Young people's perceptions of visible difference

Visible facial differences (VFDs) can pose a number of psychosocial challenges for those affected by them. In particular, the experience of being stigmatised may have a harmful effect on the psychological adjustment of the individual concerned. This is especially pertinent for young people, who are at an age where appearance becomes increasingly central to social interaction and self-esteem. Suitable and effective interventions are needed to reduce stigma in general, but in the case of appearance-related discrimination the prevalence and the processes involved are poorly understood. The aim of this research was therefore to explore young people's perceptions of visible difference. A mixed-methods online questionnaire was administered to a cross-sectional sample of 412 pupils aged 12-14 years, recruited from three UK schools. Participants were asked to look at five photographs of people with VFDs and to indicate their level of agreement with 30 statements using a 5-point Likert scale. They were also asked to answer the open-ended question 'What do you think when you see people with facial differences?' Although quantitative responses were overwhelmingly neutral, inductive content analysis revealed a number of insights. Four main themes were identified: them and us, initial reactions, common assumptions and behavioural intentions. Participants reported a wide range of complex responses. Although negative reactions and judgements were described, these were often due to seeing something unusual, or to a lack of understanding, rather than to the intention to cause harm. Conflicting emotions led to uncertainty and lack of confidence about how best to behave around people with VFDs. The findings suggest the need for a two-tiered approach to intervention: first, to raise awareness of VFDs and to facilitate the development of appropriate social skills within the general population, and secondly, to provide support to enable those with VFDs to cope with any negative reactions they may encounter.