“Opening a Pandora’s box that can’t be salvaged”: Health professional’s perspectives of appearance-related psychosocial issues in a tertiary hospital

Miss Caroline Gee1, Associate Professor Peter Newcombe2, Dr Jessica  Maskell1,3, Professor Roy Kimble1,4, Dr Heidi Williamson5

1Centre For Children’s Burns and Trauma Research, Centre for Children’s Health Research, The University of Queensland , South Brisbane, Australia, 2School of Psychology, The University of Queensland, St Lucia, Australia, 3Gold Coast University Hospital, Southport, Australia, 4Pegg Leditschke Children’s Burns Centre, Lady Cilento Children’s Hospital, South Brisbane, Australia, 5Centre for Appearance Research, University of the West of England, Bristol, United Kingdom


Living with an appearance-altering condition or injury can contribute to long term psychological and social issues for children and adolescents, such as social anxiety, negative body image and low self-confidence. However, it is not clear how appearance-related psychosocial issues are managed by health professionals and the level of support provided to patients within tertiary settings.

To gain further understanding of appearance-related psychosocial care for children and adolescents, semi-structured qualitative interviews were conducted with specialist staff at Australasia’s largest paediatric hospital to explore: Understanding of psychosocial issues associated with conditions or injuries that alter appearance, gaps and barriers in appearance-related psychosocial support within a tertiary setting, current practice for the management of appearance-related psychosocial issues and perspectives of online platforms for support and treatment.

Sixteen health professionals across a broad range of specialist areas participated. Interview data was analysed using thematic analysis. Health professionals reported reluctance to engage in appearance-related talk with patients and a lack of awareness of specialised resources and support for appearance distress. Participants identified significant service barriers within a busy tertiary hospital environment that contribute to poor management of appearance-related psychosocial concerns. Staff discussed developmental patterns for psychosocial issues and critical transition points that impact on young people’s ability to adjust positively to an altered appearance. Health professionals endorsed the use of online platforms to support and treat the consequences of appearance-altering conditions or injuries for young people. Findings offer recommendations to target further research, improve training and service provision.

Key Words

Psychosocial care, altered appearance, health professionals, tertiary hospital


Caroline is currently completing her PhD with the Centre for Children’s Burns and Trauma Research, Brisbane, Australia. Her PhD is exploring the psychosocial impact of living with an appearance-altering condition or injury for Australian children and adolescents. Caroline has completed extensive qualitative work with health professionals and young people with the aim to improve current gaps and barriers in appearance-related psychosocial service provision.

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