Is beauty really in the eye of the beholder? Exploring positive psychological factors associated with adjustment to disfigurement and the role of attachment styles, interpersonal functioning and emotion dysregulation in relation to body image dissatisfaction and perfectionism in cosmetic surgery candidates

Abstract

Objective: This systematic review explored how “adjustment” is generally defined in adults with an acquired visible difference (AVD) and what positive psychological factors have been evidence to be associated with positive coping and processes of adjustment in AVD. Method: A systematic search for peer reviewed journal articles from 1980 to February 2016 was conducted using: PyschINFO, Medline, EMBASE and CINAHL. Studies were appraised according to eligibility criteria and evaluated against a quality criterion to assess risk of bias. Results: Fourteen studies were included and were in the areas of head and neck cancer, burns and amputation. Selected studies demonstrated inconsistent conceptualisations of adjustment ranging from: lack of psychopathology, resilience, post-traumatic growth and quality of life. Psychological factors identified were; social functioning (social support, social self-efficacy), coping strategies (emotion, problem-focused, active coping) and dispositional optimism. Studies were considered to be of moderate methodological quality with weaknesses including; a lack of control/comparison groups, lack of measure sensitive to the unique challenges of living with AVD and minimal account for confounding variables. Results are discussed in the context of future research implications. Objective: This study aimed to explore the relationship between two dimensions of attachment insecurity (avoidance and anxiety), body image dissatisfaction and perfectionism using theoretically driven multiple mediation models that included emotion dysregulation and interpersonal problems as hypothesised mediators. Method: Fifty female outpatients seeking cosmetic surgery on the National Health Service (NHS) and 26 females interested in seeking cosmetic surgery within the public domain participated in this cross-sectional study (N=76). Participants completed measures of attachment avoidance and anxiety, body image dissatisfaction, perfectionism, emotion dysregulation and interpersonal problems. Results: Attachment insecurity was significantly associated with body image dissatisfaction and perfectionism. Interpersonal problems and emotion dysregulation also significantly partially mediated the relationship between attachment insecurity and body image dissatisfaction, specifically satisfaction with discrete aspects of body parts. Emotion dysregulation was also found to significantly partially mediate the relationship between avoidant attachment and perfectionism, but not anxiety. The clinical implications of this research are discussed.