The effect of a racially consonant medical context on adjustment of African-American patients to physical disability.

The effect of a racially consonant medical context on reaction to physical handicap stemming from disease is explored in a sample of 90 African-American patients with vitiligo, a disfiguring skin disorder. The adjustment of sixty-nine patients in a predominantly black hospital setting is compared to that of twenty-one patients in a predominantly white hospital setting. The patients in the predominantly black clinic, where the physicians, staff, and clientele are African-American, show significantly better adjustment than do African-American patients in a medical context that is primarily white. Interviews with a random sample of one-third of the patients in each clinic show that patients are significantly more positive to black physicians and a black hospital setting and that other patients of the same race provide informal networks of support, as does the predominantly African-American community in which the hospital is located. Implications for both medical theory and practice are suggested on the basis of these findings.

Racial variation in reaction to physical stigma: a study of degree of disturbance by vitiligo among black and white patients.

The effect of race on reaction to impaired appearance is explored in a sample of 158 patients with vitiligo, a disfiguring skin disease. Blacks and Whites do not differ in degree of disturbance by the disorder. Psychological coping resources and variables related to negative labeling of the stigma are associated with variation in degree of disturbance. Self-esteem and perceived stigmatization are associated significantly with degree of disturbance among both Blacks and Whites. Gender, age, and visibility of the condition are not related to difference in degree of disturbance within either race, although there is some evidence that they may have an indirect relationship to degree of disturbance. Importance of appearance is associated with degree of disturbance for Whites only, because of the threat of the depigmentation induced by vitiligo to the racial identity of Blacks. The implications of these findings for theory and practice are discussed.

The effect of vitiligo on sexual relationships.

To study the effect of vitiligo on interference with sexual relationships, we surveyed 158 patients by questionnaire. Although a majority of patients reported a negative impact on sexual relationships, most patients felt embarrassment when showing their body or meeting strangers. The majority of patients who reported a negative impact on sexual relationships attributed the problems to their embarrassment. Those who were particularly affected were those with low self-esteem, men, those to whom appearance is important, and single persons. Dermatologists should be especially alert to the effects of disfigurement and should attempt to assist patients with this problem.

Response to cosmetic disfigurement: patients with vitiligo.

Vitiligo presents an excellent opportunity to focus on the effect of impaired appearance on the lives of persons with this disease. We questioned 326 patients with vitiligo and obtained an overview of how they perceived others' reactions to them, their own reactions to the disease, and their experiences with physicians. Many patients are frightened and embarrassed by vitiligo, experience discrimination from others, and believe that they do not receive adequate support from their doctors. Implications of these findings for patient care are presented.

Psychosocial effect of vitiligo: a comparison of vitiligo patients with "normal" control subjects, with psoriasis patients, and with patients with other pigmentary disorders.

To ascertain the psychosocial effects of vitiligo, patients with vitiligo were compared with control subjects without skin diseases who were matched for age, sex, race, educational level, and marital status. Vitiligo patients were also compared with a matched sample of psoriasis patients and a matched sample of patients with other pigmentary disorders involving discoloration. The vitiligo patients scored lower on the Coopersmith Self-Esteem Inventory than did the "normal" control subjects. Vitiligo patients exhibited better adjustment to their disorder and experienced less social discrimination than did psoriasis patients, although the two groups did not differ on overall self-esteem. Patients with vitiligo did not differ significantly from those with other pigmentary disorders on any measure.

Psychological reaction to chronic skin disorders: a study of patients with vitiligo.

Diseases that cause physical handicaps can seriously interfere with the life of a patient. Some disorders such as vitiligo cosmetically disfigure patients without producing any physical disabilities. The effects of such diseases as vitiligo on the life of a patient have not been widely investigated. The investigation reported here utilized a questionnaire survey to focus on emotional disturbances caused by vitiligo and on the factors that differentiated patients who cope well from those who cope poorly with this stress. The results indicate that the cosmetic disfigurement of a seemingly inconsequential skin disease also can seriously disrupt the lives of a large number of patients. Those who cope well with their disfigurement have higher self-esteem than a matched control group without the disorder. Those who cope poorly have significantly lower self-esteem, which suggests that response to disfiguring diseases is affected by basic ego strength. Younger patients and those individuals in the lower socioeconomic groups show especially poor adjustment. A number of suggestions for better patient care are offered.