A visible difference refers to a physical characteristic, such as a

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a n ...

, mark,

disfigurement Disfigurement is the state of having one's appearance deeply and persistently harmed medically, such as from a disease, birth defect, or wound. General societal attitudes towards disfigurement have varied greatly across cultures and over time, ...

, or condition on the face or body that distinguishes an individual from what is conventionally considered to be the societal norm. These visible differences can arise due to a multitude of factors including but not limited to congenital conditions, accidents,

diseases A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ...

, or surgical procedures. Such differences often carry significant psychological, social, and sometimes physical implications for the affected individual.

Terminology

While the terms visible difference and disfigurement are sometimes used interchangeably, they are not synonymous and possess distinct connotations both in medical and social contexts. The term visible difference is a more neutral, encompassing descriptor for any physical characteristic that sets an individual apart from what is generally considered the societal norm. This could be due to congenital conditions, acquired conditions, diseases, or even personal choices like tattoos or piercings. The critical element is that the difference is visible, but the term does not inherently imply any impairment, disadvantage, or negative valuation. Disfigurement is a term that has traditionally been used in both legal and medical contexts to refer to physical alterations that are often perceived as impairing the appearance of an individual in a significant way. Disfigurement generally carries a more negative connotation and often implies a level of severity or permanence to the condition that may result in social, emotional, or functional difficulties for the affected individual.

Background and history

Early perceptions

The concept of visible differences has existed throughout human history, although the terminology and social attitudes have evolved. In many ancient cultures, visible differences were often attributed to

supernatural Supernatural refers to phenomena or entities that are beyond the laws of nature. The term is derived from Medieval Latin , from Latin (above, beyond, or outside of) + (nature) Though the corollary term "nature", has had multiple meanings si ...

causes or seen as a sign of

divine intervention Divine intervention is an event that occurs when a deity (i.e. God or a god) becomes actively involved in changing some situation in human affairs. In contrast to other kinds of divine action, the expression "divine ''intervention''" implies that ...

. For example,

birthmarks A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth—usually in the first month. They can occur anywhere on the skin. Birthmarks are caused by overgrowth of blood vessels, melanocy ...

were sometimes viewed as omens or indicators of future events, both positive and negative.

Modern medicine

With the advent of

modern medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...

, understanding the causes behind various types of visible differences has become more scientific. In the 19th and early 20th centuries, significant strides were made in

dermatology Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A List of dermatologists, dermatologist ...

and

plastic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes cranio ...

, which allowed for a more nuanced comprehension and treatment of these conditions. The latter half of the 20th century saw further research into the psychological and emotional impact of visible differences, paralleling the rise of psychology as a distinct scientific discipline.

Activism and milestones

The latter part of the 20th century also saw the rise of activism aimed at destigmatizing visible differences and advocating for legal protections. Landmark legislation, such as the

Americans with Disabilities Act The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 19 ...

(ADA) in the United States and the Equality Act in the United Kingdom, have created legal protections for people with visible differences. Changing Faces is a UK-based organization that advocates for people living with visible differences.

Types of visible differences

Visible differences can be categorized based on origin, location, and impact.

Congenital conditions

These are visible differences present from birth and are often the result of genetic factors or prenatal influences. *

Birthmark A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth—usually in the first month. They can occur anywhere on the skin. Birthmarks are caused by overgrowth of blood vessels, melanocy ...

: Size, shape, and color can vary. *

Cleft lip A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The te ...

or palate: A condition with an opening in the upper lip and/or palate. *

Port-wine stain A port-wine stain (''nevus flammeus'') is a discoloration of the human skin caused by a vascular anomaly (a capillary malformation in the skin). They are so named for their coloration, which is similar in color to port wine, a fortified red w ...

: Reddish or purplish marks that usually occur on the face.

Acquired conditions

These visible differences arise due to external factors, such as accidents or medical treatments. *

Scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a n ...

: Can result from injuries, surgeries, or severe acne. *

Vitiligo Vitiligo is a disorder that causes the skin to lose its color. Specific causes are unknown but studies suggest a link to immune system changes. Signs and symptoms The only sign of vitiligo is the presence of pale patchy areas of depigmen ...

: This condition causes patches of skin to lose their pigment. *

Burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur mainl ...

: Severe burns can lead to scarring and discoloration of the skin. *

Amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on ind ...

: Removal of a limb, often due to injury or infection.

Diseases

Certain diseases can cause visible differences either directly or as a side effect of treatment. *

Acne Acne, also known as ''acne vulgaris'', is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and ...

: Often associated with adolescence but can persist into adulthood, leading to scarring or pigmentation. *

Psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complet ...

: Characterized by red, scaly patches on the skin. *

Autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. At least 80 types of autoimmune diseases have been identified, with some evidence suggesting that there may be more than 100 types. Nearly ...

: Diseases like

lupus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Commo ...

can cause visible skin rashes or facial flushing. *

Alopecia areata Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often, it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are po ...

: Leads to hair loss, commonly on the

scalp The scalp is the anatomical area bordered by the human face at the front, and by the neck at the sides and back. Structure The scalp is usually described as having five layers, which can conveniently be remembered as a mnemonic: * S: The s ...

Psychological impact

The presence of a visible difference can have profound psychological implications for an individual, affecting their self-esteem, mental health, and overall well-being. Importantly, research has indicated that there is not a strong correlation between the visibility or severity of the physical characteristic and the level of psychological distress an individual might experience. This counterintuitive finding emphasizes the complexity of the emotional and psychological dimensions involved.

Self-esteem and body image

People with a visible difference often face self-esteem and body image challenges. Concerns about appearance can dominate their self-perception, which may lead to feelings of inadequacy or unattractiveness. This can be particularly challenging during adolescence when physical appearance is often highly emphasized.

Anxiety and depression

Studies have shown that individuals with visible differences are at a higher risk of developing anxiety disorders and depression. The constant awareness of being different and the fear of being judged or rejected can increase anxiety levels. Similarly, chronic feelings of isolation or stigmatization can lead to depressive symptoms.

Social isolation

The social implications of having a visible difference can sometimes lead to withdrawal or isolation. Avoidance behavior, such as skipping social events or avoiding public places, can exacerbate feelings of loneliness and perpetuate a cycle of emotional distress.

Body dysmorphic disorder

In some cases, individuals with a visible difference may develop

body dysmorphic disorder Body dysmorphic disorder (BDD), occasionally still called dysmorphophobia, is a mental disorder characterized by the obsessive idea that some aspect of one's own body part or appearance is severely flawed and therefore warrants exceptional meas ...

, a mental health condition characterized by obsessive focus on perceived flaws in physical appearance. Importantly, these perceived flaws may be minor and not very noticeable to others.

Coping mechanisms

Individuals may employ various coping mechanisms, both adaptive and maladaptive, to deal with the psychological impact. While some may resort to avoidance or denial, others may seek social support or engage in constructive problem-solving.

Visibility and distress

Contrary to common assumptions, the psychological distress associated with having a visible difference does not necessarily correlate with the visibility or severity of the condition. Factors such as personal resilience, availability of social support, and pre-existing mental health conditions often play a more significant role in determining the level of psychological impact.

References

{{reflist Human appearance Human body