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Visible difference

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A visible difference refers to a physical characteristic, such as a scar, mark, disfigurement, or condition on the face or body that distinguishes an individual from what is conventionally considered to be the societal norm.[1] These visible differences can arise due to a multitude of factors including but not limited to congenital conditions, accidents, diseases, or surgical procedures. Such differences often carry significant psychological, social, and sometimes physical implications for the affected individual.[2]

Terminology

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While the terms visible difference and disfigurement are sometimes used interchangeably, they are not synonymous and possess distinct connotations both in medical and social contexts.[3]

The term visible difference is a more neutral, encompassing descriptor for any physical characteristic that sets an individual apart from what is generally considered the societal norm.[4] This could be due to congenital conditions, acquired conditions, diseases, or even personal choices like tattoos or piercings. The critical element is that the difference is visible, but the term does not inherently imply any impairment, disadvantage, or negative valuation.[5]

Disfigurement is a term that has traditionally been used in both legal and medical contexts to refer to physical alterations that are often perceived as impairing the appearance of an individual in a significant way.[6] Disfigurement generally carries a more negative connotation and often implies a level of severity or permanence to the condition that may result in social, emotional, or functional difficulties for the affected individual.

Background and history

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Early perceptions

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The concept of visible differences has existed throughout human history, although the terminology and social attitudes have evolved. In many ancient cultures, visible differences were often attributed to supernatural causes or seen as a sign of divine intervention.[7] For example, birthmarks were sometimes viewed as omens or indicators of future events, both positive and negative.[8]

Modern medicine

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With the advent of modern medicine, understanding the causes behind various types of visible differences has become more scientific. In the 19th and early 20th centuries, significant strides were made in dermatology and plastic surgery, which allowed for a more nuanced comprehension and treatment of these conditions.[9] The latter half of the 20th century saw further research into the psychological and emotional impact of visible differences, paralleling the rise of psychology as a distinct scientific discipline.[10]

Activism and milestones

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The latter part of the 20th century also saw the rise of activism aimed at destigmatizing visible differences and advocating for legal protections.[11] Landmark legislation, such as the Americans with Disabilities Act (ADA) in the United States and the Equality Act in the United Kingdom, have created legal protections for people with visible differences.[12][13]

Changing Faces is a UK-based organization that advocates for people living with visible differences.

Types of visible differences

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Visible differences
The image features a woman (Rita Winkler) sitting against a blue background, smiling broadly. She is wearing glasses with a rounded frame, a mustard yellow knit sweater, and black pants. The woman is holding a colorful painting of a whimsical character with a rounded head, decorated with patterns and stars. She has characteristics of Down syndrome such as almond-shaped eyes and a flat profile.
Down syndrome
The image is a portrait of a middle-aged man (Mikhail Gorbachev) with short, light-colored hair, wearing large-framed glasses and a dark suit with a light-colored shirt and a dark tie. He has a noticeable red birthmark on his forehead. The background of the photo is indistinct.
Birthmarks
The image shows a man (Sam Brown) in profile wearing a U.S. Army combat uniform with an American flag patch on the shoulder. The individual has dark hair and extensive burn scarring on their face, neck, and ear area, which has affected the skin texture and pigmentation.
Burn scars
The image shows a woman (Ana María Haebig) with light brown hair styled back. She has fair skin and is looking directly at the camera with a neutral expression. Her facial features demonstrate Möbius syndrome which causes paralysis of the facial muscles. She is wearing a black blazer over a pink shirt with a collar and has drop earrings. The background of the photo is blurred and indistinct.
Moebius syndrome
The image features a woman (Winnie Harlow Cannes) with a smiling expression, waving her hand. She has vitiligo, characterized by patches of skin with depigmentation. Her hair is styled straight and parted to the side. She is wearing makeup with prominent eyelashes and eye shadow. She is dressed in an off-the-shoulder, vibrant green garment. Earrings are visible, and the setting is an event with other people in the background.
Vitiligo

Visible differences can be categorized based on origin, location, and impact.

Congenital conditions

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These are visible differences present from birth and are often the result of genetic factors or prenatal influences.[14]

  • Birthmark: Size, shape, and color can vary.
  • Cleft lip or palate: A condition with an opening in the upper lip and/or palate.
  • Port-wine stain: Reddish or purplish marks that usually occur on the face.

Acquired conditions

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These visible differences arise due to external factors, such as accidents or medical treatments.[15]

  • Scar: Can result from injuries, surgeries, or severe acne.
  • Vitiligo: This condition causes patches of skin to lose their pigment.
  • Burn: Severe burns can lead to scarring and discoloration of the skin.
  • Amputation: Removal of a limb, often due to injury or infection.

Diseases

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Certain diseases can cause visible differences either directly or as a side effect of treatment.

Psychological impact

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The presence of a visible difference can have profound psychological implications for an individual, affecting their self-esteem, mental health, and overall well-being.[19] Importantly, research has indicated that there is not a strong correlation between the visibility or severity of the physical characteristic and the level of psychological distress an individual might experience. This counterintuitive finding emphasizes the complexity of the emotional and psychological dimensions involved.

Self-esteem and body image

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People with a visible difference often face self-esteem and body image challenges.[20] Concerns about appearance can dominate their self-perception, which may lead to feelings of inadequacy or unattractiveness. This can be particularly challenging during adolescence when physical appearance is often highly emphasized.

Anxiety and depression

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Studies have shown that individuals with visible differences are at a higher risk of developing anxiety disorders and depression. The constant awareness of being different and the fear of being judged or rejected can increase anxiety levels. Similarly, chronic feelings of isolation or stigmatization can lead to depressive symptoms.

Social isolation

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The social implications of having a visible difference can sometimes lead to withdrawal or isolation.[19] Avoidance behavior, such as skipping social events or avoiding public places, can exacerbate feelings of loneliness and perpetuate a cycle of emotional distress.[20]

Body dysmorphic disorder

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In some cases, individuals with a visible difference may develop body dysmorphic disorder, a mental health condition characterized by obsessive focus on perceived flaws in physical appearance. Importantly, these perceived flaws may be minor and not very noticeable to others.[21]

Coping mechanisms

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Individuals may employ various coping mechanisms, both adaptive and maladaptive, to deal with the psychological impact. While some may resort to avoidance or denial, others may seek social support or engage in constructive problem-solving.[22]

Visibility and distress

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Contrary to common assumptions, the psychological distress associated with having a visible difference does not necessarily correlate with the visibility or severity of the condition. Factors such as personal resilience, availability of social support, and pre-existing mental health conditions often play a more significant role in determining the level of psychological impact.[2]

See also

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References

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  1. ^ Purcell, Vivienne (2020). "What Do We Mean by 'Visible Difference'?". Understanding Visible Differences. Palgrave Texts in Counselling and Psychotherapy. Cham: Springer International Publishing. pp. 1–9. doi:10.1007/978-3-030-51655-0_1. ISBN 978-3-030-51654-3. ISSN 2662-9127.
  2. ^ a b Clarke, Alex; Thompson, Andrew R.; Jenkinson, Elizabeth; Rumsey, Nichola; Newell, Robert (2013-12-16). CBT for Appearance Anxiety. John Wiley & Sons. ISBN 978-1-118-52343-8.
  3. ^ Rumsey, Nichola; Harcourt, Diana (2004). "Body image and disfigurement: issues and interventions". Body Image. 1 (1). Elsevier BV: 83–97. doi:10.1016/s1740-1445(03)00005-6. ISSN 1740-1445. PMID 18089143.
  4. ^ Thompson, Andrew; Kent, Gerry (2001). "Adjusting to disfigurement: processes involved in dealing with being visibly different". Clinical Psychology Review. 21 (5). Elsevier BV: 663–682. doi:10.1016/s0272-7358(00)00056-8. ISSN 0272-7358. PMID 11434225.
  5. ^ Newell, Rob J. (1999). "Altered body image: a fear-avoidance model of psycho-social difficulties following disfigurement". Journal of Advanced Nursing. 30 (5). Wiley: 1230–1238. doi:10.1046/j.1365-2648.1999.01185.x. ISSN 0309-2402. PMID 10564423.
  6. ^ Lansdown, Richard (1997-08-07). Visibly Different. Oxford: CRC Press. ISBN 0-7506-3424-3.
  7. ^ Krok, Dariusz (2014-12-19). "The Role of Meaning in Life Within the Relations of Religious Coping and Psychological Well-Being". Journal of Religion and Health. 54 (6). Springer Science and Business Media LLC: 2292–2308. doi:10.1007/s10943-014-9983-3. ISSN 0022-4197. PMC 4580713. PMID 25524414.
  8. ^ Egger, Andjela N.; Chowdhury, Aneesa R.; Espinal, Maria C.; Maddy, Austin J. (2019-07-30). "Birthmarks: Tradition, Culture, Myths, and Folklore". Dermatology. 236 (3). S. Karger AG: 216–218. doi:10.1159/000501273. ISSN 1018-8665. PMID 31362285.
  9. ^ Hanke, C. William; Moy, Ronald L.; Roenigk, Randall K.; Roenigk, Henry H.; Spencer, James M.; Tierney, Emily P.; Bartus, Cynthia L.; Bernstein, Robert M.; Brown, Marc D.; Busso, Mariano; Carruthers, Alastair; Carruthers, Jean; Ibrahimi, Omar A.; Kauvar, Arielle N.B.; Kent, Kathryn M.; Krueger, Nils; Landau, Marina; Leonard, Aimee L.; Mandy, Stephen H.; Rohrer, Thomas E.; Sadick, Neil S.; Wiest, Luitgard G. (2013). "Current status of surgery in dermatology". Journal of the American Academy of Dermatology. 69 (6). Elsevier BV: 972–1001. doi:10.1016/j.jaad.2013.04.067. ISSN 0190-9622. PMID 24099730.
  10. ^ Clay, Rebecca A. (2015-02-01). "The link between skin and psychology". American Psychological Association. Retrieved 2023-10-16.
  11. ^ Brescoll, Victoria L.; Uhlmann, Eric Luis (2008). "Can an Angry Woman Get Ahead?". Psychological Science. 19 (3). SAGE Publications: 268–275. doi:10.1111/j.1467-9280.2008.02079.x. ISSN 0956-7976. PMID 18315800.
  12. ^ "Americans with Disabilities Act of 1990, As Amended". ADA.gov. 1990-07-26. Retrieved 2023-10-16.
  13. ^ "Equality Act 2010: guidance". GOV.UK. 2013-02-27. Retrieved 2023-10-16.
  14. ^ Sadler, Thomas W. (2011-12-15). Langman's Medical Embryology. LWW. ISBN 978-1-4511-1342-6.
  15. ^ Mustoe, Thomas A. (2007-10-30). "Evolution of Silicone Therapy and Mechanism of Action in Scar Management". Aesthetic Plastic Surgery. 32 (1). Springer Science and Business Media LLC: 82–92. doi:10.1007/s00266-007-9030-9. ISSN 0364-216X. PMID 17968615.
  16. ^ Williams, Hywel C; Dellavalle, Robert P; Garner, Sarah (2012). "Acne vulgaris". The Lancet. 379 (9813). Elsevier BV: 361–372. doi:10.1016/s0140-6736(11)60321-8. ISSN 0140-6736. PMID 21880356.
  17. ^ Griffiths, Christopher EM; Barker, Jonathan NWN (2007). "Pathogenesis and clinical features of psoriasis". The Lancet. 370 (9583). Elsevier BV: 263–271. doi:10.1016/s0140-6736(07)61128-3. ISSN 0140-6736. PMID 17658397.
  18. ^ D'Cruz, David P; Khamashta, Munther A; Hughes, Graham RV (2007). "Systemic lupus erythematosus". The Lancet. 369 (9561). Elsevier BV: 587–596. doi:10.1016/s0140-6736(07)60279-7. ISSN 0140-6736. PMID 17307106.
  19. ^ a b Rumsey, Nichola; Harcourt, Diana (2012-05-31). Oxford Handbook of the Psychology of Appearance. OUP Oxford. ISBN 978-0-19-162894-8.
  20. ^ a b Rumsey, Nichola; Clarke, Alex; White, Paul; Wyn-Williams, Menna; Garlick, Wendy (2004-11-03). "Altered body image: appearance-related concerns of people with visible disfigurement". Journal of Advanced Nursing. 48 (5). Wiley: 443–453. doi:10.1111/j.1365-2648.2004.03227.x. ISSN 0309-2402. PMID 15533082.
  21. ^ Veale, David; Singh, AoifeRajyaluxmi (2019). "Understanding and treating body dysmorphic disorder". Indian Journal of Psychiatry. 61 (7). Medknow: S131–S135. doi:10.4103/psychiatry.indianjpsychiatry_528_18. ISSN 0019-5545. PMC 6343413. PMID 30745686.
  22. ^ Lazarus, Richard; Folkman, Susan (1984-03-15). Stress, Appraisal, and Coping. New York: Springer. ISBN 978-0-8261-4191-0.
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