Children Coping with Impaired Appearance: Social
and Psychologic Influences
Ann Hill-Beuf, Ph.D.
Professor of Sociology and Anthropology, Cedar Crest College, Allentown, Pennsylvania
Judith D. R. Porter, Ph.D.
Professor of Sociology, By/n Mawr College, By/n Mawr, Pennsylvania
Abstract: Coping with impaired appearance presents difficul-
ties for children. This study is based on interviews of children
with vitiligo, a disfiguring disorder that involves depigmenta-
tion of the skin, and focuses on social and psychologic factors that
predict effectiveness of coping. Age plays an extremely impor-
tant part in adjustment, with the junior high school years
especially traumatic. Change of location or situation also is a
predictor of stress. Children who develop other competencies
that build self-esteem cope well with the disorder. These and
other factors are explored in depth, and strategies for helping
child patients with disfiguring disorders are suggested.
Introduction
Although an increasing number of psychosocial
studies of the physically handicapped have been
conducted in recent years, these investigations
have focused primarily on the problems of adults
who are physically incapacitated to some degree.
Less attention has been given to children and to the
victims of cosmetic disfigurement alone, whose
personal problems may equal those of individuals
with other physical disabilities. Although there is
no organic or functional inability to perform normal
activities, impaired appearance may in itself have
important consequences for the psychology of chil-
dren because of the social significance of ap-
pearance and the attitudes and prejudices of society
toward one whose appearance is atypical.
For the past five years, we have investigated
psychologic and social factors causing variation in
response to cosmetic impairment in a study of adult
and child patients with vitiligo, a disfiguring dis-
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ISSN~O163-8743/S4/!$3.00
ease that involves depigmentation of the skin.
Patches of skin on exposed areas such as the face
and hands, as well as other body areas, turn com-
pletely white, leaving the patient visibly disfigured
by uneven color. The disease affects l%-2% of the
population. Its cause is unknown, but once it be-
gins, it generally continues to spread [l]. In the
majority of cases, there is no other detectable pa-
thology; the person suffers no physical discomfort,
lessened energy level, or fear of mortality [2]. For
this reason, vitiligo has been dismissed by many
physicians as “only a cosmetic disorder.” Yet, it
presents an excellent opportunity to focus directly
on the effect of impaired appearance alone on the
lives of individuals. The present study examines
psychologic and social factors that affect the man-
ner in which the children in our sample reacted to
this impairment.
Theoretical Considerations and
Hypotheses
American society has been described as a society
oriented toward a very narrow standard of beauty.
Much research indicates that appearance has a
great deal to do with the personality traits people
will attribute to a stranger, believing physically at-
tractive people [3] to have more socially desireable
traits than others. Studies show that good-looking
persons of both sexes are presumed to be kinder
and more intelligent than others [4,5], to have
greater internal control, competence and achieve-
General Hospital Psychiatry 6, 294-301, 1984
8 Elsevier Science Publishing Co., Inc. 19&p
52 Vanderbilt Avenue, New York, NY 11X17

ment, to be better liked, and to lead happier and
better adjusted lives [4,6-lo].
People with visible physical handicaps or defor-
mities have an appearance clearly at odds with this
social norm of beauty, and a number of studies
indicate that handicapped persons may indeed face
an atmosphere of prejudice or rejection due to their
physical appearance. There is a consensus among
investigators that, although sometimes traits at-
tributed to the handicapped may be positive
[11,12], attitudes toward the visibly handicapped
are more frequently negative in direction [11,13,14].
The social problems faced when the handicapped
attempt to interact with the nonhandicapped have
been delineated by a number of investigators. In-
teractions are often strained and tension-producing
and marked by stilted and artificial communication,
both verbal and nonverbal, especially with strang-
ers or casual acquaintances [15-201. In addition,
impaired individuals themselves may exhibit dis-
comfort and strain or inhibition in social rela-
tionships with those who are nonimpaired and may
anticipate discriminatory interaction with the non-
handicapped [12,21].
Although much of the existing research deals
with problems of the physically disabled, less atten-
tion has been given to people with cosmetic dis-
figurements involving the skin or face, which are
not connected with an organic disability [11,22].
Existing research in this area, in fact, suggests that
the cosmetically or facially disfigured may have
problems that equal or exceed those with other
body afflictions because of the social significance of
the skin or face [11,22-251. Facial disfigurements
are ranked among the least desireable handicaps by
both children and adults [17,26]. Adults are less
likely to help a facially disfigured than a non-
disfigured victim [27]. Facially disfigured indi-
viduals are well aware of negative social attitudes
toward them and either experience or anticipate
discrimination in a number of realms [21,23]. As a
result, many people with either facial or skin im-
pairments experience psychologic problems such
as self-consciousness, feelings of inferiority, and
withdrawal that become more grave than the phys-
ical impairment [11,23,25,28-301. Adjustment in
these cases varies by personality, social factors, and
type of disorder [23,24,31,32].
Visibdity of Deformity
One factor that has been studied with regard to the
emotional impact of impaired appearance is the
Children Coping with Impaired Appearance
severity of deformity, but there is disagreement on
the effects of severity of the deformity on psychol-
ogic response. Some findings suggest that severe
deformities lead to choice of “succumbing” reac-
tions [15,22,30]. Other studies find that the severity
of the deformity is not a good predictive factor of
emotional response [11,33,34]. The relationship be-
tween social factors, emotional response, and feel-
ings of competency has not been thoroughly inves-
tigated for many types of handicaps, but especially
for those that result only in impaired appearance.
The special importance of appearance during
youth, especially during adolescence, is a hallmark
of American society [35]. Further, the strained in-
teractions that can result when a visibly disfigured
child encounters others may have implications for
the development of overall sense of self in the child
[35-371.
While Coopersmith did not find a relationship
between appearance and self-esteem, other re-
searchers have maintained that feelings about
oneself, especially when appearance is impaired,
do influence the child’s feelings of self-worth
[15,16,38]. Douvan stresses the importance of body
image in self-esteem during puberty [35].
Coopersmith’s notion of the dimensions of self-
esteem itself can be linked indirectly to appearance.
Coopersmith states that self-esteem rests on four
characteristics:
1. a child’s feelings of being loved by others
2. a sense of competency or personal efficiency
3. a positive regard for his or her own ethics
4. a feeling that he or she has control over their
own lives or other people [38].
Competency
Certainly, the negative reaction of others to im-
paired appearance could diminish a child’s sense of
being loved. Coopersmith’s second and fourth di-
mensions of self-esteem suggest the importance of
feelings of competency and control in personal abil-
ity to respond to impaired appearance.
Erikson also notes the importance of such com-
petency feelings. In the stages of Industry and Ini-
tiative as well as later, adolescent and young adult
stages stress the importance of developing interests
and skills [39]. This focus suggests that children
who have a sense of competency will be better able
to cope with impaired appearance: they are likely to
have higher self-esteem to begin with and their self-
esteem does not rest on appearance. Also, such
295
A. Hill-Beuf and J. D. R. Porter
children, being interested and active in whatever
their “fields” may be, are likely to be much less
concerned with appearance in general.
There is little research on the importance of age (or
developmental stage) on the child’s ability to cope
with impaired appearance. Applying the develop-
mental scheme of Erikson, we should expect the
preschool years to be devoted to the acquisition of
ego skills [39]. Here too, impaired appearance
could contribute to strained interaction within the
primary group.
During the elementary school years, the central
developmental task confronting the child is the
mastering of the technology of his or her society-
be it bow and arrow or complicated reading and
mathematical skills. It is a time of learning, of gain-
ing a sense of the competence of self. Any factor
that prevents this sense of mastery, threatens the
psychologic well-being of the child at this stage in
the life cycle [39].
In addition, the importance of mastering one’s
body-also an important aspect of this stage of
development-is being learned through sports,
dance, and other physical activity. Competency
could, as stated above, help the child. However,
bad experiences at school related to appearance
could slow the acquisition of competency feelings.
Erikson calls the adolescent years the Stage of
Identity [39]. Others have noted that appearance
becomes an important aspect of one’s sense of self
in the teens [35-371. This is true of children of both
sexes, but is especially important for girls. Being
like others, belonging to the group, feeling accept-
ed as a person are all key factors for the young
person of this age [37,39]. Feelings of well-being
have been linked to the degree of happiness experi-
enced in terms of satisfaction with appearance dur-
ing adolescence [36]. These feelings and the confi-
dence they bring with them may carry over well
into the adult years [36].
This suggests that while younger children may
be preoccupied with other concerns, the adoles-
cent, especially the younger adolescent for whom
body image is of great importance, would be the
most embarrassed by impaired appearance. Older
adolescents have to concern themselves with more
demanding issues: whether or not to attend col-
lege, which career or occupation to pursue, the
selection of a mate. Thus, we might expect extreme
296
concern with appearance to fade as we move into
the older teens.
This study focuses primarily on age, visibility of
impaired appearance, and feelings of competency
as factors that influence children’s responses to
vitiligo. Some other factors that also contribute to
childrens reactions to this condition will be noted.
These are social class, gender, family stress, and
treatment mode.
Procedure
We conducted exploratory, in-depth interviews
with 19 child patients at two northeastern medical
centers that were associated with our 5-year vitiligo
study. Both centers have special vitiligo clinics and
both are associated with medical schools: Clinic A,
with a traditional Ivy League school, Clinic B with a
prominant Black university.
Initially, we intended to obtain questionnaires
and interviews for each child. This plan was dis-
missed for several reasons. First, the questionnaires
we obtained from “children” during the first year
of study frequently had been filled out by parents
and it was impossible to determine whether the
opinions and feelings expressed were those of the
children or the parents. In addition, by the fourth
year of the study the pool of child patients from the
first year had been diminished as children grew
into early adulthood or moved to other parts of the
country. Therefore, we decided to individually in-
terview each child on treatment and to include
more recent patients.
A “child patient” is defined as a person between
the ages of 3 and 18 years of age who has vitiligo
and has sought medical treatment at either Clinic A
or B. All such patients were contacted by telephone
and asked to be interviewed. Only the parents of
these nineteen patients consented.
Each child was interviewed alone. She or he was
asked to discuss the history of the vitiligo and the
path to treatment. We also asked the children the
feelings they had had about vitiligo, what experi-
ences they had had with other people because of
vitiligo, what kinds of situations made them anx-
ious about vitiligo, and whether they thought that
their reaction to vitiligo has changed over time. We
asked about support sources: to whom can the child
turn when an unpleasant incident occurs? The use
of “cover up” techniques-cosmetics, clothing-
was discussed with children of an appropriate age.
We asked each child to consider the situation of a

child his or her own age and sex who had just
experienced the onset of vitiligo. We then asked the
child “What advice would you give to this per-
son?“; “What advice would you give his parents?”
and “What advice would you give his teacher?”
In addition, the parents of each child were inter-
viewed on the history of the disorder, the child’s
emotional response to vitiligo and the success of
treatment.l They were given an explanation of the
social science part of the research project and reas-
sured regarding the anonymity of all subjects.
The childrens’ interviews themselves suggested
four classifications of response to vitiligo: (1) the
child reported some negative incidents associated
with vitiligo, but the child was only mildly con-
cerned with the disorder and seemed well adjusted;
(2) the child was moderately concerned with vitiligo
and worries about appearance, but was not de-
pressed, withdrawn, or preoccupied with it; (3) the
child was very concerned about vitiligo and ex-
presses this concern through preoccupation, de-
pression, or withdrawal; (4) the child was very con-
cerned and expressed this through hostility and
anger,
Visibility will be treated in this report as “face”
and “not face.” Our interviews with adults and
children made it clear to us that facial vitiligo is by
far the most worrisome to patients. Another reason
for using this rather simple form of classification is
the significance of the face in determining the
nature of interpersonal interactions.
We were also concerned with the child’s feelings
of competency. This issue was explored by asking
the child a series of questions about interests in and
out of the classroom, hobbies, sports, and ac-
tivities, and career and vocational aspirations. In-
formation in this area was obtained from the par-
ents in addition.
Furthermore, we asked parents about any family
strains or tensions that might have an impact on the
child, noting as well any parental emotional re-
sponse to the impaired appearance of the child.
However, one cannot assess the quality of family
life in a single interview. Therefore, we did not
attempt to classify family support. In situations
where extreme tension or special problems were
confided to us by the child or the parent, we did
take note of it. We must be aware, however, that
there is a certain homogeneity to the sample in their
being at the clinics at all. That is, most of the chil-
dren we saw have fairly supportive families who
‘One child came alone.
Children Coping with Impaired Appearance
have brought them to two of the most highly spe-
cialized treatment centers in the country. Some-
times, parents have done this despite a laissezfaire
attitude on the part of the family physician. One
suspects that child.ren with the lowest family sup-
port are untreated children who do not fall within
our sample.
As we will see, the major factors associated with
the children’s responses to vitiligo are: (1) the exis-
tence of what we shall call a “competency feeling”
as indicated by the childs consuming interest in an
activity, the acquisition of a skill, or the develop-
ment of a talent; and (2) social developmental age.
Visibility actually played a less important role
than either of these variables, though its impor-
tance should not be understated. To a lesser extent,
family stress, social class, gender, and type of treat-
ment the child-patient receives also can influence
the child’s reaction to vitiligo. The impact of race is
an important consideration. However, as our black
patients were also the more visibly afflicted and
were also concentrated in one treatment group, it is
difficult to separate the effect of race alone.
Developmental Age
Children of different ages experience vitiligo differ-
ently. (See Table 1.) Age often interacts with an-
other dimension of life, Transition, to pose crisis
points for the child.
The young child (3-6) seems relatively un-
affected by vitiligo, even when the disorder is quite
visible. Children of this age are still quite centered
on family and self. A loving set of parents can
provide a fortress against the hurts that come later
as their social worlds expand. These children are
Table 1. Age and emotional responsed vitiligo
-
Emotional response
Age Mild Moderate Very worried Anger N
4 1 1
6 2 1 3
8 1 1
9 3 3
10 2 3
13 1 1 1 3
16 4 4
18 1 1
N= 12 4 1 2 19
297
A. Hill-Beuf and J. D. R. Porter
able to believe that they are, indeed, beautiful be-
cause their mothers say they are, despite very visi-
ble and disfiguring cases of vitiligo. In addition, life
holds so many challenges and satisfactions for
them that they do not tend to focus much on ap-
pearance. One of the most delightful of our sub-
jects, a young boy of four with widespread and
visible vitiligo, exempIified this exuberance for life.
This child made friends with everyone in the wait-
ing room, drew many pictures during the period
between the interview and his treatment, wrote the
entire alphabet several times (each time with a dif-
ferent color of ink), wrote all numbers from 1 to 20
several times, looked at and commented upon all of
the pictures in the hall and, in general, was quite
engaged with his environment throughout his visit.
Another 4-year old with severe facial vitiligo con-
fided that she spends most of her “free” time mak-
ing books. She illustrates and composes the text
with some adult help.
This pattern of minor difficulty as a result of
vitiligo seems to continue throughout most of early
childhood. There is some evidence in the case of the
6-year old that the first year of school may be an
exception to this. It involves concern about meeting
new people, leaving the protective environment of
the home and having to conform to new sets of
norms. Being called names or teased at school may
cause the child much distress. However, this situa-
tion seems to abate as the child begins to feel more
at ease in school and becomes known by peers.
A more impressive change seems to occur in the
prepubertal years and in some cases it endures
through the early teens. This period (10-13) is
marked by anxiety about appearance, a greatly in-
creased amount of time spent thinking about
vitiligo, efforts at cover-up, profound shyness
around new people and extreme modesty with
one’s peers. Of course, some of these factors are
simply a part of normal adolescent development.
However, in our patients, anxieties are accentuated
because they feel they have something to be
ashamed of and to hide. Nor does physiologic ado-
lescence seem to be the only factor here.
According to the children and their parents, the
change occurs in anticipation of another transi-
tion-the move up to junior high or high school
Anxieties arise about the new location and larger
size of the school and the higher level of academic
expectations (which seem to heighten the sense of
visibility). Concern about dating is present.
Body/beauty concerns triggered by the high school
practice of group showering for sports were men-
298
tioned by several children. This seems to be the
most difficult age for children.
Older teens, while still somewhat concerned
about appearance, seem to derive compensatory
satisfaction from the acquisition of skills with which
they can later obtain a job, by sports or artistic
abilities, and by relationships with their peers.
An interesting example of these trends is to be
found in the case of “R,” a 16-year-old white male
who was treated at Clinic A. He had had vitiligo
since early childhood. Both R. and his mother re-
ported little concern about vitiligo during the ele-
mentary school years. However, in the year prior to
going to junior high school and during the junior
high school years, R. became extremely self-con-
scious about his appearance, very shy in new social
situations, and also became quite withdrawn. His
parents were very concerned. R. had other prob-
lems at this time and one suspects that vitiligo
became the lightening rod for a number of these
concerns. He was not a good student and when
other boys began to mature, he still was a child
physically.
Now, at sixteen, we found a quite different
young man. His vitiligo is still visible, but he is little
concerned with it. In examining his new situation,
we find that he has accomplished the early resolu-
tion of several Eriksonian psychologic tasks. The
child and his mother, interviewed separately, both
attribute his new adjustment to three factors. The
first is his transferral to a vocational school where
he is learning carpentry. He is very excited about
carpentry and looks forward to spending his life at
it. Second, at fifteen, his physical maturation took
place. He has caught up to other boys in terms of
height, weight, and secondary sex characteristics.
Third, he has a steady girlfriend who “doesn’t
care” about his vitiligo and with whom he has a
very warm and open relationship.
The age-related changes in emotional response
Table 2. Changes in patients’ response to vitiligo
bY age
Change Change
No change for better for worse
4-8 5
9 2 1
10 3
13 1 1 1
16 4
18 just diagnosed

that were noted by the parents as well as the chil-
dren confirm this pattern. The parents of elemen-
tary school children reported no changes; the par-
ents of pre-junior high and junior high school
students note a change for the worse as do the
children themselves; and the parents of high school
students and the patients themselves note a change
for the better (Table 2).
Feelings of Competency
One of the most interesting aspects of the inter-
views was the importance of feelings of competen-
cy in the children for overcoming the negative
impact of their impaired appearance. One can al-
ready see this, above, in the four-year-old boy excit-
ed about his alphabet, the little girl who writes
books, and the young man who is so enthusiastic
about his future as a carpenter.
There were fascinating cases in this study where
children who have severe and highly visible cases
of vitiligo on their faces are nonetheless doing very
well in terms of adjustment and coping. In these
cases, we find an avid interest in the acquisition and
use of new skills and abilities. This indicates that
the satisfaction of ego and competency needs can
go a long way in compensating for the degree of
impairment in appearance. Table 3 shows the im-
pressive relationship between such feelings of com-
petency and a milder emotional response to im-
paired appearance. Regardless of visibility, all the
children with competency feelings report only mild
emotional response to vitiligo.
This seems of considerable importance because it
suggests the therapeutic power of mastering one’s
environment. The ego strength of these children is
being fortified constantly by the joy that comes
from a sense of increased competency. (Note that
the responses are similarly distributed by visibility
categories. “Face” alone does not determine re-
sponse.) This fits with our adult data indicating
Table 3. Visibility, competency feeling, and response
Response
Visibility competency Mild Moderate
Face Yes 6
No 1 1
Yes 6
Non Face
No 3 1
N= 12 4 1
Children Coping with Impaired Appearance
more active involvement with community and
work by those who cope better [40].
Social Class
While social class was not a very powerful variable,
it did appear that smaller working class and poor
children encounter more teasing in school and in
the neighborhood. On the other hand, in adoles-
cence, the working class child seemed to have some
advantage. As the working class children planned
to work directly after high school, they were al-
ready mastering the skills with which they would
later earn a living. As noted above, competency
feelings mitigate against overconcern with ap-
pearance. The middle class child is more likely to be
preparing for college and not yet acquiring the actu-
al skills required for a job.
Treatment Mode
The two clinics have different modes of treatment.
At Clinic A, most children are given medication and
instructions for treatment to take home with them.
It is then up to the patients to maintain the regimen.
Most of those interviewed there had had summer
treatment only-soralens plus sun. At Clinic B, the
children are treated weekly at the clinic with
soralen and P.U.V.A. (ultra-violet light).
While it is not the charge of the social scientist to
assess the success of treatment, what we cun report
is that the Clinic B patients as a group are more
likely to be optimistic about vitiligo. While several
Clinic A patients had dropped out of treatment,
only one Clinic B patient had done so.
When we put this tendency together with basic
child psychology we can see that, for youth, a fairly
firm hand and a structured routine are more effec-
tive modes of treatment. Children and adolescents
are short on patience and the Clinic B program
literally forces them to stay on their regimen.
Very worried Denial
1
2
299
A. Hi-Beuf and J. D. R. Porter
What probably’happens at Clinic B is a “cycle of
success.” Treated more intensively, the children
make some actual improvements. This rewards
participation in routine treatment and perpetuates
it. More gains are then made and the cycle contin-
ues.
Gender
There was little difference in response by gender.
Certainly, boys are as upset about vitiligo as girls.
The notion that appearance is more important to
girls was not confirmed here. It is worth noting that
our only two “anger/hostility” responses are male.
This suggests that while members of the two gen-
ders are equally disturbed by impaired appearance,
this disturbance may be expresseddifferently. This is
consistent with our quantitative survey and inter-
view data from adults.
Anger and Withdrawal
One step toward understanding the interplay of the
many factors contributing to response to impaired
appearance is to examine our three most severely
affected children. Table 4 outlines some of the fac-
tors at work in their lives.
As noted above, the pattern of male anger and
female depression and withdrawal is typical of our
larger sample. The oldest of these patients, a black
male of 18, is a very recent case and the severity of
his reaction may certainly be attributable to that,
partly from shock, partly from having had little
treatment yet. In addition, it is a bizarre and visible
case of unilateral vitiligo. It is as if a line had been
drawn down the middle of his face leaving the right
side an almost movie-star handsome brown and the
left mottled and depigmented. In addition to high
visibility, we also note the absence of the father and
a lack of interest in school, job, or any activity.
Hopefully, treatment, if it is at all successful, will
begin to lift his spirits.
The other two cases are white children, aged 10
Table 4. Characteristics of the three children most disturbed by impaired appearance
Family
Visibility Race Gender Age stress
On face Bl Male 18 N.A.
Not on face Wh Male 13 Yes
On face Wh Female 10 Yes
300
and 13. The girl had vitiligo on her face. Both have
experienced recent transitions in their lives. Nei-
ther reports an avid interest, skill, or hobby. The
father of the male patient returned from Vietnam
with severe psychologic problems. The girl’s moth-
er is over-identified with the child and cries fre-
quently at the clinic about the prospect of the girl’s
future in the marriage market because of impaired
appearance. Both situations suggest the absence of
very supportive family situations for the children.
Emotional response to impaired appearance in
children thus seems to be determined by no one
variable, but by the interplay of visibility, feelings
of competency, family support, type of treatment
program, and age.
Policy Implications
The age of the child should be taken into account in
assessing the response to vitiligo. Prepubertal or
early adolescent onset is likely to have a more ad-
verse effect than others. A child with vitiligo who is
entering new situations because of a family move or
a change in school will require special help.
The physician should realize that competency
and a sense of mastery can offset some of the ad-
verse effects of vitiligo. This suggests the use of
occupational therapy with some youngsters, or the
suggestion to parents that the child be given music,
art, or other lessons. A child who is already lacking
in a sense of competency and then is afflicted with
vitiligo may require emotional therapy.
It seems that a routine, year round, closely
monitored mode of therapy is more effective in
treating children. It is too much to ask of a develop-
ing child that he or she monitor, organize, and be
totally responsible for his or her own treatment.
Laxity in treatment postpones the sense of opti-
mism that can come from even a minor gain and
thus leads to an even greater casualness about
treatment.
The nurse, dermatologist, or general practitioner
who encounters a child in whom many “negative”
Feelings of Dislocation
competency or moves Response
No Yes Anger/denial
No Yes Anger/denial
No Yes Worry-depressed

factors are contributing to poor response (poor fam-
ily support, high visibility, low competency feel-
ings, junior high school age) should consider refer-
ring the child for psychologic assistance.
Research for this article was carried out with the support of a National
Institute of Health Research Grant.
References
1. Lemer A: Vitiligo. J Invest Dermat. 32:285-310, 1959
2. Lemer A, Nordlund J: Vitiligo. What is it? Is it impor-
tant? J Amer Med Assoc. 239:1183-1187, 1972
3. Dwyer J, Mcquiro J: Psychological effects of varia-
tions in physical appearance during adolescence. Ad-
olescence 353-358, 1968
4. Miller A: Role of physical attractiveness in impres-
sion formation. Psychonom Sci 19:103-109, 1970
5. Dion K: What is beautiful is good. J Personal Sot
Psycho1 24:215-220, 1972
6. Cash T, Begley P: Internal-external control, achieve-
ment orientation and physical attractiveness. Psy-
chol Rep 38:1205-1206, 1976
7. McKelore S, Matthews J: Effects of physical attrac-
tiveness and favorableness of character on liking.
Psycholog Rep 38:1223-1230, 1976
8. Bersheid B, Walster E: Physical attractiveness. In
Berkowitz L. (ed). Advances in Experimental Social
Psychology. New York, Academic Press, vol47,1974
9. Landy D, Sigall H: Beauty is talent: Task evaluation as
a function of the performers physical attractiveness. J
Personal Sot Psycho1 39:861-873, 1974
10. Cash T, Kahr J, Polyson J, Freeman V: Role of phys-
ical attractiveness in peer attribution of psychological
disturbance. J Consult Clin Psycho1 45:987-993,1977
11. Wright B: Physical Disability: A Psychological Ap-
proach. New York, Harper and Row, 1960
12. Comer R, Piliavin J: The effects of physical deviance
upon face-to-face interactions: The other side. J Per-
sonal Sot Psycho1 23:33-39, 1972
13. Centers L, Centers R: Peer group attitudes toward
the amputic child. J Sot Psycho1 2333-39, 1963
14. Siller J, Ferguson L, Vann D, Holland B: Structure of
attitudes toward the physically disabled: The dis-
ability factor scale: Amputation, blindness, cosmetic
conditions. Proceedings of the 76th Annual Conven-
tion American Psychological Association, 651-652,
1968
15. Goffman E: Stigma, Notes on the Management of
Spoiled Identity. Englewood Cliffs, NJ, Prentice-
Hall, 1963
16. Davis F: Deviance disavowal: The management of
strained interaction by the visibly handicapped. Sot
Prob 9:120-132, 1961
17. Richardson S, Goodman H, Hastorf A, Dombusch S:
Cultural uniformity in reaction to physical dis-
abilities. Amer Sociolog Rev 26:241-247, 1961
18. Kleck R, Ono H, Hastorf A: Effects of physical de-
viance upon face-to-face interaction. Hum Rel
19:425-436, 1966
19. Wolfgang, Wolfgang: Personal space: An unob-
trusive measure of attitudes toward the physically
handicapped. Proceedings of the 76th Annual Con-
Chiidren Coping with Impaired Appearance
vention of the American Psychological Association.
3653-653, 1968
20. KIeck R: Physical stigma and non-verbal cures emit-
ted in face-to-face interaction. Hum Rel 21:19-28,
1968
21. Kleck R, Strenta A: Perceptions of the impact of nega-
tively valued physical characteristics on social in-
teraction. J Personal Sot Psycho1 39:861-873, 1980
22. Barker R, Wright 8, Myerson L, Gonick M: Adjust-
ment to physical handicaps and illness: A survey of
the social psychology of disability. Bulletin #53. New
York, Social Science Research Council, 1953
23. Mcgregor F: Some psycho-social problems associ-
ated with facial deformities. Amer Sot Rev. 16:629-
630, 1951
24. Casileth B, Lusk E, Tenaglia A: A psychological com-
parison of patients with malignant melanoma and
other dermatologist disorders. J Amer Acad Dermat
7~742-746, 1982
25. Nadelson T: A person’s boundaries: The meaning of
skin disease. Cutis 21:90-94, 1978
26. Goodman N, Richardson S, Dombush S, Hastorf A:
Variant reactions to physical disabilities. Amer Sot
Rev 28:429-429, 1963
27. Piliavin I et al: Costs, diffusion, and the stigmatized
victim. J Personal Sot Psycho1 32:429-438, 1975
28. Levinski R, Kass I: Functional disturbances associ-
ated with ichthyosis. J Psycho1 13:173-177, 1942
29. Whitlock F: Psychophysiological Aspects of Skin Dis-
ease. London, W. B. Saunders, Ltd., 1976
30. Shuster S, Fisher G, Harris E, Binnell D: The effects of
skin disease on self-image. Br J Dermat 99:18-19,
1978
31. Brown D, Bettley: Psychiatric treatment of exzema: A
controlled trial. Br Med J 2:729-734, 1971
32. Roegnik R, Roegnik H: Sex differences in the psycho-
logical effect of psoriasis. Cutis. 21:529-533, 1978
33. Mcgregor F: Facial Deformities and Plastic Surgery.
New York, Charles Thomas, 1953
34. Porter J, Beuf A, Nordlund J, Lemer A: Personal
response of patients to vitiligo. The importance of
physician-patient interaction. Arch Dermat
114:1384-1385, 1979
35. Douvan E: New sources of conflict in females in ado-
lescence and early adulthood. In Bardwick J (ed).
Feminine Personality and Conflict. Belmont, CA,
Brooks/Cole, 1970
36. Berscheid E, Walster N, Bahensteit C: The happy
american body: A survey report. Psycho1 Today.
7:119-131, 1973
37. Sorenson RC: Adolescent Sexuality in Contemporary
America. New York, World, 1973
38. Coopersmith S: Antecedents of Self-Esteem. San
Francisco, W. H. Freeman, 1967
39. Erikson E: Childhood and Society. New York, W. W.
Norton, 1963
40. Porter J, Beuf A: 1983 Final Report; 1979-1983: Social
and Psychological Effects of Vitiligo. (Unpublished)
Direct reprint requests to:
Judith D. R. Porter, Ph.D.
Bryn Mawr College
Bryn Mawr, PA 19010
301