Changes in Appearance in the Presence of Major Stress Events

Method

Results

Scores on the MSE portion of the inventory could potentially range between 0 and 120. Actual scores ranged between 0 and 111 with an overall mean score of 30.71 (SD = 18.2). There was no significant difference in MSE scores by gender (Males: n = 55, M = 28.13, SD = 18.6; Females: n = 73, M = 32.66, SD = 17.88); t(126) = 1.40, p < .17. However, MSE scores were significantly negatively correlated with age, r(128) = -.42, p < .001: Younger individuals reported significantly higher levels of stress than did older individuals. MSEs experienced most frequently included having a family member, close friend, or significant other experience emotional difficulties (64.1%); starting a new job (62.5%); experiencing emotional difficulties (59.4%); and the hospitalization of a family member, close friend, or significant other (56.2%). Events least frequently experienced included going through a divorce (2.3%), undergoing (or having their significant other undergo) an abortion (4.7%), pregnancy (7.0%), parental divorce (7.0%), and getting married (8.6%).

The MSEs rated as most personally significant for those reporting the occurrence of the event include graduating school (n = 45, M = 3.71, SD = 0.63), going through a divorce (n = 3, M = 3.67, SD = 0.58), pregnancy (n = 9, M = 3.67, SD = 0.71), the start of a serious relationship (n = 52, M = 3.65, SD = 0.62), and the death of a loved one (n = 54, M = 3.57, SD = 0.66). Events with the lowest means for personal significance included legal problems (n = 19, M = 2.37, SD = 1.17), parental divorce (n = 9, M = 2.56, SD = 1.24), difficulties with friendships (n = 52, M = 2.63, SD = 1.05), illness (n = 28, M = 2.71, SD = 1.05), and hospitalization (n = 43, M = 2.72, SD = 1.18).

Scores on the CA portion of the inventory had a possible range of 0 to 84. Actual scores ranged between 0 and 53, with a mean score of 17.24 (SD = 12.95). There was no significant difference in MSE scores by gender (Males: M = 16.98, SD = 14.6; Females: M = 17.45, SD = 11.7); t(126) = 0.20, p < .85. The most commonly made or considered CAs included weight changes (60.2%), working out to alter body shape (58.6%), tattoos (55.5%), and changes in hair color (54.7%). CAs least made or considered included wearing nonprescription glasses (6.2%), receiving plastic surgery (7%), shaving off one’s beard (10.2%), wearing contacts rather than prescription glasses (10.2%), and altering the shape of one’s eyebrows (10.2%).

Pearson correlational analysis revealed a significant positive relationship between overall stress experience (MSE total) and real or contemplated CAs; CA scores: r(128) = .50, p < .001. Individual stress events and their relationships to CA scores were then assessed through correlational analysis. The results, presented in Table 1, revealed that several individual stress events were significantly correlated with CA scores, including stresses related to school, relationships, and mental health issues.

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Table 1.

Correlations of Individual Stress Events with CA Score.

MSE	Pearson’s r
Began school	.31**
Hired at new job	.18*
Promoted at work	.14
Fired from work	.13
Obtained academic achievements	.31**
Difficulties at school	.51**
Graduated from school	.15
Married	.13
Divorced	−.07
Parents divorced	.05
Began a serious relationship	.31**
Ended a serious relationship	.32**
Self/significant other conceived	.15
Other a gave birth	.11
Self/significant other aborted pregnancy	.12
Other passed away	−.06
Other hospitalized	.14
Hospitalized	.01
Other became ill	.09
Became ill	.02
Experienced emotional problems	.36**
Other experienced emotional problems	.27**
Difficulties with friendships	.45**
Lost contact with a family member	.11
Difficulties with the law	.07
Child left home	−.13
Left parents’ home	.35**
Experienced relationship difficulties	.51**
Drug problems	.31**
Other had drug problems	.36**
All MSEs	.50**

Note: MSE = major stress event; CA = change in appearance. All MSEs and CAs occurred within the same 2-year period.

a

“Other” indicates a close family member, significant other, or friend.

*

p < .05. ** p < .01.

A quartile division of MSE scores were used to classify participants into one of four groups (see Table 2): Low (MSE scores of 0-18), Mild (19-28), Moderate (28-42), and High (43-110). A one-way ANOVA revealed highly significant differences in CA scores across the four groups, F(3, 124) = 16.81, p < .001 (see Figure 1). Post hoc testing (Fisher’s Least Significant Difference [LSD]) revealed significantly different CA scores for all group pairs at the p < .005 level or better, except for between the Mild and Moderate MSE groups (p < .34; see Figure 1).

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Table 2.

MSE Groups’ Means and Standard Deviations for Overall CA Score, CA Actual Changes, and CA Permanent Changes.

	Overall CA	CA actual changes	CA permanent changes
MSE group	M (SD)	M (SD)	M (SD)
Low (n = 32)	7.72 (6.4)	1.8 (1.5)	1.9 (2.0)
Mild (n = 33)	15.64 (12.0)	3.7 (3.1)	3.8 (3.0)
Moderate (n = 29)	18.31 (10.0)	4.3 (2.6)	4.7 (2.3)
High (n = 34)	26.85 (14.0)	6.5 (3.5)	6.5 (3.5)

Note: MSE = major stress event; CA = change in appearance. A quartile division of MSE scores were used to classify participants into one of four groups: Low (MSE scores of 0-18), Mild (19-28), Moderate (28-42), and High (43-110).

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Figure 1.

Mean change in appearance (CA) score for major stress event (MSE) groups.

The above analysis examined both actual and contemplated changes. We then examined actual appearance changes only by excluding “intent” responses on the CA portion of the inventory (scores of 1 [I have considered doing this] and 2 [I have often considered doing this]) and focusing on “action” responses (scores of 3 [I have done this once] and 4 [I have done this more than once]). One-way ANOVA analysis confirmed the relationship between MSEs and CA scores for only actual appearance changes rather than considered changes, F(3, 124) = 15.63, p < .001. Again, post hoc testing (Fisher’s LSD) revealed significantly different CA scores for all group pairs at the p < .006 level or better, except for between the Mild and Moderate MSE groups (p < .39).

We further examined the relationship by considering only the subset of changes that are permanent or relatively permanent CAs (getting tattooed, pierced, plastic surgery, and weight gains/losses). One-way ANOVA analysis revealed significant differences in CA scores for permanent changes across the four groups, F(3, 124) = 15.73, p < .001. Post hoc testing confirmed that the High and Low groups were significantly different from all other groups (p < .01), whereas the Mild and Moderate groups did not have significantly different CA scores (p < .24).

Finally, multiple regression analysis was used to identify predictors of CA scores. This analysis confirmed the role of MSEs in influencing CAs (β = .33, t = 4.27, p < .001). Furthermore, age significantly affected the relationship between stress events and CAs (β = .42, t = 5.50, p < .001): Younger participants were significantly more likely than older participants to alter appearance in response to MSEs. Gender, surprisingly, however, did not significantly predict variation in CA score (β = .07, t = 1.03, p < .31).

Discussion

In the present study, stressful life events were strongly and positively correlated with both considered and actual CAs. Individuals who experienced more personally meaningful stressful life events within a 2-year period changed or considered changing their appearance significantly more often than individuals who had fewer or less personally meaningful stressful experiences. This relationship between MSEs and CAs was observed for both relatively minor changes (e.g., haircuts) and relatively permanent appearance modifications (tattooing, piercing, plastic surgery, and weight change). These findings suggest that experiencing personally meaningful stressful life events is a major driving force behind one’s intent or decision to change outward appearance in some manner.

One intervening factor influencing the relationship between stress and CAs was age. Younger individuals were significantly more likely to report greater exposure to significant major life events and to CAs in response to MSE than were older individuals. Campo et al. (2004) did not find any effect of age on CAs, although it is important to note, as the authors did, that their sample of college undergraduates was homogenously young. In their subsequent study of a sample with a wider age range, these researchers (Campo et al., 2007) did find that age significantly impacted changes made to appearance.

This age difference in changes to appearance may reflect diverse stress experiences occurring in early and later adulthood. Early adulthood is often a time of life with major life events occurring frequently, often while beliefs and attitudes are still malleable. As individuals age, the occurrence of daily stressors decreases (Stawski, Sliwinski, Almeida, & Smyth, 2008), major life events become more infrequent, and beliefs and attitudes become crystallized (Caspi & Roberts, 2001). Major life events that challenge these beliefs or attitudes are often ignored or are viewed as less significant or influential to the individual. Thus, younger individuals may more readily encounter critical stress events of personal significance, the driving force for intentional self-change proposed by Kiecolt (1994). The high incidence rate of stressful life events and the greater significance of many of these events for individuals in early adulthood coupled with the fixed sense of self and belief crystallization seen in older individuals may contribute to the observed age-related differences.

A further explanation for the age difference may lie in that fact that half of the stressful life events on the inventory involved interpersonal events (e.g., death of a loved one, loss of friendship, experiencing a break up, etc.). Younger individuals tend to place greater importance on establishing interpersonal and intimate relationships than older individuals who often have already experienced these developmental identity tasks (Jackson & Finney, 2002). Tanti, Stukas, Halloran, and Foddy (2008) found that the individual self becomes more socially oriented as one moves through pre-, early-, mid- and late-adolescence. These changes in social environment are generally more influential to younger individuals and can even shift a young adult’s developmental trajectory (Galambos, Barker, & Krahn, 2006). The substantial number of interpersonal life events on the inventory may also help explain the age-related differences in appearance change.

Finally, existing research points to the greater resiliency of older individuals in the face of stressful events (Foster, 1997). Ong, Bergeman, Bisconti, and Wallace (2006) reported that positive emotions, which can mitigate stressful events, are higher among high-resilient individuals, whereas individuals with low resilience tend to show greater negative emotional responses and a heightened reaction to stressful events. Thus, older individuals’ ability to cope with stressful experience coupled with the reduced number of stressors may provide the best explanation for the age-related differences observed in the present study.

We failed to find a significant difference by gender for either stress scores or CAs scores, contrary to the gender difference for CAs reported in both Campo et al. (2004, 2007) studies. These researchers noted in both studies that females were significantly more likely to report CAs than were males. The discrepancy in findings is likely due to difference in the types of changes assessed on the relative scales. The Campo et al. (2004, 2007) inventory, the Changes in Appearance Scale, had comparatively more items assessing changes in clothing and accessories, such as “I love wearing conspicuous looking clothing,” “I sometimes wear clothes that do not fit or are not meant for my age group,” “I sometimes wear too many clothes on top of each other,” “I wear sunglasses, even when the sun is not shining,” and “I sometimes find that I am not wearing enough clothes” (Campo et al., 2004). Our inventory, although it included many of the same changes studied by Campo et al. (e.g., tattooing, hair dying, piercing, make-up, plastic surgery, etc.), was focused on more substantial and long-lasting changes and less so on short-term changes involving a minimal expenditure of energy (such as fashion, cosmetic, and jewelry changes). The discrepancy in findings between the current study and the previous work likely reflects the range of appearance modifications assessed by the respective scales.

Alternatively, the gender differences observed in the Campo et al. (2004, 2007) studies may be attributable to unique characteristics of their assessed populations. The 2004 study found a correlation between CAs and levels of schizotypy in a normal population, whereas the 2007 study examined CAs made in populations of individuals with various mental disorders. Perhaps females with mental disorders (or who are susceptible to them) are more likely to alter their appearance than males with mental illness. Our research was conducted exclusive of ties to mental disorders or behaviors indicative of susceptibility, and this critical population difference may explain why we found no significant difference in appearance changes between males and females. In either case, the present results indicate that males as well as females consider or make CAs in response to stress events.

The occurrence of appearance changes in association with stressful events highlights the transformational role of these events as motivators for intentional self-change as a coping mechanism (Kiecolt, 1994). Folkman and Lazarus (1988) have identified eight types of coping behaviors as adaptive mechanisms to stressful life events, including confrontive coping, distancing, self-control, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal. Physical alterations of appearance may reflect three of Folkman and Lazarus’s eight identified coping mechanisms: self-control, seeking social support, and positive reappraisal. Positive reappraisal, a common coping mechanism, involves reassessing the self or changing one’s self-concept when confronted with an emotionally poignant event, for example, “I changed or grew as a person in a good way,” “I came out of the experience better than when I went in,” “I rediscovered what is important in life” (Folkman & Lazarus, 1988, p. 468). One possibility is that individuals directly modify physical appearance as a means of regaining control of one’s body and one’s self. Alternatively, an individual may be reaching out nonverbally to a particular social group or category through altering physical appearance in a manner that matches that group. Finally, individuals may use the experience gained from a stressful life event to grow in a positive new direction (positive reappraisal). As the external self often is a display of one’s internal self, a new, reappraised internal self may warrant the alteration of one’s external appearance.

Tattoos, a relatively common, permanent, and intentional change to one’s physical appearance often used as a mechanism to cope with stress and mismanaged emotions (Atkinson, 2004; Oksanen & Turtiainen, 2005), reflect several of the coping behaviors identified by Folkman and Lazarus (1988). Most obviously, the physical change to self embodied in tattoos is a direct illustration of the positive reappraisal method of coping behavior (Folkman & Lazarus, 1988): Tattoos are often used to illustrate directly life changing or emotionally poignant events on the body by physically marking the beginning or end of a transitory state in an individual’s life (Oksanen & Turtiainen, 2005). Furthermore, tattooing exemplifies the coping mechanism of self-control (Folkman & Lazarus, 1988), as one is able to regulate one’s emotions, values, and cultural identity by directly controlling one’s physical appearance (Atkinson, 2004). Finally, tattooing may represent a way of symbolically joining a social group, as observed in Atkinson’s (2004) study of Canadian tattoo artists, and thus illustrates the coping mechanism of seeking social support (Folkman & Lazarus, 1988).

From a clinical perspective, the current research, based on a nondiagnosed heterogeneous population, suggests that frequent or subsequent changes to physical appearance may be an external indication that an individual is undergoing significant, multiple life stressors. Dramatic, major CAs thus may signal a person in emotional distress and in need of strong interpersonal support. Campo et al. (2007) determined that frequent appearance changes may act as an indicator or predictor of susceptibility to a mental disorder, such as depression or anxiety. A patient’s alteration to his or her physical appearance may very well represent a meaningful nonverbal behavior, communicating to the therapist that an important internal event is occurring. As with all nonverbal behavior in a therapy situation, “everything a person does, every action or movement he makes, can be used by a trained, knowledgeable, and sensitive observer as a basis . . . for categorizing . . . the individual—his state, thoughts, feelings, personality, or cultural patterns” (Wiener, Devoe, Rubinow, & Geller, 1972, p. 187), and may be interpretable as revealing an internal state involuntarily or unknowingly. DePaulo (1992) argues that nonverbal behaviors, traditionally associated with emotional expression, may also communicate opinions, moods, values, personality dispositions, psychopathologies, and physical and cognitive states. Furthermore, nonverbal behavior is not necessarily spontaneous and unregulated, but rather potentially controllable behavior that can be systematically used to create a particular impression on the observer (DePaulo, 1992).

Thus, therapists are often aided by addressing noticeable changes in a client’s appearance, in light of the possibility that the change may reflect a recently experienced significantly stressful event. The decision to alter appearance may reflect underlying concerns or conflicts, and external changes to appearance may occur before an individual has the ability to verbalize internal changes. In particular, therapists are likely to benefit by focusing close attention to the physical appearance and presentation of their patients. Whereas appearance changes alone—such as tattoos, piercings, surgeries, clothing choice, make-up use, and so on—may have some relevance to therapeutic situations, dramatic changes from one appearance to another during the course of therapy are of particular importance and may provide the opportunity for the skilled clinician to encourage exploration of life events surrounding the appearance change.

Although these results show many strong correlations between the occurrences of stressful life events and altering one’s physical appearance, further research is needed to establish the parameters of this relationship. In particular, an examination of other demographic factors (such as ethnicity and religion) would be instructive, as would assessment of people from different living environments. The majority of participants in the present study completed the inventory in an urban environment. Individuals who live in cities are often more open to and accepting of unconventional dress and appearance than individuals who live in suburban and rural locales. Further research on the occurrence of stressful life events and alterations of appearance may want to consider these important factors.

The present research has demonstrated a significant relationship between experiencing stressful life events and altering one’s physical appearance. These findings offer a glimpse into the construction of body image by suggesting that the way one perceives and displays one’s self physically is closely related to one’s inner psychological world. Body image dissatisfaction as a consequence of stressful life events may provide the direct motivation for changes in body appearance to promote self-image. A marked alteration in appearance may not be change for change’s sake but rather an important indicator of a shift in the internal perceptions of self.