Q & A: Body Image Disturbance
Q: What Is body image disturbance?
A: Body image is your internalized view of your weight, shape, and appearance. It is your perceived view of your body, as opposed to an objective view from an outside observer. Interestingly, for most people there is a surprisingly low correlation between how they see themselves and their actual appearance to others.
A disturbance (or disturbances) in body image may involve a range of behaviors. For instance, an affective disturbance would consist of an emotional reaction to some feature of the body (like feeling anxious about your waist size), while a cognitive disturbance would be revealed by specific negative self-statements regarding appearance (such as “I look fat.”). Avoiding social situations that produce a focus on the body (such as parties) is frequently associated with affective and cognitive dimensions of body image disturbance. A perceptual disturbance might involve the tendency to actually misperceive one’s body features (like someone thinking they’re fat even though they are emaciated).
However, there is emerging evidence that a true perceptual deficit is not present in most cases of body image disturbance.
When more than one aspect of body image disturbance is evident, the individual may experience a severe impairment in social and occupational functioning, leading to a significant body image disturbance that may border on body dysmorphic disorder (BDD). With BDD, the distress about one’s appearance often leads to depression or avoidance of social situations.
Q: What is the connection between body image disturbance and eating disorders?
A: Negative body image characteristics are one of the symptoms for the diagnosis of anorexia nervosa and bulimia nervosa. Specifically, for anorexia, one of the DSM-IV-TR criteria is an “intense fear of gaining weight or becoming fat, even though underweight.” For bulimia, the body image criterion is “self-evaluation is unduly influenced by body shape or weight.” Body image issues also exist in individuals with binge eating disorder.
Body image disturbance is the most consistent predictor of the onset and maintenance of an eating disorder. For example, greater satisfaction with emaciated appearance predicts poorer weight gain and greater likelihood of relapse in anorexia. In terms of bulimia, body image disturbance at the end of treatment is one of the best predictors of relapse after 7 months. For adolescents, body image disturbance may onset binge eating and the remission of these bulimic behaviors.
Q: What are the causes of body image disturbance?
A: Body image disturbance appears to be most prevalent in industrialized nations where cultural beauty standards exceedingly stress the importance of thinness. Unfortunately, these ideals are unrealistic, unhealthy, and unachievable for the vast majority of women. Feminist theorists explain that the culture of thinness is a means by which patriarchal society can effectively control women and that women are far more likely than men to have been socialized to equate attractiveness with success.
Personality features may also explain which individuals are most susceptible to body image problems. For instance, the tendency to internalize the thin ideal to the point that it becomes incorporated into one’s own belief system is one type of personality feature. Another is the inclination to compare one’s own appearance to others. These often take the form of “upward comparisons,” which means the target for comparison is someone who is more attractive or thinner, thus adding to one’s own appearance dissatisfaction. Prevention work has found that modifying these beliefs is possible and that changes in this risk factor appear to be related to changes in levels of body dissatisfaction and eating.
Parental modeling and peer attitudes may also transmit and reinforce cultural standards of thinness and appearance. Parental influences include not only the parent’s own eating behaviors and body image beliefs, but also attitudes toward their children’s weight or shape. Peer influences may take the form of direct comments or indirect modeling of dietary restriction or body image concerns. Insults, cruel comments, and teasing regarding appearance have been linked to not only body disturbances, but also to the onset of dieting and bulimic behaviors.
Finally, a variety of other factors such as a history of sexual abuse, sexually inappropriate commentary or sexual harassment, accident or injury, disease (e.g., breast cancer), pregnancy and the postpartum period, aging and menopause have all been found to be related to the onset of some form of body image disturbance.
By J. Kevin Thompson, PhD, & Leslie J. Heinberg, PhD
Reprinted with permission from Eating Disorders Recovery Today
2004 Volume 2, Number 5
©2004 Gürze Books
About the Authors
J. Kevin Thompson, PhD, is Professor of Psychology at the University of South Florida in Tampa. He has authored, coauthored, edited, and coedited five books on the topics of body image, eating disorders, and obesity.
Leslie J. Heinberg, PhD, is an Associate Professor of Psychiatry, Division of Child and Adolescent Psychiatry at Case Western Reserve University School of Medicine. Her interests include sociocultural aspects of body image, body image in medical populations, and predictors of treatment success for eating disorders.