Purpose of ReviewLittle is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.Recent FindingsFindings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings.SummaryReframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.

BackgroundDisfigurement (visible difference) from wide-ranging congenital or acquired conditions, injuries, or treatments can negatively impact adolescents’ psychological well-being, education and health behaviours. Alongside medical interventions, appearance-specific cognitive behavioural and social skills training to manage stigma and appearance anxiety may improve psychosocial outcomes. YP Face IT (YPF), is a Web-based seven session self-help program plus booster quiz, utilising cognitive behavioural and social skills training for young people (YP) struggling with a visible difference. Co-designed by adolescents and psychologists, it includes interactive multimedia and automated reminders to complete sessions/homework. Adolescents access YPF via a health professional who determines its suitability and remotely monitors clients’ usage.ObjectiveTo establish the feasibility of evaluating YPF for 12-17 year olds self-reporting appearance-related distress and/or bullying associated with a visible difference.MethodsRandomized controlled trial with nested qualitative and economic study evaluating YPF compared with usual care (UC). Feasibility outcomes included: viability of recruiting via general practitioner (GP) practices (face to face and via patient databases) and charity advertisements; intervention acceptability and adherence; feasibility of study and data collection methods; and health professionals’ ability to monitor users’ online data for safeguarding issues. Primary psychosocial self-reported outcomes collected online at baseline, 13, 26, and 52 weeks were as follows: appearance satisfaction (Appearance Subscale from Mendleson et al’s (2001) Body Esteem Scale); social anxiety (La Greca’s (1999) Social Anxiety Scale for Adolescents). Secondary outcomes were; self-esteem; romantic concerns; perceived stigmatization; social skills and healthcare usage. Participants were randomised using remote Web-based allocation.ResultsThirteen charities advertised the study yielding 11 recruits, 13 primary care practices sent 687 invitations to patients on their databases with a known visible difference yielding 17 recruits (2.5% response rate), 4 recruits came from GP consultations. Recruitment was challenging, therefore four additional practices mass-mailed 3,306 generic invitations to all 12-17 year old patients yielding a further 15 participants (0.5% response rate). Forty-seven YP with a range of socioeconomic backgrounds and conditions were randomised (26% male, 91% white, mean age 14 years (SD 1.7)); 23 to YPF, 24 to UC). At 52 weeks, 16 (70%) in the intervention and 20 (83%) in UC groups completed assessments. There were no intervention-related adverse events; most found YPF acceptable with three withdrawing because they judged it was for higher-level concerns; 12 (52%) completed seven sessions. The study design was acceptable and feasible, with multiple recruitment strategies. Preliminary findings indicate no changes from baseline in outcome measures among the UC group and positive changes in appearance satisfactio...

Facial palsy (FP) affects an estimated 100,000 people in the United Kingdom (Facial Palsy UK, 2012). It is characterised by facial muscle weakness resulting from damage to the facial nerve and is associated with congenital conditions, such as Moebius syndrome, and acquired conditions, such as Bell's palsy, Ramsay Hunt syndrome, trauma affecting the facial nerve, and acoustic neuroma. FP can cause a range of issues including: corneal exposure leading to blindness; visual disturbance; problems with facial function, leading to difficulties with facial expression, eating, drinking, hearing and/or speaking (Shindo, 1999).Current treatment options include: injections of Botulinum Toxin A (Filipo, Spahiu, Covelli, Nicastri, & Bertoli, 2012); static and dynamic surgical procedures (Ghali, MacQuillan, & Grobbelaar, 2011) and facial therapy focusing on rehabilitating function and appearance (van Landingham, Diels, & Lucarelli, 2018). Options to protect the ocular surface include eyelid repositioning surgery, eyelid loading with weights and tear duct surgery (Schrom, Buchal, Ganswindt, & Knipping, 2009). Changes in facial function and appearance due to FP, as well as uncertainty about recovery, can result in anxiety, social isolation and concealment of facial appearance, with individuals with FP also reporting low self-esteem, high levels of self-consciousness and concerns about mood (Norris et al., 2019). These psychosocial difficulties may reflect the impact of FP on the use of the face to express emotions, a skill which is crucial for communication (Coulson, O'Dwyer, Adams, & Croxson, 2004). The visible difference associated with FP is often made more apparent by difficulties in facial movement with many affected avoiding facial expression of emotion (Bradbury, Simons, & Sanders, 2006). Others can interpret this absence of expression negatively, leading to greater avoidance of social interactions by individuals with FP. These parallel issues lead to a combined challenge of being unable to express oneself and stigma for having a visible facial difference (Bogart, Tickle-Degnen, & Joffe, 2012). ObjectivesNo paper has systematically reviewed the literature investigating the psychosocial impact of FP. Instead, previous reviews have focused on observer perceptions (Nellis, Ishii, Boahene, & Byrne, 2018) and the quality of patient-reported outcome measures (Ho et al., 2012). This review aims to provide a deeper understanding of FP by 1) systematically reviewing the impact of FP on levels of psychological distress, social function and quality of life (QoL) and 2) determining the demographic factors (e.g. age, duration of FP, aetiology, gender etc.) associated with poorer psychosocial outcomes. Methods Protocol and registrationInclusion criteria and methods for study selection were specified in advance and documented in a BLINDED-registered protocol (DETAILS BLINDED FOR SUBMISSION).. Information sourcesStudies were identified by searching electronic databases and by scanning the reference lists of included studies. Literature ...

A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.

Objective : To explore older adults' experiences of living with cleft lip and/or palate (CL/P), focusing on aging and appearance. Design : An exploratory-descriptive qualitative study. Participants : Individual semi-structured interviews (five via telephone, one face-to-face) conducted with six adults between the ages of 57 and 82 years. Results : Interview transcripts were analyzed using interpretative phenomenological analysis, which resulted in five themes: cleft across the life span, keeping up appearances, being one of a kind, resilience and protection, and cleft in an ever-changing society. A CL/P had an ongoing impact on participants' lives, although its relevance shifted over time and some aspects of life (e.g., romantic relationships, decisions about having children of their own) were particularly affected. Participants seemed at ease living with CL/P as an older adult and considered it an important aspect of their identity, yet they still described feeling isolated at times and had little contact with other people with a cleft. They felt that health care could be more considerate to the needs of older people with a cleft, particularly around dentistry and information provision. Participants thought societal attitudes toward visible differences had changed over the years, but not necessarily for the better. A paradox was evident between reports of being noticed by others because of their cleft and simultaneously feeling invisible or ignored because of their age. Conclusions : These findings have implications for provision of care for older adults with a CL/P and for younger people with a CL/P who will be the older generation of the future.