmatised may have a harmful consequence on the psychological aligning of the individual concerned. This is peculiarly pertinent for young people, who are at an agewhere advent becomes increasingly central to social interaction and self-esteem. Suitable and effective interventions are needed to reduce stigma in general, simply in the example of appearance-related discrimination the prevalence and the processes involved are poorly understood. The aim of thisresearch was therefore to explore young people's perceptions of visible divergence. A mixed-methods online questionnaire was administered to a cantankerous-sectional sample of 412 pupils aged 12–fourteen years, recruited from three Great britain schools. Participants were asked to expect at 5 photographs of people with VFDs and to indicate their level of agreement with 30 statements using a v-point Likert scale. They were as well asked  to respond the open-ended question 'What practice you think when y'all see people with facial differences?' Although quantitative responses were overwhelmingly neutral, anterior content assay revealed a number of insights. Four main themes were identified: them and united states of america, initial reactions, common assumptions and behavioural intentions Participants reported a wide range of circuitous responses. Although negative reactions and judgements were described, these were often due to seeing something unusual, or to a lack of understanding, rather than to the intention to cause damage. Conflicting emotions led to doubt and lack of confidence about how all-time to carry effectually people with VFDs. The findings suggest the need for a two tiered approach to intervention: beginning, to raise sensation of VFDs and to facilitate the evolution of appropriate social skills inside the general population, and secondly, to provide support to enable those with VFDs to cope with any negative reactions they may meet.

Primal words

adolescence, appearance, attitude, disfigurement, stigma

Introduction

In today's society, involvement in appearance has never been more prevalent. In 1984, Rodin and colleagues were the first to describe dissatisfaction with appearance as 'normative' within the general population, whereas physical attractiveness is now consistently linked to success and happiness (Rodin et al, 1984; Rumsey, 2008). Given that advent 'ideals' are condign more extreme in westernised nations, and that an increasing number of people are aspiring to these ideals (Grogan, 2008), the current focus on being physically attractive and the conventionalities that 'what is cute is skillful' (a term coined by Dion et al, 1972) may exist harmful to individuals whose appearance is perceived to be outwardly different from the norm.

This focus on appearance may be particularly pertinent for young people. Due to changes in body shape during puberty, adolescence is arguably 1 of the most difficult life stages in terms of physical aligning. The desire to 'blend in' and be perceived as 'normal' is a fundamental facet of well-being in adolescence (Liossi, 2003), and physical appearance has become the prime number focus for evaluating this. The added focus on friendships and dating exacerbates the importance of self-presentation and has a pregnant bear on on the daily life of teenagers (Lovegrove and Rumsey, 2005).

According to the nearly recent estimations by the United kingdom-based charity Changing Faces (Partridge and Julian, 2008), approximately i in 111 people in the UK have a pregnant visible facial departure (VFD). A large proportion of VFDs are present from birth, just many others are caused through injury or a health condition. The noticeability of a VFD may provoke unwelcome interest from others, including staring, unwanted questioning, aural comments and avoidant behaviour by members of the general public, leading to a loss of anonymitywhich can be uncomfortable for many (Rumsey, 2002).

A number of studies investigating the perceived social experiences of individuals with a VFD have reported frequent stigmatisation and apparent acts of bigotry (due east.k. Carroll and Shute, 2005; Strauss et al, 2007). Meantime, early research demonstrated that peoplemay behave differently when coming into contact with a person with a VFD. For example, members of the public were less likely to respond questions when approached past a 'market place researcher' with a VFD compared with amarket researcher without this difference (Rumsey and Bull, 1986), and significant numbers of people would avert sitting next to someone on a train who appeared to accept a port-wine stain (Houston and Bull, 1994). The presence of aVFD may also influence people's expectations. For case, teachers may underestimate the intellectual ability of children who have a VFD (Richman, 1978), jurors may offering less sympathy to people with VFDs who are victims of criminal offense (Kerr et al, 1985), and employers may reject suitably qualified job applicants who accept aVFD (Stevenage and McKay, 1999).

More than contempo investigations take employed Implicit Association Tests (IATs) with members of the general public, equally a manner of gauging their subliminal behavior. A report past Grandfield et al (2005) claimed that participants displayed pregnant implicit preferences for people with clear peel compared with those with a dermatological condition. Similarly, an online survey investigating implicit attitudes among the general public (Changing Faces, 2008) concluded that the majority of participants establish it more difficult to attach positive characteristics to images of people who were visibly dissimilar compared with those without VFDs.

How and why advent-related stigma occurs is unclear (see Box i). Theories derived from evolutionary psychology point that biases such equally these may be inherent and stock-still, where stigma is conceptualised every bit a natural reaction to something that is different or potentially threatening (e.yard. Gilbert, 1997). In contrast, explicit discriminatory behaviour, such equally deliberate avoidance or making derogatory comments, may be a mechanism of social workout (e.thousand. Bernstein, 1976; Langer et al, 1976). For example, a number of studies have suggested that unfavourable societal stereotypes may be reinforced by negative representations of visible departure in the media (Black and Pretes, 2007; Wardle and Boyce, 2009).

image

Despite the lack of consensus nigh the causes and prevalence of social stigma, the negative furnishings of perceived and/or real differences are not in dispute. Non merely does social stigma have a negative impact on how others might behave, only as well information technology may accept a harmful consequence on the psychosocial evolution and well-being of the individual (Link and Phelan, 2011). Given that social involvement and perceived social support account for a significant proportion of the variance in psychosocial aligning to visible difference and quality of life (due east.1000. Corry et al, 2009), it is clear how the impact of social stigma may be extremely damaging.Negative social interactions take been shown to provoke negative emotions (east.one thousand. social anxiety), maladaptive thought processes (due east.g. fear of negative evaluation), unfavourable self-perceptions (eastward.1000. lowered self-esteem and unfavourable torso epitome) and negative behaviour patterns (e.g. excessive social abstention or aggression) in individuals with a visible difference (Rumsey and Harcourt, 2004).

As the effect of social stigma on individuals can be far reaching, there is a need to provide suitable and effective interventions to reduce both stigma and its impact. Given that appearance-related bigotry is currently poorly understood, there is a real need for further exploratory work to inform such interventions. This paper examines from an exploratory qualitative perspective the perceptions and behavioural intentions of young people towards those affected by a VFD.

Conduct of the written report

Design and method

Cantankerous-sectional information exploring the perceptions and intended behaviours of young people towards individuals with a VFD were collected through the use of an online mixed-methods questionnaire, every bit function of a projection deputed by Changing Faces and funded by the Section for Education. The study adhered to the Code of Ethics and Conduct of the British Psychological Society (2009) at all times, and was granted blessing by the Research Ethics Committee at the Academy of the Westward of England in Bristol. Formal permission was obtained from each of the participating schools, and oral consent was obtained from all of the participating teachers.

For children nether the age of sixteen years, parental consent should normally also be sought (British Psychological Society, 2009). For this study, an optout approach to parental consent was used. Parents were informed nearly the written report via an information sheet a number of weeks earlier the study was conducted, and were given instructions on how to opt their child out of the report if they chose to do and so. Parental consent was thus assumed if no opt-out request was received. Participants received a separate information canvass and were offered the option of declining on the day if they chose not to accept part in the study.

Each participant was linked to a unique participant code before whatsoever data collection began. Participants' names and codes were stored together on a passwordprotected database to which only the chief researchers had admission. Once collected, the raw data were stored in an anonymous database alongside each participant's code. If the parent or participant chose to opt out of the study after data collection had taken place, the participant was identified using their unique lawmaking, and their information were subsequently deleted.

Information were analysed independently by two researchers from the Heart for Appearance Research, based at the Academy of the W of England in Bristol.

The opt-out approach is mostly considered to be acceptable in cases where loftier response rates are crucial to the written report, where the study has been assessed every bit 'depression risk', and where the participants are at an age at which they are considered to have the chapters to decide for themselves whether or not to give consent (see world wide web.ethicsguidebook.ac.uk). This approach has too been used previously in large-calibration studies involving children in schools (east.g. Halliwell and Diedrichs, in press; Stallard et al, 2012).However, the importance of voluntary participation in the case of minors should not exist disregarded, especially when bug of coercion and/or social acceptability may influence their decision to participate (Ungar et al, 2006). Although care was taken to inform the participants of the study procedure in order to allow them to make their own decision, children are used to carrying out instructions from their teachers, and therefore may not take raised whatever concerns. The classroom-based method may also take invited an element of peer pressure to participate. In add-on, it is possible that not all of the parents received the participant information sheet from their children.

In order to address this main ethical business concern every bit fully as possible, prior consultations were held with teachers and headteachers from each participating school, as well as with representatives from the Section for Education and members of the Changing Faces Young People'due south Quango. Methodological and ethical problems were discussed at length. After conscientious consideration of the issues raised above, and following extensive consultation with various stakeholders, a pragmatic approach to obtaining assent was considered to be adequate for this study. In the time to come, research such every bit this could annunciate studies within school newsletters or bulletins, via schoolhouse SMS or email services, or by hosting an information evening for parents.

Participants

Three schools took office in the study. All three schools were not-fee-paying and attended by boys and girls aged xi–18 years, but they varied with regard to type of school (secondary modern, selective grammar or comprehensive academy) and geographical location (S-East England, N-W England or Southward- West England). Participants were recruited from Years eight and ix, where the hateful age of participants was xiii years. Data were initially excluded if pupils or parents chose to opt out or if an incomplete data set was submitted (northward = five). A further seven participants were excluded from the qualitative analysis on the grounds that they provided a generic response (e.grand. 'Zip' or 'I don't know'). In total, data for 405 pupils (197 girls and 208 boys) were included in the final assay. Of these pupils, 14 identified themselves as having a visible difference; one had a cleft lip, one had acne, 9 indicated varying forms of facial scarring, and three pupils did not specify the VFD. In improver, 84 participants claimed to know someone with a VFD. This was largely due to one of their classmates being born with a 'cleft lip' or having a facial 'birthmark.'

The online questionnaire

The questionnaire was originally designed and piloted by researchers from the Heart for Appearance Inquiry (Fox et al, 2010), and was afterward adjusted for online utilize (Stock et al, 2010). Perceptions of individuals with a VFD were surveyed across the whole sample. Participants were asked to look at 5 photographs of people with a VFD, and then to complete the questionnaire. Five adults (2 men and 3 women) with a multifariousness of congenital and caused VFDs were shown in the photographs. All of the photographs were cropped to evidence only close-up shots of each person'southward confront, and to eradicate whatever potential cues in the background. All v people in the photographs had neutral expressions. Images were obtained from Irresolute Faces and are available on request.

For the quantitative component, participants were asked to indicate their level of agreement with xxx statements about people with VFDs (e.g. 'People with disfigurements are shy') on a Likert calibration ranging from 1 ('strongly concord') to v ('strongly disagree'). For the qualitative component, participants answered the question 'What do y'all think when y'all see people with facial differences?' Questionnaires were completed within the normal classroom environment with a teacher present.

Data analysis

Quantitative analysis revealed that the majority of the participants' responses were neutral (n = 355; 88%). This possibly reflects the difficulty involved in capturing complex perceptions using quantitative measures. To explore immature people's perceptions of VFDs in more depth, qualitative responses were analysed using inductive content analysis. Codes were allocated separately by ii researchers and then cross-checked for understanding. Any disagreements were discussed and adjusted accordingly. A summary of the full number of comments plant in relation to each theme and subtheme is presented in Tabular array i.

Results

Four major themes were identified, namely them and us, initial reactions, mutual assumptions and behavioural intentions. These themes reflected the responses received from all iii schools. Responses from those who identified themselves as either having a VFD or knowing someone with a VFD did not differ significantly from the majority of responses, although a very slight increase in the level of noesis and expressed sympathy was observed. No significant gender differences were institute. The themes and their corresponding subthemes are discussed below and illustrated with quoted extracts.

Them and the states

2 contrasting standpoints that were ordinarily articulated past participants were those of 'difference' and 'similarity.' The participants commented on how they viewed people with a VFD, while also reflecting on how the images made them feel near themselves.

Dissimilar but the same

People with VFDs were described past some participants every bit 'normal people' or as beingness 'merely the same' every bit everyone else (n = 21). Although these statements focused on parity, this is at odds with the way that the young people seemed to implicitly separate themselves from those with a VFD, by using the terms 'them' and 'us.'

diversityhealthcare-Content-analysis

TABLE 1: Content analysis.

In dissimilarity, 30 participants explicitly described people with VFDs as beingness very 'dissimilar' to themselves, or 'not normal people.' Other participants talked most people with VFDs being 'special' and 'unique', expressing how their facial differences set them apart from other people and fabricated them distinctive in a positive way.

Interestingly, a juxtaposition between the notions of similarity and deviation was also observed, with 21 participants expressing both viewpoints inside the same response: 'They are different but they are still normal people.'

In conjunction with this, the participants in this study oft stated that although people with VFDs looked 'different' from the outside, they were still 'the same' and 'good' on the within.

Irrespective of their individual standpoint, the bulk of the participants stated that everyone should exist treated equally and accepted for who they are, regardless of advent:

I believe everybody is equal whatever the case.

They are human beings like you and me and we should treat them equally.

Information technology doesn't matter what they look similar, we should always treat them with respect.

Although the participants clearly felt quite strongly virtually this subject, many of them seemed to experience conflicting feelings when trying to express their views.

Social comparison

In total, 48 participants reflected on how they felt about themselves subsequently viewing the images of people with VFDs; this prompted them to engage in downwards social comparison (Festinger, 1954). The young people unremarkably stated that they felt 'glad that it hasn't happened to me', while expressing feelings of gratitude for 'the fashion I am' and 'what I look similar.'

Seeing images of people whom they considered to be less fortunate than themselves encouraged the participants to view things from an altered perspective:

I feel lucky for myself just to be healthy. I beginning thinking of the little things in life that make me happy.

I think near how lucky we are not to accept to alive with extreme conditions like these. I should be more grateful.

Some participants expressed feelings of guilt for investing in and worrying nigh their own appearance:

I feel guilty in a way, as I take my looks for granted.

I feel a bit featherbrained at present because I get worried if I simply have a little spot on my face.

By and large, the participants seemed to feel 'humbled' by the images of people with VFDs. Three participants went on to comment on the role of society in creating and maintaining concerns well-nigh appearance:

I think in that location is too much pressure on people to be pretty. It should be the personality and what's within that counts.

Initial reactions

A number of conflicting emotions and cognitions were reported by the participants when thinking nearly how they might experience if they came into contact with someone with a VFD.

Sympathy

By far the most common reaction was sympathy, with 258 participants reporting that they 'felt sorry' or 'felt sad' for people with VFDs. These feelings primarily originated from the belief that it was unfair for anyone to have a VFD:

I experience a bit upset because why did these people have to take a facial disfigurement? What have they washed to deserve this?

I feel very pitiful for them because information technology'due south not their fault.

Shock

In full, 34 participants also talked about feeling 'shocked' and 'surprised' when presented with the images of people with VFDs:

I get speechless and don't know what to say. I would exist shocked if I saw them in the street.

When I saw them I was simply like 'woahhh', I didn't know people could look like that.

I feel a bit shocked considering information technology is something that you don't see every 24-hour interval.

Fear

Feelings of fear were cited by 27 participants as their outset response when encountering a person with a VFD, using words such as 'unsafe' and 'frightening':

I would experience a bit uneasy.

I think it'due south a flake disturbing and I would be scared to meet any of them.

Scary, must exist photoshop edited.

Ane participant commented on how their fear stemmed from the link between VFDs and villains in the media:

I am unintentionally scared because often in films and books, the bad characters accept some sort of facial disfigurement.

Curiosity

Some other common response was that of marvel. In total, 46 participants asked questions relating to the images of people with VFDs. For case:

It looks like they must be in a lot of pain. I wonder does it hurt?

Were they built-in with it? How did information technology happen?

These people must have life-threatening illnesses and I would think 'Could I catch it?'

Other participants were curious as to why the people with VFDs had not sought treatment to 'fix' or 'cure' their difference:

Is there a way of getting rid of it? Why haven't they got surgery or something?

Can't they afford to have surgery? I hope their face changes the way they want.

Entertainment

Three of the participants admitted that laughter would exist their primary reaction. However, this was frequently speedily followed by admissions of guilt about such a response:

Every bit presently as I saw them I actually laughed, but and so I realised I shouldn't and information technology'southward not funny.

I would experience the laughter coming up ... but I know information technology'south not right of me to be mean.

Aversion

In total, 52 participants expressed aversive feelings towards the images of people with VFDs, using terms such as 'agonizing', 'nasty' and 'horrible.' Other participants said that the pictures made them experience ill:

I don't mean to be rude simply information technology makes me feel sick.

However, it is important to notation the distinction between those who were strongly averse to the images (eastward.g. those who stated 'It's disgusting') (due north = twenty), those whowere mildly balky (eastward.chiliad. 'It doesn't look very nice') (n = fourteen) and those who idea the people in the images looked slightly 'weird' or 'strange' (n = 18).

Although this theme has primarily described individual responses, these commonly appeared in a sequence, with the initial shock or surprise quickly giving mode to curiosity and sympathy. Participants who institute the photographs frightening or aversive in the get-go instance often went on to say that they would shortly 'have the difference' and 'grow addicted of the person due to their personality':

At showtime I would be startled, simply then I would just feel sorry for them and want to know what happened.

My first impression is of surprise, only then I bank check myself, and think that information technology really doesn't affair.

Many of the quotes illustrating this theme also reveal the participants' lack of noesis and understanding of the aetiology and treatment of VFDs. However, 2 young people offered additional insights into their reactions. For example:

I think it'southward strange mainly because I've never met anyone with a disfigurement.

Common assumptions

The emotions and cognitions described by the participants often seemed to originate from, or be linked to, a number of common positive and negative assumptions.

Social challenges

Equally described previously, the near mutual initial reaction was that of sympathy. Although this can be seen as a mildly positive reaction, it also encompasses the more negative assumption that people with VFDs are more likely to have 'unhappy' and 'hard' lives because of the style they look. This concern was expressed by 91 participants. For example:

I experience upset and sorry for them because they must have had a hard life and they could have been bullied at school, higher and university.

I feel pitiful for the people because they volition never take the same life I will.

It would be hard to get a beau/girlfriend.

They can't practise some stuff like other people can.

Many of the immature people were concerned that those with VFDs would confront discrimination based on their advent:

I experience sad for them because they are usually non fully accepted into society.

I think it's horrible when I see people with facial differences because they won't go the opportunities that we get.

I feel sorry for them because they are discriminated against for something they can't change.

Admiration and respect

Due to the assumption that people with VFDs would experience difficult social encounters and inequity, 9 participants expressed feelings of admiration and respect, assertive those with VFDs to exist 'brave' and 'strong':

I feel proud of them for being proud of who they are.

It just makes me think how difficult it must have been to abound upwards with a facial disfigurement and to face life with courage and determination ever since they were little.

Having to go out each twenty-four hour period, living your life withal knowing that everyone is staring at y'all, anyone who has facial disfigurements are very, very brave for going out and showing the world who they are.

Although apparently not ill-meaning, this theme revealed some of the assumptions that announced to exist implicitly embedded in these young people'south understanding of the world.

Behavioural intentions

Young people's reflections on how they idea they might bear if they met someone with a VFD were strongly highlighted past the data. For many, this was an important topic, due to the confusion and feet that they thought they would experience due to not knowing how to behave appropriately or how to overcome social barriers.

Uncertainty

Being uncertain about what to say and how to deed around people with VFDs was a commonly reported behavioural response. For 14 participants, this stemmed from a lack of confidence and a lack of understanding about how to approach and interact with someone who was visibly dissimilar.

Many of the participantswere curious and therefore wanted to talk to the people with VFDs and enquire them questions most their condition:

I take the urge to touch information technology and ask lots of questions about it.

I would similar to speak to them and ask them if it affects their life and how they bargain with it.

Despite this curiosity, the immature people in this study did non want to cause offence or embarrassment by appearing to be too interested:

I experience nervous and a bit guilty for being curious, and I wouldn't know what to say.

I wouldn't want to make them experience different by cartoon attention to it.

You experience a chip embarrassed and you don't know what to do. You lot effort not to look at them because you don't want it to feel like you lot're staring at them.

If they came over to talk to me I would panic because I don't know whether they don't want me to await directly at them.

Avoidance

As a means of coping with this doubt, and with their feelings of fright or unease, 13 participants stated that they would resort to avoiding the person with the VFD:

I don't look at them, I would just look abroad.

I know this is a little harsh but I would try and avoid them. Information technology makes me feel uneasy and I don't know what to say to them and if what I say would offend them.

I don't think I would become upward to them or start a conversation. I would probably but keep my altitude.

One or two of the participants felt that this concern might prevent them from forming a longer-term relationship with a person who was visibly different:

I know this is bad, but I would be a little reserved about making friends with them because I wouldn't know how to act effectually them.

Compassion

In total, 21 participants talked well-nigh wanting to help or to practice something positive for those with VFDs. Often these intentions related back to the feelings of sympathy and business that people with VFDs might confront discrimination. Equally, the participants felt that these people did non deserve to live with such conditions and therefore merited compassion and kindness:

It must take been hard. It makes me feel I should aid, but how?

I wish I could aid them somehow. I wish this didn't happen to people. I feel sad and I want to help them.

These comments demonstrate how a lack of awareness and confidence may result in behavioural responses such equally avoidance, which may be interpreted negatively by people with VFDs. 5 young people felt that the way in which they behaved would be influenced by how severe they perceived the difference to be:

Some of them aren't that bad, but others are more scary so I wouldn't want to be well-nigh them.

Still, half dozen participants stated that the person's difference would not affect how they behaved towards them:

I would treat them like I would treat everyone else.

I'm going to go over and say 'Hi.'

Discussion

Qualitative analysis revealed the range and complexity of immature people's responses to the VFDs of others. This highlighted a number of challenges for those wishing to intervene, and provoked a number of suggestions as to how this intervention might exist achieved.

As described in the first theme, participants frequently used the terms 'them' and 'the states' when describing how they felt about people with VFDs. Although many of the participants insisted that people with VFDs were 'normal' and should be 'treated equally', the use of these terms illustrated the way in which the immature people had synthetic those with a VFD as belonging to a split group from themselves. This was also the case for those participants who described people with a VFD as being 'special' or 'unique', despite the likelihood that these statements were intended to be positive in nature.

The young people in this study expressed a range of initial reactions to the photographs of people with VFDs, many of which were quite emotive. The near mutual response was shock or surprise, with some participants too citing fear as their starting time response. These initial reactions are likely to stalk from seeing something different or unusual, and although such responses may not be ill meant, they may be inherent and resistant to change (Gilbert, 1997). Since the way in which the person with a VFD perceives and interprets social encounters is a clear predictor of consequence in visible difference (Billaud Feragen et al, 2009), information technology may exist beneficial to assist the person with the VFD to understand the range of natural reactions to their difference, and to reframe their interpretations of these social situations in a positive and constructive fashion, rather than believing them to exist entirely challenging or stigmatising.

In addition, a number of studies in the field of appearance have examined the influence of the affected person's own behaviour on the success of social encounters with others. For example, the early work of Rumsey et al (1986) examining the effect of the presence or absenteeism of an artificially practical facial birthmark in combination with a high or depression level of social skill found the most positive social encounters to occur with those who had a VFD and a high level of social skill. This highlights the master methodological weakness of the present study in its use of photographs every bit opposed to real-life encounters. Seminal research has shown that although appearance is of import for forming initial impressions of others, numerous other factors, including social skill and indicators of temperament, become more important after the first 15 seconds of meeting someone new (Balderdash and Rumsey, 1988). Equally well as helping those with a VFD to counteract the potentially negative effects of other people'southward initial reactions to their difference, interventions could as well address the opportunity for them to make the most of each social experience by using encouraging trunk linguistic communication and proactive conversational skills in order to overcome social barriers and to instigate and maintain positive social encounters (see also world wide web.ypfaceit.co.uk).

Many of the young people provided evidence of their belief that those with a visible difference would face up bigotry and 'have a hard life.' This assumption resulted in a number of conflicting emotions and judgements. The participants felt saddened by the fact that these people were affected by a VFD, and believed this to be 'unfair.' This also led them to express a desire to help those with a VFD, although they were unsure how they might be able to do this. Participants described their feelings of admiration and respect towards people with a VFD, based on the assumption that these individuals would accept to endure discrimination on a daily basis. This also led to participants engaging in some down social comparisons, in which they expressed gratitude that they were not affected past a VFD, and guilt for beingness so concerned about their own appearance.

Although some of the participants clearly held some unhelpful assumptions near individuals with VFDs, this was by and large related to the fact that they had little noesis, understanding or experience of these types of conditions. One participant commented on the influence of the media in maintaining unhelpful stereotypes of people with a VFD. Some participants believed that a 'quick fix' was available in the form of surgical intervention. Others were afraid that they might 'grab' the VFD, reflecting the possibility that people have an unconscious desire to avoid annihilation that might be contagious (Rumsey and Harcourt, 2004). There is clearly a demand to continue to heighten sensation about visible differences among the general public, and to encourage the adoption of an inclusive social environment both in schools and in society every bit a whole (Frances, 2004).

The range of conflicting emotions and assumptions that the participants described appeared to provoke uncertainty near how best to behave. Participants were inquisitive nigh the condition but did non want to cause offence or embarrassment by appearing to be likewise interested or asking too many questions. Similarly, participants stated that they would not want to upset the person with the VFD by staring at them, simply would detect information technology hard not to expect at them out of curiosity. In some cases this conflict led to participants feeling nervous or guilty, which in turn resulted in them stating that they might avert the person with the VFD. Consequently, information technology may be beneficial to teach young people social skills to encourage advisable behaviour towards those with an appearance different from the norm, and to build young people'due south confidence in these types of social situations. Lovegrove and Rumsey (2005) demonstrated the potential of such an intervention in a school setting. Afterward seven 1- hour sessions, young people's levels of confidence about approaching someone who looked different to them had significantly increased compared with the non-intervention grouping.

Although the majority of the participants' reactions, assumptions and predictable behaviours were non intentionally harmful in nature, a minor minority of the immature people in this study did limited more negative views and emotions. These participants used some judgemental adjectives to describe the people with VFDs, such as 'disgusting' or 'weird.' These descriptions were linked to laughter or aversion as the primary response, which in plough may result in behaviours that are unhelpful to people with VFDs. According to a key paper by Clarke (1998), information technology tin only take one unhelpful person, or one negative incident, to destabilise a person'southward self-esteem and confidence. Although this grouping represents a very small proportion of the participants in this report, in that location is a strong need to emphasise this element in intervention pattern.

A number of additional limitations of this study must exist best-selling. Although the written report attempted to capture the views of a various grouping of young people, the identification of cultural differences was not a specific focus of the research. Although little inquiry in this surface area has been conducted within minorityethnic communities, some studies have found interesting and insightful variations that are important to investigate farther (Hughes et al, 2009). In terms of methodology, the researchers had lilliputian command over the manner in which responses were collected, due to the school setting. Although care was taken to deliver appropriate instructions to teachers, the responses may not have been as confidential and unbiased as one would hope. Finally, the potential for questions to be leading is always a business in this type of investigation. However, an equal number of positive and negative statements were presented to participants in an attempt to reduce this potential effect. Although the study invited cocky-reported responses, which must be interpreted with some caution due to the potential for an effect of social desirability, this report did not replicate the motion-picture show of predominantly negative perceptions and high levels of stigma that has been indicated in some of the previous research. Rather, the data revealed the issue to be far more than complex, with the majority of the initial reactions and unhelpful behaviour beingness associated with a lack of understanding and confidence, rather than being intentionally harmful. This report has also highlighted some of the problems inherent in the methods previously and currently used to examine people'south perceptions of VFDs. Time to come enquiry in this area should consider more appropriate ways of capturing the complexity of responses.

The findings of this study tin help to inform the pattern of interventions to promote positive attitudes to diversity in appearance. They propose that at that place is a demand for intervention at a number of different levels, including the level of awareness and education about VFDs among the full general public, the behavioural skill and conviction of others in approaching and interacting with someone with an unusual facial appearance, and, for those who have a VFD, an agreement of the complexity and range of responses that they may receive from others.

ACKNOWLEDGEMENTS

The authors wish to thank the staff at Irresolute Faces and the schools which took part in the research. This project was commissioned by Changing Faces and funded by the Section for Education. The authors are as well grateful to those members of the Heart for Appearance Enquiry who provided communication throughout the conduct of the study and the writing of this paper.

ACKNOWLEDGEMENTS

None.

References


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