Body Image After Burns: Insights for Burn Rehabilitation Therapists

Maggie NIU, Counseling Psychologist

Norther Service Center, Sunshine Social Welfare Foundation

Why Body Image After Burns Matters in Rehabilitation?

Burn injuries are life-altering, not only because of the physical scars they leave behind but also due to their profound impact on body image. For burn survivors, body image is deeply intertwined with self-esteem, social interactions, and overall recovery. Burn therapists can play a pivotal role in helping survivors navigate these challenges. This post explores the issue of body image after burns and provides insights to enhance therapeutic support.

What is Body Image?

Body image refers to the thoughts, feelings, and perceptions a person has about their physical appearance and functionality. It is influenced by personal experiences, societal standards, and cultural attitudes toward beauty and physical form. A positive body image involves accepting and appreciating one's body, while a negative body image can lead to emotional distress, low self-esteem, and withdrawal from social interactions. For burn survivors, the sudden and often drastic changes to their appearance and physical capabilities can profoundly disrupt their sense of body image.

How Burns Affect Body Image?

Scars: Visible and Hidden

Obviously, visible scars on the face or exposed areas like arms and hands, or obvious scars due to their different color or height, will have a direct impact on body image. These scars often provoke unwanted attention, stares, and even unfriendly behavior. This visible impact can cause significant distress and social anxiety [1]. However, hidden scars—those that can be covered by clothing—can be equally challenging. Survivors may avoid exposing these scars, delaying adaptation and affecting relationships and self-confidence.

Functional Impairments and Self-Perception

Burns change more than just appearance. Functional impairments, such as reduced mobility or loss of abilities, alter how survivors perceive their bodies. For example, the inability to participate in outdoor activities due to the skin's impaired thermoregulation function can diminish a survivor's sense of identity, particularly if such activities were central to their pre-burn life. The difficulty of recognizing oneself and adapting to the forced change of appearance all affect the formation of self-concept of patients.

The Stages of Adapting to Body Image Changes

James Partridge, founder of the UK charity Changing Faces and a burn survivor himself, hypothesized that a person's adaptation to changes in his appearance from the onset of burn injury can be divided into three stages [2].

Survival and Early Recovery (0–6 months): During hospitalization, with its focus on physical survival, survivors coping with early anxiety about their changed appearance often avoid mirrors or confronting their wounds.
Adjustment and Reality (6 months–2 years): In this post-hospitalization stage, as scars stabilize, survivors encounter societal reactions and grapple with emotions like sadness, anger, and anxiety. This period often highlights the challenges of reintegration into daily life and societal norms.
Acceptance and Advocacy (2+ years): Many survivors eventually embrace their scars, reject cultural stereotypes of perfection, and advocate for appearance diversity.

Adaptation to burns and its impact on appearance is a process, and the intensity of the impact will vary, depending on the time since injury. Although someone who is still hospitalized and undergoing emergency care will worry about how burns affects his appearance, the extent of the impact may become more obvious only later, when the person is discharged from hospital and must now return to life in society.

Implications for Burn Therapists

The period of adjustment and reality (6 months–2 years after injury) is indeed critical for burn therapists, as it coincides with the intensive rehabilitation phase. During this time, burn survivors face significant physical and psychological challenges related to body image, and these issues can have direct implications for therapy. Here's what this means for burn therapists:

1. Understanding, Identifying and Recognizing Body Image-Related Emotional Distress

Burn survivors often experience sadness, frustration, and even depression due to the visible and functional impact of scars. These emotions can affect their motivation to participate in therapy. As patients move from viewing their scars as temporary to accepting them as permanent, they often grapple with redefining their identity. We must have the sensitivity to identify the distressed state of the burn survivor, as well as the level of this distress. Therapists should adopt a compassionate approach, acknowledging these emotional struggles and integrating psychosocial support into their sessions. Therapists can facilitate this process by encouraging self-expression through journaling, art therapy, or group discussions with other survivors. This helps patients process their experiences and develop a more positive narrative around their recovery. Collaborating with psychologists or counselors, or referring patients to these specialists can help address these emotional barriers. Short-term supportive services can help patients with moderate body image distress, but intensive psychological care and long-term counseling may be necessary for patients with more severe body image distress.

2. Fostering Realistic Expectations During Rehabilitation

The scars and physical limitations survivors face are often still evolving during this stage. Patients may feel discouraged when their progress or changes in their scar appearance don’t meet their expectations. Therapists play a key role in helping patients understand about scar maturation and reasonable rehabilitation timelines. By setting achievable goals, celebrating small wins, and maintaining a focus on gradual improvement, patients’ anxiety over the uncertainty of recovery can be alleviated.

3. Helping Build Social Reintegration Skills

Since this period often involves re-entry into society, burn survivors may struggle with social anxiety or discomfort due to altered appearance. Therapists can help by integrating social reintegration skills training in the patient's rehabilitation plan, such as encouraging role-playing or practicing interactions in safe environments. This can include strategies for responding to questions or comments about their scars, as well as exercises to boost confidence in public settings.

4. Integrating Functional Goals with Body Image Concerns

Functional limitations, such as restricted mobility or reduced ability to perform daily tasks, further impact how survivors perceive their bodies. Therapists should design rehabilitation programs that not only restore function but also empower survivors by highlighting their physical progress. For example, demonstrating measurable improvements in mobility or strength can counteract feelings of helplessness or loss.

By understanding the profound body image challenges during this period, burn therapists can better tailor their rehabilitation plans to address not only the physical but also the emotional and social dimensions of recovery. This holistic approach ensures that burn survivors are supported in every aspect of their journey toward adaptation and acceptance.

To learn more about how burns affect body image, and how burn professionals can accompany burn survivors as they process changes in appearance, don’t miss our online course Helping Burn Patients Cope with Post-Burn Body Image Issues.

References:

Lawrence JW, Fauerbach JA, Heinberg L, Doctor M. Visible vs hidden scars and their relation to body esteem. J Burn Care Rehabil. 2004 Jan-Feb;25(1):25-32.

Partridge, J. (1990). Changing Faces: The Challenge of Facial Disfigurement.