Journal of Community & Applied Social Psychology, Vol.

I , 45-56 (1991)

The Importance of the Individual in the ‘Causal’

Relationship between Attractiveness and Self-esteem

PAMELA KENEALY* and KATE GLEESON

Department of Psychology, University College of Swansea

NEIL FRUDE
School of Psychology, University of Wales College of Cardifs

WILLIAM SI-IAW
Department of Orthodontics, Dental Hospital of Manchester and Turner Dental School

ABSTRACT

This paper argues that many psychological explanations underlying health and social behaviour
stress the importance of the relationship between attractiveness and self-esteem. The nature
of this relationship is not well understood, yet can have important implications for the indivi-
dual in areas of medical intervention which involve treatment on aesthetic grounds. A survey
of psychosocial factors among 1018 children aged 11-12 years is reported. The study examined
the association between perception of physical attractiveness and self-esteem in order to clarify
the relationship between self-esteem and self versus others’ perception of attractiveness. Self-
ratings of attractiveness were linked to judges’ ratings to determine whether subjects under-
rated, over-rated, or accurately perceived their own physical attractiveness. The results showed
that although ratings of general facial attractiveness by others were associated with self-per-
ceived attractiveness, in the specific area of dental health, attractiveness (as judged by others)
was not. There were no significant relationships between ratings of attractiveness by others
and self-esteem. Self-perception of attractiveness, however, was significantly associated with
self-esteem. Further analyses showed that children who under-rated their own facial attractive-
ness had a lower mean score for self-esteem than over-raters or accurate perceivers (who
did not differ significantly). In contrast, under-raters of dental attractiveness had a lower
mean score for self-esteem than over-raters, but did not differ significantly from accurate
perceivers. Over-raters of dental attractiveness had a higher mean score for self-esteem than
accurate perceivers. These finding suggest that if an over-rater were to receive treatment on
aesthetic grounds it is unlikely, given that they have high self-esteem already, that such interven-
tion will have a profound psychological impact. These data indicate the importance of deter-
mining the way in which individuals evaluate their appearance compared to others, and may
help to clarify previously equivocal findings concerning the relationship between self-esteem
and attractiveness.

Key words: Individual, self vs other, relationship, attractiveness, self-esteem.

* Address for correspondence: Dr Pamela Kenealy, Department of Psychology, University College of

Swansea, Singleton Park, Swansea SA2 8PP.

1052-928419 110lOO45-12$06.OO Final manuscript received 29 January 1991

0 1991 by John Wiley & Sons, Ltd.
46 P. Kenealy et al.
INTRODUCTION

The seminal work which developed the concept of self-esteem (Cooley, 1902; Mead,
1934) stressed the importance of the reflected appraisals of others in shaping the
self-concept. Consequently it has been assumed that the appraisal of our attractive-
ness by others has not only an effect on our body image, but subsequently an impact
upon self-esteem also. More recent research, however, suggests that individuals
actively moderate their self-image rather than passively absorbing the judgements
of others, and that this moderating process is directly related to self-esteem (Brown,
Collins and Schmidt, 1988; Klima, Witteman and McIver, 1979).
The relationship between attractiveness and self-esteemwould seem to be of funda-
mental importance in many of the psychological explanations underlying health and
social behaviour. However, the ‘causal’ nature of the relationship is not well under-
stood, and the importance of the individual’s role in mediating between the appraisals
of self and others is often ignored. Research indicates that there is no simple relation-
ship between the assessment of external appearance by others and self-evaluation
of attractiveness (Bull and Rumsey, 1988). It seems unlikely that actual physical
attractiveness maps onto self-perception in any direct fashion. Coping mechanisms
not only allow the individual to ignore or modify feedback from others; they also
allow them to award their own attractiveness a higher position on the preferential
hierarchy (Horowitz, Cohen and Doyle, 1971).Furthermore, the less attractive person
may render physical appearance a less salient component in their own self-esteem
(Graber, 1981). Adams (1977) claims that there is, in fact, a relationship between
self-perceptionof attractiveness and objective rating of attractiveness; however, Bers-
cheid and Walster (1974), in reviewing a number of studies, claim that although
there is a significant correspondence between objective and self-ratings of attractive-
ness, the ‘relationship is a good deal less than perfect’ (p. 185) and the correlation
coefficients are usually low.
The relationship with self-esteem and the discrepancy between evaluation by others
and self-perception of attractiveness are particularly significant in those areas of
medical intervention which rely heavily on psychological explanations in determining
the urgency of treatment-need on aesthetic grounds. For example, much orthodontic
work is justified on the assumption that physical appearance has a profound effect
on the psychosocial well-being of the individual, not only in terms of interpersonal
relationships (Dion & Berscheid, 1974; Kenealy, Frude and Shaw, 1989; Kleck,
Richardson and Ronald, 1974; Lerner & Lerner, 1977; Samuels & Proshek, 1973)
but also with regard to psychological attributes such as self-esteem (Mathes and
Kahn, 1975). However, ‘Despite numerous statements in the orthodontic literature
supporting the importance of the psychological aspects of malocclusion, there is
a paucity of investigations dealing with body image and self-concept as they relate
to occlusion’(Klima, Witteman and McIver, 1979, p. 507).
As far as dental appearance is concerned, research by Shaw (1981) suggests that
children are frequently unable to recognize and describe their own dental features.
Clemmer and Hayes (1 979) found that orthodontic patients’ self-images bore little
relationship to measurable malocclusion, while Hershon and Giddon (1980) found
that both orthodontic patients and non-orthodontic groups underestimated the pro-
trusiveness of their lips by comparison with objective measures. Horowitz et d.,
(1 971) found only a weak overall relationship between actual occlusal condition
 Self vs Other: Attractiveness and Self-esteem 47
and self-image which they suggested may ‘possibly be explained because there is
only a tenuous connection between actual occlusal condition as measured by dentists
and an individual’s perception of those conditions’ (p. 198). However, the findings
are inconclusive. Other research shows that children are often able to perceive their
own dental appearance accurately to the extent that they can pick out a photograph
in a scale of attractiveness which is equivalent to their own dental attractiveness
as rated by an orthodontist (Evans & Shaw, 1987). Even so, accurate perception
of dental appearance is not equivalent to accurate self-evaluation, and even where
people do perceive a dentofacial abnormality, they are not necessarily dissatisfied
with their appearance and do not necessarily regard themselves as unattractive.
Indeed, not only are people with definite malocclusions sometimes quite satisfied
with their appearance, people with good occlusion sometimes report a feeling of
dissatisfaction (Baldwin & Barnes, 1965; Drake, 1977; Hilzenrath & Baldwin, 1971;
Howitt, Stricker and Henderson, 1967; MacGregor, 1970; Virolainen, 1967). In a
study in which a general sample of school children were interviewed, Shaw (1981)
found that 48 per cent of those children with moderate to severe dental irregularities
were satisfied with their teeth, while others who had no visible irregularities were
dissatisfied. In addition, Howitt et al., (1967) found that approximately one-third
of subjects who expressed dissatisfaction with their teeth actually had reasonably
aesthetic dental conditions. Aesthetic self-evaluation, then, does not depend solely
on an ability to perceive physical appearance accurately. Unsurprisingiy, therefore,
Graber (1981) reports only a low correlation between objective measures of dental
attractiveness and degree of satisfaction with teeth.
It seems that, as far as dental attractiveness is concerned, there is no simple relation-
ship between self-perception of attractiveness and actual physical appearance, and
that orthodontists may have overestimated the psychological impact of malocclusion
on these processes.
Thus we might argue that orthodontic intervention is unlikely to have a direct
impact on self-perception of attractiveness, and consequently little impact upon self-
esteem. However, the recipients of such treatment feel that it will have an effect
on their psychological well-being in so far as good teeth are regarded as an important
factor in interpersonal success (Linn, 1966), and in fact, Oulette (1979) reports that
the majority of orthodontic patients in his survey (85 per cent approximately) report
that they perceived an increase in their own self-confidence following treatment.
Dennington (1975) reports that even the anticipation of improved appearance, when
an orthodontic appliance is fitted, results in improved self-esteem. Despite these
reports in the literature, researchers have tried and failed to show a relationship
between actual physical attractiveness and self esteem (Lerner & Karabenick, 1974);
Starr, 1980). In addition, attempts to correlate objective dental measures with self-
esteem have resulted in low correlations (Dennington, 1975;Murphy, 1976) or corre-
lation with only one specific type of distortion (Klima, 1975; Klima et al., 1979).
A number of studies have point towards the conclusion that it is not attractiveness
per se that is associated with self-esteem, but individuals’ evaluation of their own
attractiveness. If people are able to perceive their physical appearance accurately,
but not able to assess their physical attractiveness accurately, then it seems likely
that self-perception of attractiveness will play a greater role than actual attractiveness
in determining self-esteem (Graber, 1981).
There is a great deal of support for this contention in the literature. While Starr
48 P. Kenealy et al.
was unable to show a relationship between physical attractiveness rated by others
and self-esteem (Starr, 1980), he did demonstrate that higher self-ratings of attractive-
ness are associated with higher ratings of self-esteem (Starr, 1982). Varni, Rubenfeld,
Talbot and Setoguchi (1989) found a substantial and significant correlation between
general self-esteem and self-perceived physical appearance, and showed additionally
that, out of a range of social and behavioural factors, self-perception of physical
appearance was most predictive of self-esteem. Many other researchers (e.g. Bers-
cheid, Walster and Bohrnstedt, 1973) have shown a relationship between negative
body-image and low self-esteem. This relationship has been demonstrated in both
males and females (Mahoney, 1978). Indeed Starr (1982) goes as far as to claim
that self-ratings of attractiveness may merely be another means of measuring self-
esteem.
This body of research clearly establishes a relationship between self-evaluation
and self-esteem which suggests that the under- or over-rating of personal attractive-
ness is directly related to self-esteem. However, because such studies have not incor-
porated objective ratings of attractiveness into their designs, it is not possible to
establish firmly the nature of the relationship between self-appraisal and self-esteem.
Pitt and Korabik (1977) were able to combine all three elements in a study which
showed that people with high selfyesteemjudge their facial profiles as significantly
more ideal than they actually are, while people with low self-esteem judge their
profiles to be significantly less ideal. They go on to argue that ‘a person’s perception
of his facial profile is determined by his psychological self-satisfaction rather than
by his objective appearance’ (p. 460). In an attempt to apply Pitt and Korabik’s
findings to a newly developed scale of dental attractiveness, Evans and Shaw (1987)
asked subjects to select from a scale of photographs the one which they considered
was equivalent to their own teeth in terms of attractiveness. The results showed
an association between the under-rating of attractiveness (relative to the orthodon-
tist’s rating) and low self-esteem. This adds further weight to the argument that
there is a relationship between self-esteem and the under- and over-rating of attract-
iveness by the individual.
In addition, the literature on self-esteem suggest that people who gain high scores
on masculinity scales also achieve high self-esteem scores (Koffman and Lipps, 1980).
In fact, males consistently achieve higher scores than females on self-esteem measures
in normal populations (Feather, 1985). If self-esteem is indeed correlated with self-
perception of attractiveness, we would expect to find that more males over-rate their
attractiveness. Certainly Cavior (1970) found that young girls consistently rate their
attractiveness much lower in comparison with judges’ ratings and tend to emphasize
deficiencies in appearance which the judges disregard or fail to perceive.
The purpose of the present study was to investigate the association between percep-
tion of physical attractiveness and self-esteem in order to describe the role of the
individual and to clarify the relationship between self-esteem and self versus other’s
perception of attractiveness. Self-ratings of attractiveness were linked to judges’ rat-
ings to determine whether subjects under-rated, over-rated, or accurately perceived
their physical attractiveness. The relationship between under-ratindover-rating and
self-esteem was examined, as were sex differences in under- and over-rating. In
addition, the study explored the relationship between objectiveratings and self-ratings
of attractiveness; objective ratings of attractiveness and self-esteem; and self-percep-
tion of attractiveness and self-esteem.
 Serf vs Other: Attractiveness and Seg-esteem 49
METHOD

The present research was conducted as part of a longitudinal survey of the social
and psychological effects of orthodontic treatment, the general aims and method
of which have been described elsewhere (Shaw, Addy, Dummer, Ray and Frude,
1986). In a preliminary screening, 4810 children were listed. The final sample of
children were selected by disproportionate stratified sampling (Moser & Kalton,
1979) so that occlusal conditions of low prevalence but high orthodontic interest
were well represented in the study cohort. Measures of attractiveness were obtained
and self-esteem questionnaires were distributed to the children themselves. Each
child was interviewed individually.

Targets
The targets of the attractiveness ratings were 1018 children between 11.5 and 12.5
years of age, from schools in South Glamorgan, Wales.

Measures of Attractiveness
Objective ratings by others. An objective measure of dental attractiveness was
established. This involved preparing study casts of each subject from alginate impres-
sions. The casts were independently rated by a panel of three judges. The panel
of judges consisted of one research assistant, one lay person, neither of whom had
received any dental training, and an orthodontist. The correlations between the
judges’ ratings of the casts were all highly significant (p < 0.001), indicating that
the inter-judge reliability was high. A summary ‘dental cast score’ was calculated
for each subject by averaging the ratings of the three judges.
In addition, an objective measure of facial attractiveness was established. Standard
35 mm colour transparencies of each child’s face, with lips gently at rest, were pro-
jected onto a screen and judged by five adults, none of whom knew the targets
personally. The correlations between the judges’ ratings of attractiveness were all
highly significant (p < 0.001), again, indicating that the inter-judge reliability was
high. A summary ‘facial attractiveness score’ was calculated for each subject by
averaging the ratings of the fivejudges.

Serf-rating of attractiveness. During the course of an interview the children were

asked to rate themselves in terms of their own attractiveness compared to that of
the other members of their class, choosing one of five statements ranging from ‘one
of the worst looking’ to ‘one of the best looking’.

Under-rating/over-ratingmeasure. Two different criteria were used to categorize

subjects as over- or under-raters. These were based upon the two different objective
measures of attractiveness by others-‘dental’ (based upon the dental cast score)
and ‘facial’ (based upon the facial attractiveness score).
The categorization of the subjects into under-raters, over-raters, and accurate per-
ceivers for both facial and dental criteria, was achieved by converting both the objec-
tive ratings and the self-ratings to Z scores, and subtracting the self-rating from
the objective rating. Thus where a subject had a self-rating score that was higher
than the objective rating (a minus difference score) they were classed as an ‘over-rater’.
Likewise, where a subject had a lower self rating than objective rating (a plus differ-
50 P. Kenealy et al.
ence score) they were classed as an ‘under-rater‘. Where there was no difference
between objective and self-rating (a zero difference score) the subject was classified
as an ‘accurate perceiver’.

Self-esteem measure. The subjects completed a self-concept inventory (Piers and

Harris, 1969) as part of a battery of questionnaires, the remainder of which related
to other aspects of the survey. The Piers-Harris Children’s Self Concept Scale is
a widely used self-report instrument designed for children up to 16 years of age
(Wolf, Sklov, Hunter, Webber and Berenson, 1982). The scale was designed primarily
for research on the development of children’s self-attitudes and correlates of these
attitudes. The scale consists of 80 items from an original pool of items developed
from Jersild’s (1952) collection of children’s statements about what they liked and
disliked about themselves. The items are written in statements and require a yes/no
response.

RESULTS

Table 1. Correlation matrix of ratings of attractiveness by

others (face and dental), self-rating, and self-esteem
Attractiveness
Self Face Dental
Self 0.1643* 0.00089
(n = 845) (n = 853)
Self-esteem 0.2760* 0.0566 -0.026
(n = 856) (n = 801) (n = 1017)
* p < 0.0001.
Numbers of children differ due to refusal of one school to participate
in the interview and self-rating aspects of the study.

A correlation matrix (Pearson’s product-moment correlation) for both objective

ratings of attractiveness (by others), self-rating of attractiveness and self-esteem was
computed. The results, presented in Table 1, showed that whereas objective ratings
of dental attractiveness by others were not associated with self-perceived attractive-
ness, objective ratings of general facial attractiveness were significantly correlated
with self-perceived attractiveness, although the correlation coefficient was low (0.16).
Furthermore, objective ratings of attractiveness (by others: dental and facial) were
not associated with self-esteem. Finally, the results showed that there was a relation-
ship between self-perception of attractiveness and self-esteem.

Ratings of attractiveness
Dental attractiveness criteria. A one-way analysis of variance on the data summar-
ized in Table 2 revealed a significant effect of perception of dental attractiveness
on self-esteem ( F = 12.63,p < 0.0001). A least significant difference ranges test showed
that there were significant differences (p < 0.05) between the over-raters (mean 58.63)
and the accurate-perceivers (mean 56.09) groups, and between the over-rater and
 Self vs Other: Attractiveness and Self-esteem 51
the under-rater (mean 54.27) groups in self-esteem. This indicated that over-raters
had significantly higher self-esteem than under-raters and accurate perceivers, whilst
the under-raters were not significantly different from the accurate perceivers.

Table 2. Differences in self-esteem of children who are over-

raters, under-rates and accurate raters of own attractiveness
Mean self-esteem score
(a) Facial attractiveness
Under-raters 55.37*t
Accurate raters 57.49t
Over-raters 57.36*
(b) Dental attractiveness
Under-raters 54.27t
Accurate raters 56.09*
Over-raters 58.63*t
* and -f Denote significant differences from one another at 0.05 level
(LSD comparison procedure).

Facial attractiveness criteria. A one-way analysis of variance revealed a significant

effect of perception of facial attractiveness on self-esteem (F=6.92, p < 0.001). A
least significant difference ranges test showed that there were significant differences
(pC0.05) between the over-raters (mean 57.36) and the under-raters (mean 55.37)
groups, and between the accurate-perceivers(mean 57.49) and the under-raters groups
in self-esteem. This indicated that for the facial attractiveness criteria under-raters
had significantly lower self-esteem than over-raters or (in contrast with the dental
attractiveness criteria) accurate-perceivers, whilst the over-raters were not signifi-
cantly different from the accurate-perceivers.

Sex diferences in over- and under-raters. An analysis of variance was computed

for self-esteem by sex and objective dental attractiveness, and a separate analysis
was computed for self-esteem by sex and objective facial attractiveness. The results
indicated that although both analysis showed a significant main effect of undedover-
rating on self-esteem (dental criteria F = 9.06, p < 0.001; facial criteria F = 6.94,
p < 0.001) there was no significant main effect or interaction of sex in either analysis.
This indicated, contrary to expectations, that male subjects were no more likely
to over-rate their attractiveness than female subjects.

DISCUSSION

As far as the objective rating of dental attractiveness by others is concerned, the

results supported the view that there is no relationship between the self-evaluation
of attractiveness and actual physical attractiveness. While this challenges the conclu-
sion drawn by Adams (1977), these findings are in accord with a number of studies
(cf. Berscheid and Walster, 1974) which suggest that there is no strong relationship
between the self-rating of attractiveness and its objective evaluation. This finding
is not surprising, since it has been demonstrated that, even where children are able
52 P. Kenealy et al.
to perceive their appearance accurately, this will not necessarily result in a self-
evaluation which is in line with objective judgements. However, our findings are
somewhat equivocal, for there is a highly significant (p < 0.0001) (although low value:
0.1643) correlation between the objective rating of facial attractiveness by others
and self-rating of attractiveness. This finding is compatible with Berscheid and
Walster’s (1974) conclusion that the relationship between actual attractiveness and
self-evaluation is a good deal less than perfect.
As anticipated, the results show that perception of attractiveness by others (ratings
of dental and facial attractiveness) is unrelated to self-esteem, a finding which is
in line with the research reported by Evans and Shaw (1987).
The literature suggests that self-esteem has a direct impact on this process of
self-evaluation. Indeed, many researchers confidently espouse the nature of the rela-
tionship: ‘It seems that a person’s perception of his facial profile is determined by
his psychological self-satisfaction rather than by his objective appearance’ (Pitt and
Korabik, 1977, p. 460). Indeed, on the basis of the literature which emphasizes
the importance of self-esteem in the development of self-image (Robson, 1988) it
seems logical to argue that a positive self-image leads individuals to feel good about
their appearance. However, a more cautious approach is taken in the interpretation
of the results of the present study, for it is equally possible that a positive body
image increases an individual’s self-esteem (Berscheid et al., 1973). In fact, it may
even by the case, as Berscheid et al. argue, ‘that the groundwork for both positive
body image and high self-esteem is set early in life and that some other factor deter-
mines both’ (p. 126).
In fact, our results have clearly established that there is a relationship between
self-evaluation of attractiveness and level of self-esteem, and that, furthermore, those
who over-rate their attractiveness have significantly higher self-esteem that either
those who under-rate or those who perceive their attractiveness accurately. Although
the differences in self-esteem are significant because of the large sample size the
actual difference between the means is relatively small. Therefore, although there
is a statistically significant effect the psychological significance of the effect in any
given individual may be rather small. The findings of a study which bears some
resemblance to the present one, that of Evans and Shaw (1987), are of great interest
here. While they did find a significant difference between over-raters and under-raters,
Evans and Shaw found no significant difference between over-raters and accurate
perceivers in terms of self-esteem, and drew the conclusion that over-rating is not
associated with high self-esteem, although under-rating is associated with low self-
esteem. This finding is in line with our analysis which used an objective rating of
facial attractiveness in the criteria for categorizing subjects as under- and over-raters.
However, these results are in contrast to our analysis in which dental attractiveness
formed the basis of the criteria which established under- and over-rating. In this
analysis there is a significant difference between over-raters and those who accurately
perceive their attractiveness, as well as a significant difference between over-raters
and under-raters. It is perhaps surprising that the analysis utilizing the dental attract-
iveness criteria reveals a pattern which is in contrast with the results of Evans and
Shaw because the undedover-rating criteria are very similar in both cases.
It would seem, therefore, that where the criteria to determine overiunder-rating
depend upon facial attractiveness, over-rating of attractiveness will be associated
with high self-esteem, and where the criteria depend upon dental attractiveness,
 Selfvs Other: Attractiveness and Self-esteem 53
under-rating of attractiveness is associated with low self-esteem. This does raise the
question of which criteria should be used for determining the under- and over-rating
of attractiveness. It is argued here that either method may be appropriate, but the
decision about use will depend upon the nature of the domain under investigation.
For our purposes, the over- and under-rating of attractiveness in relation to dental
appearance would appear to be the more appropriate measure, and the results of
such an analysis do, indeed, make intuitive sense, in that it appears likely that people
with high self-esteem will also have a relatively high opinion of other aspects of
self and identity. In addition, these findings are in accord with those of a number
of researchers. For example, Coopersmith (1967) found that people with high self-
esteem are more able to reject devaluing information, suggesting that having high
self-esteem may render the individual at least partly immune to negative external
cues about their appearance. Lundgren (1978) found that those with high self-esteem
were less sensitive to criticism from others. Swanson and Weary (1982) found that
one of the consequences of low self-esteem is the tendency to accept unfavourable
assessments as accurate. It is a relatively simple task to explain the difference between
the self-esteem of the under- and over-raters. In order to do this Brown et al‘s
(1988) arguments are particularly valuable. They contend that all individuals experi-
ence a strong desire to enhance self-worth, but that people with low self-esteem
are more constrained in their attempts at self-enhancement by the concern that they
will be unable to defend a positive self-identity successfully. Thus people with high
self-esteem seek to confirm their positive self-views, while those with low self-esteem,
although seeking to enhance their self-image, are unable to do this in a direct fashion.
They tend not to utilize direct forms of self-enhancemedt which link the self to
positive identity, but rather to use less direct means, the self being only indirectly
linked to positive identities by association with others. Shrauger (1975) suggest that
affectively, all individuals seek self-enhancement feedback, but cognitively, those
with low self-esteem are more ready to believe and accept negative feedback which
confirms their low self-image.
Despite the fact that many orthodontic researchers have justified intervention by
the assertion that the physical appearance of teeth has a direct psychological impact
(cf. Klima et aZ., 1979), the argument is obviously a problematic one. Although
self-rating of attractiveness is associated with self-esteem, general facial and dental
attractiveness, as judged by others, is not. Therefore, it would seem that, as far
as physical appearance is concerned, it is the self-evaluation of appearance rather
than actuaZ physical appearance which is associated with psychological adjustment.
On close consideration of the results of the present study, the far-reaching impli-
cations of the relationship between over-rating and self-esteem become apparent.
It appears that one cannot justify orthodontic intervention on purely psychological
grounds, at least as far as the self-concept is concerned. Those who have low self-
esteem and who under-rate their physical attractiveness are those patients who show
a smaller deviation from the ideal in terms of dentition (under-raters’ dental cast
mean score =41.99; accurate raters’ mean =25.98; over-raters’ mean = 16.99). There-
fore, there may well be little room for objective improvement of appearance, and
as any improvement would by definition be a minor one, there may be no guarantee
of a consequent increase in self-esteem. On the other hand, we have no reason to
believe that those who have objectively less attractive teeth, but who over-rate their
appearance, are likely to suffer in terms of self-esteem and consequently no grounds
54 P. Kenealy et al.
for intervention at least as far as psychological well-being is concerned in the short
term, the longer-term effects on self-esteem have yet to be established. Therefore,
psychological measures such as self-esteem, on their own, provide little in the way
of justification for orthodontic intervention.
These data clearly support the argument that the relationship between self-evalu-
ation of attractiveness and self-esteem is not of a simple causal nature. If we try
to establish the impact of attractiveness on self-esteem, we cannot afford to rely
solely upon assessment of physical appearance by others, as any relationship between
appearance and self-esteem must depend to some extent upon individuals’ self-evalu-
ation of their own attractiveness. On the other hand, if we wish to use the effect
of attractiveness on self-esteem in the justification of orthodontic intervention, a
measure of general appearance appears to be inadequate in explaining the relation-
ship.
As a solution to this problem, it seems to be of paramount importance to establish
whether individuals under- or over-rate their physical attractiveness. Doing so will
provide the orthodontist with an effective indicator not only of the likely outcome
of intervention in terms of the individuals’ self-esteem, but also of its success as
far as co-operation with treatment is concerned; we may assume that those who
under-rate their appearance will be highly motivated to improve their dental status,
and thus to improve their overall appearance, while those who are satisfied with
their appearance will be far less motivated to comply. Furthermore, if over-raters
do receive treatment, given that they have high self-esteem already, it is unlikely
that such intervention will have a profound impact on self-esteem. However, if
the minimal damage of the under-rater is corrected there may be some improvement
in self-esteem, although perhaps not a great deal of improvement in actual physical
appearance.
Therefore, by determining the way in which individuals evaluate their appearance
and relating this self-evaluation to an objective rating of appearance made by others,
it may be possible to predict the effect on self-esteem of any intervention, as well
as the likelihood of compliance with treatment. From the assessments of appearance
by both self and others a classification of whether the individual over-rates, under-
rates, or is an accurate perceiver of their own physical attractiveness can be deter-
mined. While treatment of over-raters may have a greater improvement on physical
appearance than treatment of under-raters (because the over-raters are objectively
less attractive before treatment), as the findings from this study have shown that
over-raters have higher self-esteem than under-raters, improvement in self-esteem
may be greater for under-raters than over-raters (because their level of self-esteem
is lower before treatment).

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Berscheid, E. & Walster, E. (1974). ‘Physical attractiveness’. In: Berkowitz, L. (Ed.) Advances
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