Body Image

Is body image based solely on one’s appearance?

Body image is a multi-dimensional subjective experience, comprised of perceptual, affective, cognitive, and behavioral dimensions. These dimensions interact and influence each other.  Our perception is based on the mental images we have of our appearance, as well as the sensations of being in our bodies. Sometimes our perception is accurate—that is, our mental image matches up with the reality of our appearance and how others perceive our appearance—but sometimes it is distorted and we see something very different from what others see. When perception is distorted, we may overestimate our overall body size or size of body parts or evaluate our bodies differently than others—usually more harshly or with a magnified focus.

The feelings associated with body image can run the emotional spectrum, but in body image disturbance, they tend to take the form of shame, disgust, fear, or sadness. Such feelings may be a constant backdrop, causing significant distress and preoccupation.  Cognitions are beliefs about our appearance (e.g., “being too big or round”), as well as about the meaning of our appearance (e.g., “therefore, I am unacceptable or worthless”). In body image disturbance, individuals tend to equate appearance with overall self-worth.  Consequently, if these individuals are dissatisfied with their appearance, they are dissatisfied with themselves as a whole. This is one of the defining characteristics of clinical body image disturbance which differentiates it from “normative discontent,” the typical dissatisfaction women feel about their ‘flawed” bodies.

Finally, behavioral aspects of body image involve excessive checking and body avoidance. Body checking can take many forms, such as weighing, measuring, pinching, or looking in the mirror. Body checking is driven by the desire to get information or reassurance about one’s appearance or body size in an attempt to alleviate anxiety. On the opposite end of the spectrum is body avoidance, which involves avoiding exposure (of the self or others) to one’s appearance, through wearing baggy clothes, avoiding mirrors, not being touched, etc. The purpose is to avoid upsetting information about one’s appearance or body size and is fueled by dissatisfaction and the sense that one’s body is unacceptable. Both body checking and avoidance are common in individuals with body image disturbance and part of a cycle of distress and preoccupation.

How does a poor body image negatively impact one’s life?

Body image disturbance can negatively impact one’s life in myriad ways. First, it is linked to negative emotions such as self-consciousness, shame, anxiety, and sadness, and can contribute to clinically significant anxiety or depression. Second, body image disturbance can be very preoccupying and distract from focusing on other topics, which can cause educational or occupational impairment. For example, research shows that when young women think about their appearance while taking a math test, their performance is markedly worse than young women who don’t think about their appearance. For individuals with body image disturbance, thoughts about appearance
persist throughout the day and detract from concentration or enjoyment of everyday activities. Further, such individuals may avoid important recreational activities such as exercising with others, going to the beach, going clothing shopping, etc., or endure these activities with much distress because of their extreme self-consciousness and self-criticism. In extreme cases, individuals will diet or restrict their eating significantly, or engage in other disordered eating behaviors such as excessive exercise, purging, diuretic or laxative abuse, all in an effort to “fix” their appearance.

How does one determine when body image concerns would necessitate an intervention?

Body image concerns require intervention when the distress is so extreme that it negatively affects mood, quality of life, or causes impairment. This is qualitatively different than the typical woman’s dissatisfaction, which is usually comprised of fleeting concerns and desire for a “better body.” Questions to ask are: “How miserable do you feel about this?” “How much of your day does this take up?” “How would your life be different if you felt better about your body?” “What things do you avoid or endure with distress because of how you feel about your body?” “What behaviors do you engage in to try to improve your body?” “How much has your weight or shape influenced how you feel about yourself as a person?”

How are college students in particular affected by body image concerns?

Two issues should be highlighted about body image concerns among college students. First, body image disturbance is a risk factor for the development of an eating disorder, such as Anorexia or Bulimia Nervosa. Eating disorders typically start in adolescence, so college is a high-risk period, and body image disturbance and related disturbances should be evaluated and monitored closely. Second, the college environment in particular may promote body image disturbance. Female students may feel overwhelmed by comparisons to each other and may attempt to deal with the stress of college by focusing on an aspect of their lives and identities that they feel they can “control” and “improve”, namely, their bodies.

What is the difference between poor body image and Body Dysmorphic Disorder?

Body Dysmorphic Disorder is a mental illness characterized by an imagined defect in appearance and preoccupation with that defect that causes clinically significant distress or impairment in functioning. Typically, facial features, skin, or hair, are the focus of concern, although any body part(s) may be the focus.

As far as treatment, such as individual or group therapy, what has proven most effective in working through body image disturbances?

Cognitive behavior therapy has empirical support as an effective treatment for body image disturbance, both among individuals with eating disorders and BDD, as well as individuals without diagnosed disorders. Cognitive behavior therapy can be applied in a self-help format (e.g., a self-help workbook) or delivered as part of group or individual therapy.  This intervention can be very effective in helping to improve one’s body image.

Dr. Sherrie Delinsky
Clinical Psychologist, Wellesley, MA
Assistant Psychologist, McLean Hospital
Instructor, Harvard Medical School

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