People are less empathetic toward those who have facial disfigurements


People with attractive faces are often seen as more trustworthy, socially competent, better adjusted, and more capable in school and work.

The correlation of attractiveness and positive character traits leads to a “beautiful is good” stereotype.

However, little has been understood about the behavioral and neural responses to those with facial abnormalities, such as scars, skin cancers, birthmarks, and other disfigurements.

A new study led by Penn Medicine researchers, which published today in Scientific Reports, uncovered an automatic “disfigured is bad” bias that also exists in contrast to “beautiful is good.”

“Judgements on attractiveness and trustworthiness are consistent across cultures, and these assumptions based on facial beauty are made extremely quickly.

On the other hand, people with facial disfigurement are often targets of discrimination, which seems to extend beyond the specific effects of lower overall attractiveness and may tie in more with the pattern of results with stigmatized groups,” said the study’s lead author Anjan Chatterjee, MD, a professor of Neurology, and director of the Penn Center for Neuroaesthetics.

“In order to right any discrimination, the first step is to understand how and why such biases exist, which is why we set out to uncover the neural responses to disfigured faces.”

Neuroimaging studies show that seeing attractive faces evokes brain responses in reward, emotion, and visual areas compared to seeing faces of average attractiveness.

Specifically, attractive faces evoke greater neural responses as compared to faces of average attractiveness in ventral occipito-temporal cortical areas, which process faces and other objects.

Additionally, attractiveness correlates with increased activations in the anterior cingulate cortex and medial-prefrontal cortex–areas which are associated with rewards, empathy, and social cognition.

The researchers set out to evaluate the behavioral and brain reactions to disfigured faces and investigate whether surgical treatment mitigates these responses.

In two experiments, the researchers used a set of photographs of patients with different types of facial anomalies, before and after surgical treatment, to test whether people harbor a “disfigured is bad” bias and to measure neural responses.

In the first experiment, a behavioral study with 79 participants, the researchers tested if people harbor implicit biases against disfigured faces and if such implicit biases were different from consciously aware, self-reported explicit biases.

The behavioral experiment consisted of an implicit association test (IAT) and an explicit bias questionnaire (EBQ) to identify whether people have a negative bias for disfigured faces.

For the IAT, the researchers used the set of before and after photographs as a stimulus.

The EBQ consisted of 11 questions which query conscious biases against people with facial disfigurements. While the team found no indication of an explicit bias, they found that non-disfigured faces were preferred in the IAT.

This bias was particularly robust for men.

In a follow up functional MRI (fMRI) study with 31 participants, researchers tested brain responses to the same picture pairs.

Participants judged the gender of each photograph they viewed.

The researchers found increased neural responses in visual regions of the brain (the ventral occipito-temporal cortical areas) and decreases in regions associated with empathy (the anterior cingulate and medio-prefrontal cortex).

This shows brain scans with the lack of anterior cingulate cortex activity

Brain responses to pictures of disfigured faces. The image is credited to Penn Medicine.

In sum, the authors found that people have implicit negative biases against people with disfigured faces, without knowingly harboring such biases.

The diminished neural responses in the anterior cingulate cortex suggests that people are less empathetic when looking at individuals with disfigurement–this is also a potential neural marker of dehumanization, as diminished neural responses in the anterior cingulate cortex is also observed in response to other stigmatized people, such as the homeless and drug addicts.

“The emphasis of attractiveness and its association with positive attributes highlights the pervasive effect of appearance in social interaction.

Chatterjee said. “While we found that corrective surgery mitigates negative social and psychological responses to people with facial anomalies, we are also exploring alternative strategies to minimize bias towards people with facial conditions.”

According to the charity Changing Faces, one personin 111 in the United Kingdom today has a disfigurementto the face (Changing Faces, Face Equality, 2014).

Disfigurement is defined as a state of persistent andsignificant alteration to an individual’s appearance bydisease, injury, or developmental disorder (Krishna,2009).

Disfigurement is associated with stigma and, inthe words of Crocker, Major, and Steele (1998) ‘‘a per-son who is stigmatised is …devalued, spoiled or flawedin the eyes of others’’ (p. 504; see also Dembo, Leviton,& Wright, 1975; Lawrence, Rosenberg, & Fauerbach,2007).

A disfigurement affecting the face has a parti-cularly strong impact because of the importance of the face in social interaction; the direction of looking is normally toward the face of a conversational partner(e.g., the eye-tracking study of Vertegaal, Slagter, vander Veer, and Nijholt, 2001).

Kendon (1967) exploredseveral functions of attention to the face during social interaction, including turn taking, shared attention,and detection of emotion.

The face indicates a person’sidentity, age, emotion, and mood, and may even indicatea person’s intelligence (e.g., Zebrowitz, Hall, Murphy, &Rhodes, 2002)

The importance of the face in social interaction implies that a person with facial disfigurement couldbe expected to invoke strong emotion in perceivers(e.g., Dovidio, Major, & Crocker 2000).

There are anumber of factors that suggest the likelihood of specific emotions, and these will are considered in turn.Anxiety and embarrassment can result when interac-tion partners do not know how to react, where to look,or how to hold a normal conversation (Heinemann,1990).

Hebl, Tickle, and Heatherton (2000) describedhow most people can recall instances of ‘‘awkwardmoments’’—clumsy words they wish they had not said—in interaction with a stigmatized individual.

Further,people with facial disfigurement are generally perceivedto be lacking in social skills and confidence (e.g., Eagly,Ashmore, Makhajani, & Longo, 1991; Feingold, 1992;Goode, Ellis, Coutinho, & Partridge, 2008; Stevenage& McKay, 1999; A. Stone & Wright, 2012).

This couldreadily become a self-fulfilling prophecy (e.g., Rumsey& Harcourt, 2012, p. 380).

Curiosity and surprise are natural consequences of therarity of facial disfigurement (e.g., MacGregor, 1990).

For example, Stevenage and Furness (2008) asked parti-cipants to watch a video of a conversation or to hold a conversation with a partner over a webcam.

Recall ofthe contents of the conversation was poorer if the partnerhad a (fake) disfigurement, attributed to the seizing of attention by the disfigurement. Similarly, Madera andHebl (2012) reported in an eye-tracking study that their participants paid particular attention to a facial disfigurement.

Strong emotional reactions, including disgust, repul-sion, and anger, are likely to be invoked by the perceptionof a face that is particularly aesthetically unappealing(e.g., Giancoli & Neimeyer, 1983; MacGregor, 1953; D.L. Stone & Colella, 1996).

Fear of contagious disease isproposed to be an evolved disposition (e.g., Dijker &Raeijmaekers, 1999), which should lead to avoidance of individuals with facial anomalies, such as rash, spots,or discolouration, which could be indicators of disease(e.g., Schaller & Neuberg, 2012).

On a more positive note, individuals may respond with empathy-based emotions including the sadness ordistress that arises from the acknowledgment of sufferingby members of a socially disadvantaged group, ratherthan the prejudice-based associations of dislike and aver-sion (e.g.,. Andreychik & Gill, 2012; Fultz, Schaller, &Cialdini, 1988).

Similarly, some individuals may feel pityrather than aversion (e.g., MacGregor, 1953).

When con-fronted by another person in distress, with no means of alleviating the distress, the perceiver may experience hisor her own form of sadness, sorrow, or distress.

Despite these reasons for expecting particular emotional reactions to the perception of an individualwith a facial disfigurement, there is very little empirical evidence of the nature of the emotions most commonly and strongly experienced by the perceiver.

One recent exception is Shanmugarajah, Gaind, Clarke, and Butler(2012), who reported that disgust was experienced whenviewing a disfigured face.

Experimental indication of an emotional reaction was reported by Blascovich, Mendes,Hunter, Lickel, and Kowai-Bell (2001), whose parti-cipants displayed more stress in interacting with an experimental confederate with a simulated birth markon his or her face than the same confederate without afacial stigma, but this does not address specific emotions.

Indirect evidence is offered by many studies showing thatpeople with facial disfigurement report frequent experi-ences of negative attitudes (e.g., Clarke, 1999; Harcourt& Rumsey, 2008; Hearst & Middleton, 1997; Jowett &Ryan, 1985; Lanigan & Cotterill, 1989; Newell & Marks,2000; Rumsey & Harcourt, 2004; Walters, 1997) andphysical avoidance (Houston & Bull, 1994; Rumsey, Bull,& Gahagan, 1982).

Again, though, these studies do not document the actual emotions experienced by the interac-tion partners.

Some studies have observed reactions of anger or pity to a range of stigmas involving physical dis-ability or disease, depending on whether the stigma isperceived as controllable (anger) or uncontrollable (pity;Menec & Perry, 1998; Weiner, Perry, & Magnusson,1988), but this does not address facial disfigurement specifically and covers only a narrow range of emotions.

The lack of empirical evidence of the actual emotions experienced by perceivers is unfortunate, as steps toreduce the problems experienced by people with facial disfigurement in social interaction can be beneficially informed by knowledge of the emotions that are usually invoked.

Although it must be recognized that the subjec-tive interpretations placed on the behavior of othersby the individual with visible difference can have a major influence on their perception of their interaction partner(e.g., Kleck & Strenta, 1980), these interpretations can beexpected to rely, at least partly, on the actual behavior ofothers.

The present study was designed to advance our under-standing of the emotions experienced by a perceiver of aperson with facial disfigurement.

The basic design of theresearch was to present participants with a set of faces in one of three categories—attractive, unattractive, andwith facial disfigurement—and to ask for self-report of subjective experience of a set of 21 emotions organizedfor clarity of exposition into four subscales: Negative,Positive, Sorrow, and Curiosity.

Differences were predicted between the participants who viewed disfigured faces compared to the other two groups: higher levels of Negative, Sorrow, and Curiosity emotions and lower levels of Positive emotions. No spe-cific prediction was made for differences between theemotions invoked by attractive and unattractive faces.

The unattractive faces were included to distinguish between the lack of attractiveness and the presence of disfigurement.

Differences between unattractive faces,which lie within the range of normal, unaltered faces,and disfigured faces, will help to delineate the impactof striking and persistent alteration to facial appearance.

Experiment 1 showed partial support for the predic-tions but with unexpected results for the self-report of Negative emotions invoked by the perception of people with facial disfigurement. Experiment 2 investigated twopotential explanations for this observation

Funding: This work was supported by the Penn Center for Human Appearance and the Global Wellness Institute.

University of Pennsylvania
Media Contacts: 
Hannah Messinger – University of Pennsylvania
Image Source:
The image is credited to Penn Medicine.

Original Research: Open access
“Behavioural and Neural Responses to Facial Disfigurement”. Franziska Hartung, Anja Jamrozik, Miriam E. Rosen, Geoffrey Aguirre, David B. Sarwer & Anjan Chatterjee.
Scientific Reports. doi:10.1038/s41598-019-44408-8


Please enter your comment!
Please enter your name here

Questo sito usa Akismet per ridurre lo spam. Scopri come i tuoi dati vengono elaborati.