Anxiety and self-consciousness in patients with facial lacerations one week and six months later
Introduction
Scarring after maxillofacial trauma or elective operations may cause particular problems for patients because of the unique functional importance of the face.1 The face is the focus of communication as well as being central in people's perceptions of another person.2 It is thought to be more important than any other aspect of our physical appearance in terms of our “identity”.1 It has been suggested that our reactions to a change in facial appearance may be the result, in part, of the fact that we are biologically attuned to recognise and respond to faces from birth.
Whereas a lot of research has been undertaken into the psychological effects of major facial disfigurement, the impact of less severe disfigurement is seldom considered. It has been estimated that there are as many as 400,000 people in the UK with minor disfiguring conditions resulting from a scar, blemish, or deformity that affects their ability to lead a normal life.3
Even such minor injuries may act as a powerful “trigger” for psychological symptoms,4 and there is no clear correlation between the severity of an injury and the psychological distress that it causes.5, 6, 7 Adjustment to a major disfigurement may be more straightforward for patients than adjusting to a relatively minor facial disfigurement;8 minor injuries can leave a person more uncertain about the reactions of others. Social interaction can be difficult for those with facial disfigurements.9, 10, 11 Newell and Clarke suggested that the difficulties experienced by those with facial disfigurements may be as a result of a phobic anxiety specific to social intercourse.12 Any subsequent avoidance of social intercourse can then perpetuate the problem. Anxiety has also been found to be a problem for people with facial disfigurement.13 Sen et al.14 reported that over 30% of patients with severe maxillofacial trauma were anxious or depressed when tested with the hospital anxiety and depression scale.15 Anxiety affects how people react to events by making them use less efficient coping mechanisms.16
Psychological problems associated with facial disfigurement are influenced by a number of factors, including age, sex, socio-economic class, site of the disfigurement, and cause of the injury. People have different social influences at different ages, and women may be more sensitive than men to changes in body-image. It has been reported that patients in low socio-economic classes are more affected by their state of health.17 The site of disfigurement is also important. Partridge reported that disfigurements in the communication triangle of the face (between the eyes and the mouth) provoked more embarrassment that those elsewhere in the face.18 As for the cause of the injury, accidents and assault have the greatest psychological impact.4
Our aim was to investigate prospectively the psychological impact of relatively minor facial disfigurement resulting from maxillofacial trauma. We used psychometric tests to measure the effect of these injuries on patients’ self-consciousness and anxiety.
Section snippets
Patients
After approval from the local research ethics committee, 63 patients were recruited at the accident and emergency (A&E) department of the University Hospital of Wales. There were 51 men and 12 women who had been referred to the oral and maxillofacial surgery team for repair of facial lacerations. Only lacerations of between 1.5 cm and 10 cm in length were included in this study. Lacerations within the eyebrows or hairline, or below the lower border of the mandible, were excluded. All wounds were
Characteristics of scars
The mean (S.D.) length of the scar at the one-week appointment was 3.6 cm (2.1); 18 patients had a second scar in the same area. For the purpose of analysis, the length of the main scar was classified as either less than 4 cm or 4 cm or more.
Descriptive data for Derriford scales and STAI
Scores on the GSC scale ranged from 4 to 67 (median = 23) and on the SSC scale from 3 to 68 (median = 20). GSC scores were lower but SSC scores were higher than norms in those people who were concerned about their appearance19 (Table 1). Scores on both scales were
Discussion
We have shown that relatively minor maxillofacial injuries may cause considerable and persistent psychological changes. It has been shown that the extent of injury is not necessarily linked to psychological sequelae,5 but we found the size of the scar did have a psychological impact on the patients.
We showed that the psychological sequelae of facial lacerations were also influenced by other external factors. Patients’ living arrangements were related to general self-consciousness; an effect
References (24)
Folklore surrounding facial deformity and the origins of facial prejudice
Br J Plast Surg
(1981)- et al.
Assessment of repair of facial lacerations
Br J Oral Maxillofac Surg
(1997) - et al.
Body dysmorphic disorder: a cognitive behavioural model and pilot randomized controlled trial
Behav Res Ther
(1996) - et al.
The positive appearance center
Cancer Pract
(1994) - et al.
Visibly different coping with disfigurement
(1997) - et al.
Psychological distress after assaults and accidents
BMJ
(1990) - et al.
Psychological sequale of facial trauma
J Trauma
(1997) - et al.
Initial post-traumatic stress responses following motor-vehicle accidents
J Trauma Stress
(1996) Challenging disfigurement
Community Pract
(2000)- et al.
Letters. Facial disfigurement
BMJ
(1997)
Do people avoid sitting next to someone who is facially disfigured
Eur J Soc Psychol
A long-term psychological follow-up study of burned adults
Acta Psychiatr Scand
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