Severity of Cleft Lip Deformity and
Social Adjustment
Joyce Tobiasen, Ph.D.
Clinical Professor of Surgery
University of Missouri School of Medicine
Kansas City, Missouri
 
Facial deformity is a stigmatizing condition much like
race, homosexiality, obesity, and mental retardation.
Stigmatized idividuals deal with serious discrimination
in our society. Children and adults with oral-facial
clefts are sterotyped and disadvantaged socially and
economically. They have, on the average, a lower income,
are less likely to marry and have fewer friends than
siblings or peers.
Social psychological theory predicts that affected
individuals should suffer corresponding low self-esteem
and social adjustment problems. Studies have inconsistently
reported low self-esteem. However, converging studies
do support social adjustment problems, especially in
scud competence. A major purpose of the studies now
reported is to examine if individuals with oral-facial
clefts engage in self-esteem maintenance strategies
that may affect social competence.
SInce facial deformity per se is the stigmatizing feature
of oral-facial clefts, then, it may follow, that the
more severe the deformity, the worse the stigmatization
and subsequent effects on self-esteem and social competence.
Facial Impairment Scales for Children (FISC) were developed
to measure severity of oral cleft deformity. These scales
have been thoroughly studied and have known reliability
and validity. New photographs are fitted to the scales
to achieve a severity rating.
Next we studied the relationship between self, peer,
and parent, ratings of facial impairment and measures
of self-esteem, social adjustments and ratings of cleft
deformity. Patients who rated their cleft impairments
(N=31) on the FISC as less severe relative to peer ratings,
had significantly higher ratings of self-esteem. They
were compared to a non-clinical group (N=20).
The patients who rated their faces as less significantly
impaired than peer ratings were rated more socially
competent in all areas-social, school and activities
by their parents on a standard measure. These findings
suggest that patients who psycologically minimize the
severity of their facial impairments relative to peer
ratings are able to function more adaptively to a wide
variety of social spheres. On the other hand those who
have facial ratings that are either conguent or worse
than peer ratings have social competence ratings of,
on the average, one half to one standard deviation below
the normative group. The finding's also suggest that
self perceptions of appearance is a better indication
of adjustment than peer ratings. These findings suggest
that a stigmatized person is not a passive victim but
an active processor of social interaction.
|
