Body image and appearance distress among military veterans and civilians with an injury-related visible difference: A comparison study

Injuries sustained during military conflict can significantly impact appearance. Yet, little is known about the psychosocial experiences of veterans with conflict-related appearance-altering injuries (AAI) and whether current civilian interventions are appropriate for this group. To inform the development of acceptable and effective support for veterans with appearance-related psychosocial difficulties, this study aimed to identify factors associated with psychosocial adjustment to an altered appearance among both veterans and civilians with AAI. A cross-sectional online survey was completed by 121 veterans and 197 civilians who had sustained AAI. Multivariable regression was used to examine factors related to adjustment in the two groups. Overall, both groups reported similar experiences, with some key exceptions. Veterans reported significantly greater depression and Post Traumatic Stress Disorder, significantly lower Body Image (BI) psychological flexibility, BI life engagement, and higher perceived appearance-related stigma. BI psychological flexibility was identified as a key predictor of appearance-related outcomes in both groups. Self-compassion predicted social anxiety and depression symptoms in both groups, but only appearance outcomes among civilians. Based on these identified associated factors, it is suggested that both groups, but particularly veterans, may benefit from an Acceptance and Commitment Therapy-based intervention, including explicit self-compassion activities, and practical social skills training.