Recovery and Reintegration After Burn Injury



Recovery and Reintegration After Burn Injury


Marta Rosenberg

Laura Rosenberg

Walter Meyer III




Survivors of burns face adjustment to various physical, health, and psychosocial changes including acceptance of visible and hidden burn scars. Several factors may impact this adjustment including one’s belief system and perception of body image, perceived and actual support systems including family and friends, one’s comfort in diverse social settings, health status, resilience, and preburn and postburn emotional history. This chapter provides a summary of the literature related to the impact of burns (particularly burn scars); relevant aspects related to body image and stigmatization; psychosocial and psychiatric outcomes for burn survivors; the assessment and treatment of itch, neuropathic pain, and posttraumatic stress disorder (PTSD); and postburn social reintegration.


Visible and Hidden Scars

One of the frequent consequences of burns is scarring and contractures, and both surgical and nonsurgical methods have been used to address these issues.1 Reconstructive surgical interventions include, but are not limited to, application of skin grafts and skin flaps, release of contractures, scar reduction, tissue expanders2 (see Chapter 12), and more recently laser treatment (see Chapter 13). Nonsurgical methods include applying pressure on the scars through the use of pressure garments and skin massage, and attendance to daily rehabilitation and exercise programs2,3 (see Chapter 19).

Visible differences created by burn scars can lead to difficulties in physical and psychosocial functioning. Physical difficulties due to loss of function, pain, and itch are frequent and can impact daily functioning at home, work, and school and in diverse social settings. Psychosocial difficulties related to changes in appearance, difficulties accepting these changes, and difficulties with body image and self-concept may lead to social anxiety, depression, and problems with adjustment.4,5,6,7,8 Both visible and hidden scars (scars in areas usually covered by clothing) may impact how a person feels and their comfort in different social situations. They often experience unwanted attention and questions about their burn scars, which may make socializing uncomfortable. They may encounter social situations in which others do not quite know how to behave around them. Some survivors may attempt to cover up their scars to avoid uncomfortable social encounters (see Chapters 20 and 21). Therefore, the availability of social skills-based programs, cognitive-behavior therapy (CBT), and support systems is crucial for assisting survivors with postburn adjustment, acceptance of burn scars, gaining self-confidence, and feeling comfortable in different social settings. Studies are needed to identify which interventions are most effective for individuals with visible differences.8


Body Image and Stigmatization

Body image is an individual’s perception regarding physical appearance.9 This process is influenced by personal views
such as values and beliefs,7 social and cultural experiences,7,10,11 and appearance norms.7 In many countries people are often exposed to information about physical attractiveness from the mass media9,11 including magazines, television, movies, and more recently social media and individuals’ interests in taking selfies. Young children’s perceptions of their body image are influenced by messages they receive from their parents and family members.10,11 School-aged children begin to observe similarities and differences between themselves and their peers, and peer acceptance becomes increasingly important as children transition to adolescence.10,11 Body image concerns may continue throughout adult life.7

It is often believed burn survivors may experience body image dissatisfaction related to the changes in physical appearance due to scarring.12,13,14 Some studies found a modest relationship between burn scar severity and body image.15,16 Thombs and colleagues17 examined body image dissatisfaction of adult burn survivors at discharge and 6 and 12 months after injury. They found that women with major burns reported greater body image concerns, and that the importance of appearance was strongly associated with body image across time. Lawrence and colleagues18 examined the relationship between burn scar severity and body esteem of adults with burns. They found a strong relationship between scar severity and body-esteem for individuals who strongly valued their appearance. The opposite was true for individuals who rated their appearance as not important. In this study, females reported lower body-esteem with regard to appearance than males; however, males rated themselves as less attractive than others. Fauerbach and colleagues15 studied the impact of body image dissatisfaction on quality of life for adults with major burns. They controlled for burn size, facial injury, and preburn mental and physical quality of life. Results suggested burn survivors who were dissatisfied with their appearance experienced decreased mental and physical quality of life at 2 months postinjury.

Limited research has examined body image in pediatric burn survivors. Lawrence and colleagues16 compared body esteem of children with burns and an age-matched comparison group. No differences were found between the body esteem scores of men burn survivors and controls. However, women burn survivors reported higher body esteem than the comparison group. The authors speculated that the uniqueness of the sample, acceptance of burn scars, and social support may explain these findings.16 Russell et al.19 studied self-concept in young adults who sustained severe childhood burns. Burn survivors reported more difficulty on several subscales on a self-concept measure in comparison to a normative reference group. Areas of difficulty included: physical function, appearance, sexuality, moral conduct, personal values, academics and work, and identity. They reported that decreased self-concept was related to affective and anxiety disorders. Pope and colleagues20 compared long-term psychosocial outcomes of young burn survivors to a control group of peers from school. Burn survivors, especially men, reported better body image and weight satisfaction than the control group. However, as the size of burn increased there was more dissatisfaction with appearance and lower quality of life. The development of healthy coping strategies and acceptance of burn scars may explain these findings.20


Oct 16, 2018 | Posted by in Dermatology | Comments Off on Recovery and Reintegration After Burn Injury

Full access? Get Clinical Tree

Get Clinical Tree app for offline access