Socioemotional functioning with facial paralysis: Is there a congenital or acquired advantage?

OBJECTIVE: Facial paralysis (FP) may impact emotional clarity, attachment, stigma, anxiety, and depression. The distinction between being born with it or acquiring it later may prompt developmental differences with consequences into adulthood, yet this has not been systematically studied. Two competing hypotheses were tested. First, the acquired advantage hypothesis states facial expression early in development plays a crucial role in socioemotional functioning, perhaps via facial feedback, and people with acquired FP would function better. Second, the congenital advantage hypothesis states impaired facial expression during early development promotes adaptation for socioemotional functioning, and people with congenital FP would function better. METHOD: Adults with congenital (n = 112) or acquired (n = 434) FP completed survey measures of emotional clarity, attachment security, stigma, anxiety symptoms, and depression symptoms. RESULTS: One-sample t tests showed that congenital and acquired participants had greater anxiety, depression, and stigma compared with the measures' norm data, and only acquired participants had more problems with emotional clarity and attachment than norms. ANCOVAs indicated that acquired, compared with congenital, participants had greater problems with emotional clarity, anxiety, and depression, controlling for age, gender, and FP severity. Hierarchical multiple regressions found that stigma, emotional clarity problems, younger age, insecure attachment, and acquired onset predicted anxiety and depression. CONCLUSION: People with FP, especially acquired FP, are at greater risk of socioemotional problems, yet no interventions exist. Contrary to work suggesting that facial feedback is crucial for socioemotional development, results suggest that those born with FP are better adapted than those who acquire it. (PsycINFO Database Record (c) 2020 APA, all rights reserved).