The 12-item General Health Questionnaire (GHQ-12) has been recommended as a reliable screening instrument for psychological distress in all clinical groups. However, a fundamental tenet underlying the utility of this widely used screening instrument is that it is a unitary measure of psychological distress. The factor structure of the GHQ-12 was evaluated in individuals experiencing significant facial disfigurement drawn from plastic surgery, dermatology, and media-recruited populations. Confirmatory factor analysis was conducted on self-report GHQ-12 data from 362 individuals with significant facial disfigurement. Nine factor models were tested on all three versions of the recommended GHQ-12 scoring method. Internal reliability analysis was also conducted. The GHQ-12 was found to be internally reliable irrespective of scoring method adopted. However, three-factor models offered superior fit to the data compared to the presumed unidimensional structure. The GHQ-12 is a multidimensional instrument comprising three subscales embedded within the tool in individuals with facial disfigurement. The measure may be usefully developed as an instrument comprising three subscales in this group. The claim that the GHQ-12 is a unitary measure of psychological distress is unsupported.