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      Factors Associated With Psychological Adjustment in Adults With Cleft Lip and/or Palate: Findings From a National Survey in the United Kingdom

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          Abstract

          Objectives:

          Research has identified adults born with cleft lip and/or palate (CL/P) to be at risk of poorer psychological outcomes compared to the general population. This study investigated factors that may contribute to positive and negative adjustment in adults born with CL/P.

          Design:

          A survey was designed and distributed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research CAR at the University of the West of England (UWE). There were 207 eligible responses (95% completed online) received between July and October 2018. Dependent variables included the Body Esteem Scale for Adolescents and Adults, Harter’s Self Perception Profile for Adults (Global Self-Worth, Social Competence, and Intimacy subscales), the Fear of Negative Appearance Evaluation Scale, and the Revised Adult Attachment Scale. Independent variables were the Revised Life Orientation Test, biodemographic data, and self-reported single-item questions.

          Results:

          Factors associated with positive adjustment included reports of a happy childhood, talking about CL/P with family, close friendships, comfort in public spaces, satisfaction with appearance, and a positive life orientation. Psychological distress was associated with a desire for further surgery to improve appearance and/or function.

          Conclusions:

          Several factors were identified that may influence psychological adjustment in adults with CL/P. Throughout childhood, family-centered practice to support family cohesion and an open dialogue about CL/P is indicated, as is support for young people to develop social confidence. For adults returning to the cleft service, treatment options for appearance and/or functional concerns should be explored, with access to psychological support when indicated. Interventions to increase optimism, resilience, and self-acceptance may also be warranted throughout the life span.

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          Most cited references50

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          Optimism.

          Optimism is an individual difference variable that reflects the extent to which people hold generalized favorable expectancies for their future. Higher levels of optimism have been related prospectively to better subjective well-being in times of adversity or difficulty (i.e., controlling for previous well-being). Consistent with such findings, optimism has been linked to higher levels of engagement coping and lower levels of avoidance, or disengagement, coping. There is evidence that optimism is associated with taking proactive steps to protect one's health, whereas pessimism is associated with health-damaging behaviors. Consistent with such findings, optimism is also related to indicators of better physical health. The energetic, task-focused approach that optimists take to goals also relates to benefits in the socioeconomic world. Some evidence suggests that optimism relates to more persistence in educational efforts and to higher later income. Optimists also appear to fare better than pessimists in relationships. Although there are instances in which optimism fails to convey an advantage, and instances in which it may convey a disadvantage, those instances are relatively rare. In sum, the behavioral patterns of optimists appear to provide models of living for others to learn from. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Working models of attachment: implications for explanation, emotion and behavior.

            Two studies examined attachment style differences in social perception. In Study 1, participants wrote open-ended explanations for hypothetical relationship events and described how they would feel and behave in response to each event. Compared with secure participants, preoccupied participants explained events in more negative ways; they also reported more emotional distress and behaviors that were likely to lead to conflict. Avoidant participants also provided negative explanations, but did not report emotional distress. Path analysis indicated that attachment style differences in behavior were mediated by explanation patterns and emotional distress. Study 2 was designed to replicate Study 1 and test the relative importance of attachment style and relationship quality to predicting each outcome. Results indicated that both variables were significant predictors of explanations, but only attachment style predicted emotional responses. These findings are consistent with the idea that adults with different working models of attachment are predisposed to think, feel, and behave differently in their relationships.
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              Body-esteem scale for adolescents and adults.

              Body esteem (BE) refers to self-evaluations of one's body or appearance. This article outlines a BE questionnaire for adolescents and adults that has 3 subscales: BE-Appearance (general feelings about appearance), BE-Weight (weight satisfaction), and BE-Attribution (evaluations attributed to others about one's body and appearance). The subscales have high internal consistency and 3-month test-retest reliability. Females scored lower than males on BE-Weight and BE-Appearance. BE-Weight was the only subscale uniquely related to weight, especially in females, with heavy individuals tending to be dissatisfied with their weight. BE-Appearance was the only subscale that consistently predicted self-esteem. BE-Appearance and BE-Weight covaried more with Neeman and Harter's (1986) Appearance subscale than with other self-esteem subscales; BE-Attribution covaried more with social self-esteem subscales than did BE-Appearance and BE-Weight.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                The Cleft Palate-Craniofacial Journal
                The Cleft Palate-Craniofacial Journal
                SAGE Publications
                1055-6656
                1545-1569
                April 2022
                July 08 2021
                April 2022
                : 59
                : 4_suppl2
                : S7-S17
                Affiliations
                [1 ]Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
                [2 ]Cleft Lip and Palate Association, London, United Kingdom
                [3 ]Centre for Appearance Research, Bristol, United Kingdom
                Article
                10.1177/10556656211028494
                34235990
                6497012d-872b-4747-b23f-9b60229cb089
                © 2022

                https://creativecommons.org/licenses/by-nc/4.0/

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