Reimaging after an alteration in appearance or function involved 3 phases with assimilation, accommodation, and interpretation
Participants 32 adults were recruited through advertisements in newspapers and contact with health professionals. All had a substantial alteration in physical appearance or function (weight change > 22.7 kg; loss or paralysis of body parts; ostomies; scarring from burns, surgery, or trauma; surgical reconstruction; or cardiac transplantation). 28 participants completed all aspects of the study. Age range was 19-85 years with a broad range of socioeconomic backgrounds. 89% were white and 75%
... women. Methods Participants were interviewed 3, 6, 12, and 18 months after their alteration in body function or appearance. Interviews were done using a broad interview guide with relevant prompts. The interview focused on participants' perceptions of themselves and their experiences during the study, and their thoughts, feelings, adaptive strategies, and perceptions of the responses of others. Interviews were taped, transcribed, and verified by members of the study team and a grounded theory was developed. Main results The process of reimaging was complex, highly subjective, unique to each person, forward moving, and occurred simultaneously with grief for the loss of the former appearance or function. The process involved 3 phases: body image disruption, wishing for restoration, and reimaging the self. 4 responses characterised the body image disruption phase: shock and painful awareness; attempts to minimise awareness of the alteration by denial, avoidance, or concealment; painful awareness experienced as depression, anger, and self pity; and grieving the loss. During the wishing for restoration phase, participants struggled between hopefulness, which prompted them to mobilise personal resources and maximise efforts to improve healing, appearance, or functioning; and intense emotional pain when they faced the reality that restorative efforts were not yielding desired results. In the reimaging the self phase, participants weighed the value of continued efforts at restoration against the cost in energy, time, and effort. They began to replace idealised expectations with more realistic views of the self and self capabilities. The focus shifted from restoring the body to reimaging the self. The 3 phases were characterised by 3 ongoing processes: assimilation, the cognitive and emotional process of taking in the change; accommodation, learning ways to live with the change; and interpretation, perceiving the meaning of the change for the self and others. Factors which influenced progression through the phases included the extent to which individuals valued appearance compared with function; self esteem; perceived attitudes of others; and access to and acceptability of medical technology. Conclusion Through a reimaging process, most individuals who had a recent alteration in body appearance or function achieved positive outcomes on reconciliation, in which they gradually accepted their new body image, and normalisation, in which they adapted personal goals and lifestyles and learnt to live with the limitations of their changed bodies.