Objective: To investigate levels of appearance-related concern in a normative population of adolescents. Design: Action research methodology was used to help adolescents develop a questionnaire that elicited peer views on appearance (Part 1) and to further develop the Changing Faces psychosocial strategies for dealing with appearance-related bullying (Part 2). Participants: Adolescents aged 11–19.5 years were involved in the development of a questionnaire on the extent and nature of appearance-related concerns: 36 in development of antibullying strategies and 210 in an intervention. Intervention: Part 3 of the project was an intervention that included information on the importance of appearance in human interactions as well as learning and practicing eight nonconfrontational coping strategies. Main Outcome Measures: The questionnaires developed by the adolescents, in addition to Rosenberg's Self-Esteem Questionnaire for Adolescents, were used preintervention, postintervention, and at 6 months postintervention. Results: Of 11–13 year olds questioned, 75% cited teasing or bullying about their appearance as causing considerable distress. Concerns were compounded by a perceived lack of effective coping strategies. At 6 months postintervention, perceived levels of bullying had decreased by almost two-thirds, and there were significant improvements in global self-esteem, confidence to tackle teasing and bullying, and confidence with disfigurement issues. A nonintervention comparison group showed no such improvements. Conclusions: Offering young people social skills to cope with teasing or bullying about appearance may substantially reduce general bullying as well as that specifically targeted at disfigured individuals. Involving young people in the design of an intervention to be used with them may be crucial to the intervention's eventual success, and strategies learned to cope with appearance-related bullying are easily adaptable for use in other types of confrontation
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