Social anxiety in people with facial palsy: The role of fear of negative evaluation and appearance-fixing behaviour

Br J Health Psychol. 2025 Sep;30(3):e70018. doi: 10.1111/bjhp.70018.

ABSTRACT

OBJECTIVES: The current study aimed to explore whether people with facial palsy experienced more social appearance anxiety, social anxiety, fear of negative evaluation, and engaged in more appearance-fixing behaviour than controls without facial palsy. The secondary aim was to investigate whether fear of negative evaluation and appearance-fixing behaviour were predictive of social appearance anxiety in people with facial palsy.

METHOD: People with facial palsy (n = 78) and people without facial palsy (n = 86) completed online questionnaires with measures of social anxiety, social appearance anxiety, fear of negative evaluation, and appearance-fixing behaviour.

RESULTS: The facial palsy group experienced significantly greater social appearance anxiety, social anxiety, and fear of negative evaluation than the control group; controlling for depression. The facial palsy group also engaged in significantly more appearance-fixing behaviour than the control group. Further, controlling for depression, fear of negative evaluation from others and appearance-fixing were both found to be significant positive predictors of social appearance anxiety in the facial palsy group.

DISCUSSION: Findings are consistent with Clark and Well’s (1995) cognitive behavioural model of social anxiety. Findings indicate a need for screening and provision for psychological support for social anxiety in people with facial palsy and that cognitions relating to fear of negative evaluation and appearance-fixing behaviour are potentially useful targets for intervention.

PMID:40891371 | DOI:10.1111/bjhp.70018