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Moss, T. P. (2005) Body Image: An International Journal Of Research, 2, 151-159

Abstract

Although the role of the objectively and subjectively rated severity of appearance problems is often debated, the impact of severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to self-consciousness of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment. Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe objective severity was most related to poor adjustment.

British Journal Of Plastic Surgery, 54 (3): 223-226 Harris D.L., & Carr AT, (2001).

Abstract

Using information gathered in the introductory sections of the Derriford Appearance Scales (DAS24 and DAS59), the prevalence and epidemiological characteristics of concern about physical appearance have been determined for a carefully constructed sample of the general population of southwest Devon (rural and urban). In all, 2108 usable replies were received from a postal survey of a targeted population of 5400 men and women, aged 18 and over and randomly selected with constraints for age, sex acid socio-economic status. The prevalence of concern about physical appearance was highest among women through to age 60 and younger men. There was no association with socioeconomic status or living status. Concerns about the nose, weight and skin disorders were reported most frequently by both men and women and additionally concerns about breasts and abdomen were reported by women and premature balding by men. The mean DAS24 and DAS59 full-scale scores of 19% of male and 25% of female responders who were concerned about appearance exceeded the mean scores of preoperative patients undergoing reconstructive and cosmetic plastic surgery. Concern about appearance is widespread in the general population. More often than not, concern is about one feature only, which runs counter to the hypothesis that concern about appearance reflects a neurotic trait. The high levels of measured psychological distress and dysfunction found in a substantial minority of those in the general population who are concerned about appearance highlight the need for appropriate services.

Objectives. To develop a psychometrically robust and widely applicable short form of the Derriford Appearance Scale (DAS59) which (i) will reliably and validly assess the distress and difficulties experienced in living with problems of appearance (ii) is acceptable to clinical and non- clinical populations and (iii) facilitates research and clinical decision-making through good standardisation and sensitivity.

Design. Cross-sectional survey designs using clinical (outpatient and inpatient) and general population samples.

Method. 25 items were selected initially from the 59 items of the original Derriford Scale. These were refined to 24 through item analyses and the scale was standardised on 535 patients with a range of problems of appearance and on a representative general population sample (1107)

Results. All 24 items contributed well to the total score and internal consistency was high (alpha = .92). Test retest reliability (six months) was good (.82) and criterion validity (with the DAS59) was excellent (.88). Good construct validity was demonstrated in differences between patient and general population samples and between members of the general population concerned and not-concerned about their appearance, and in patterns of convergent and divergent correlations with a range of established scales. The general population data revealed widespread concerns about appearance.

Conclusion. The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is psychometrically robust and discriminates well between patient groups, between clinical and non- clinical populations and, within the general population, between those concerned and those not-concerned about their appearance.

The DAS59 has been designed and developed to meet the need for an objective measure of the spectrum of psychological distress and dysfunction that is characteristic of disfigurements, deformities and aesthetic problems of appearance. Content validity has been assured by basing the scale’s items on a detailed autobiographical study of representative patients. Internal consistency is high (0.98) and test-retest reliabilities are good (general population: 0.75; clinical population: 0.86). Correlations with other appropriate standardised tests show good criterion validity and good construct validity. Factor analysis of 2741 data sets (general population and clinical population) identified three factors that are not feature specific and two that are (bodily and sexual features, facial features). The DAS59 thus generates a full-scale score and five factorial sub-scale scores. The DAS59 has been standardised on the clinical population across a range of patient groups and on the general population subdivided into those concerned and those not concerned about appearance. The DAS59 is highly sensitive as a measure of change following treatment with large and significant preoperative-postoperative reductions in full-scale and factorial scores of patients treated for facial features or bodily/sexual features. The DAS59 offers benefits for patient selection in both cosmetic and reconstructive plastic surgery and in the evaluation of outcome. It provides valid and reliable data for clinical audit and governance and for evaluating the merits of one treatment protocol against another.