Table 2.

Experiential Themes of Body Image Disturbance: Representative Quotes from Semistructured Interviews.

Theme	Subtheme	Examples
Personal dissatisfaction with appearance	Head and neck–specific concerns	“Aside from the scar [on my neck], the only thing that bothers me is the symmetry. The alignment of my jaw is off.” (Participant 8) “The only thing that has changed for me are the scars and the swelling [on my neck], I have to deal with it. It’s hard for me.” (Participant 16) “Symmetry is a big, big, big concern and I worry if it’s ever going to match my right side of my face. With me having a surgery, I know that probably it won’t be completely like my right face but that is one of my worries. Will it ever match my right face? Will my left eye really ever match my right eye? Will my left cheek ever really match my right cheek? So yes, symmetry is one of my big concerns.” (Participant 19)
	Global attractiveness	“I’m less attractive now. Because I don’t look like the way I used to look. My face has change dramatically. That’s not something easy which you could ease on to.” (Participant 15) “There are times where I feel less attractive as a woman. I do. Just because of how my face presents and when you go out that’s the first thing that anybody sees. They see your face.” (Participant 19)
Other-oriented appearance concerns	NA	“People look at me weird sometimes but I don’t know some of them so. . . . Just like when I go into a store or something like that people like stare at me. They give you that pity look.” (Participant 4) “I just noticed that my grandchildren, they are so young. They just like stare or, out in public. This isn’t as bad now but when I first was able to go out in public, I felt like everybody was staring at me.” (Participant 5) “People kept staring at me. It made me feel embarrassed.” (Participant 11) “Children run and even parents, they act like you are a freak or something. And you are called names and stuff just when you go out in public and I think the mental part of it is more than anything else, more so than the scars. You just have to deal with people’s judgments on everything and the way they look at you.” (Participant 15)
Appearance concealment	Camouflaging	“I have 3 or 4 jackets with hoods on the sweatshirt jackets with hoods and I’ll wear them even in the summertime if I have to go out to a public place. . . . I go out in public and I had my hoodie on to cover up so they don’t see it.” (Participant 1) “I adapt to my appearance, like with wearing these bandanas. When I cover it [my neck] up, I just feel a little more confident. I just feel more relaxed or I don’t feel like somebody’s staring at me.” (Participant 7) “I try covering it [my scar] because it does bother me and I don’t want anything like this. . . . I would just feel terrible, then like, I try covering it [my scar] all the time.” (Participant 13) “I usually wear scarves to hide it [neck scar] so I don’t have to show most of the scarring. But you can’t wear a scarf high enough to cover the face.” (Participant 15)
	Suppression	“Avoid the mirrors . . . sometimes I just couldn’t look in that mirror and see myself and just put my head down and walk away out of there.” (Participant 1) “There is sometimes when I would rather not check and look, like it took me a while to look at my tongue. I didn’t want to see it.” (Participant 5)
Distress with functional impairment	NA	“But I couldn’t eat anything. That was really hard. The first time, the first part of the surgery when I couldn’t talk. It appeared that I was just there. I couldn’t eat, I couldn’t talk, I couldn’t drink anything, my face was messed up. I was feeling like I was just a skip from the grave.” (Participant 2) “Talking has changed because I like to talk and I used to talk but now I can’t very well. I don’t eat. I eat by the G-tube; nothing by mouth. I get spit and mucous dripping out of my mouth.” (Participant 12)
Social avoidance	Avoidance due to disfigurement	“I don’t really go out in public, you know what I am saying, get out with people. Even when my daughter has something at school, I am really reluctant to even go, even though I know everybody there and people are really nice to me, you know what I am saying, the school knows me but I just don’t want to embarrass her. . . . I’m ashamed, and going out the way I look. I mean, I don’t want to embarrass her or anybody or have anybody really just say anything.” (Participant 1) “I relate more with people now over the phone than I do in person. My depression really kicks in and I just don’t really want to go out. I just really talk to somebody on the phone than have a face to face with anybody.” (Participant 15) “It [scars on my face] really shuts you down mentally because it makes you not want to go out in public at all and be seen around anybody. I mean, I stay home twice as much now than I did before.” (Participant 15)
	Avoidance due to functional	“I avoided going out. . . . I didn’t want to talk. I didn’t want to go out and see anyone. I wasn’t going to family functions. I didn’t want anybody coming over. I just avoided everything, really.” (Participant 5) “I just don’t like going out with a new group of people that I don’t know. I just feel like they’ll be looking at you and say you don’t talk right or something like that. I say something they don’t understand but it just kind of embarrassing to me they don’t understand the way I’m talking.” (Participant 6) “I feel like it [social interactions] has changed if I’m trying to meet someone new. I’m more inclined not to talk as much because I’m self-conscious and I don’t enjoy talking because of how I sound.” (Participant 17)