Chapter 1 Body Image Concerns Throughout the Lifespan Jacalyn J. Robert-McComb, PhD, FACSM Texas Tech University

Learning Objectives The difference between normal body image concerns, body dissatisfaction, and the pre-occupation with body image concerns, or a pathological concern for thinness; The difference between normal body image concerns, body dissatisfaction, and the pre-occupation with body image concerns, or a pathological concern for thinness; Mediating factors that contribute to body image dissatisfaction in females; Mediating factors that contribute to body image dissatisfaction in females; Pre-pubertal, adolescent, young adult, midlife and older adult body image concerns; Pre-pubertal, adolescent, young adult, midlife and older adult body image concerns; Clinical assessment tools for the evaluation of body image; and Clinical assessment tools for the evaluation of body image; and Effective body image education and management programs referenced in the scientific literature Effective body image education and management programs referenced in the scientific literature

Introduction Body image is a multidimensional construct Body image is a multidimensional construct “Body image”, according to Thompson, is the internal representation of your own outer appearance “Body image”, according to Thompson, is the internal representation of your own outer appearance Concerns about body image Concerns about body image desire to look attractive desire to look attractive body dissatisfaction body dissatisfaction concern with thinness or perfection concern with thinness or perfection

Introduction cont. Medical issues arise form body dissatisfaction ranging from anorexia nervosa to obesity. Medical issues arise form body dissatisfaction ranging from anorexia nervosa to obesity. Assessment, prevention, and treatment of body image concerns associated with medical disease, is termed the “single most neglected area in the study of body image Assessment, prevention, and treatment of body image concerns associated with medical disease, is termed the “single most neglected area in the study of body image Clinicians need to be aware of the development of body image disturbances, knowledge of body image assessment techniques, and prevention and management programs to be able to educate and guide their patients. Clinicians need to be aware of the development of body image disturbances, knowledge of body image assessment techniques, and prevention and management programs to be able to educate and guide their patients.

The Difference Between Normal Body Image Concerns, Body Dissatisfaction, and the Pre-Occupation with Body Image Concerns, or Body Image Disturbances Body image is individualized Body image is individualized Factors that shape individuals body image: Factors that shape individuals body image: 1. Current/proximal  Everyday experiences, how they are interpreted, and their effects on mood and behavior 2. Historical/developmental  Socio-demographic factors  Peer and familial influences  Internalization of cultural ideal  Personality attributes

Body Image Defined by numerous terms: Defined by numerous terms: Body dissatisfaction Body dissatisfaction Negative body image Negative body image Body dysphoria Body dysphoria Body image distortion Body image distortion Body esteem Body esteem Body image disturbance Body image disturbance Body image concerns Body image concerns

Body Image Cont’ Dissatisfaction Dissatisfaction Common problem in many Westernized women Common problem in many Westernized women The negative subjective evaluation of one’s physical body The negative subjective evaluation of one’s physical body Weight, figure, stomach and hips Weight, figure, stomach and hips Distortion Distortion Typically denotes a clinical problem Typically denotes a clinical problem Most recognized with body image disturbances in eating disorders and body dymorphic disorders Most recognized with body image disturbances in eating disorders and body dymorphic disorders

Mediating Factors that Contribute to Body Image concerns in Females Media Media Culture Culture Difference in athletic and social setting Difference in athletic and social setting Family and Social class Family and Social class

Media Enormous impact on the issue regarding body dissatisfaction Enormous impact on the issue regarding body dissatisfaction Portrays how women “should” look Portrays how women “should” look Effect of fashion magazines and the internet on females Effect of fashion magazines and the internet on females Consumer portrays media differently depending on one’s own culture Consumer portrays media differently depending on one’s own culture

Culture “Metacommunion system” “Metacommunion system” Characteristics of culture Characteristics of culture The medium of personhood and social relationships The medium of personhood and social relationships Consciousness Consciousness An extension of biological capabilities An extension of biological capabilities

Difference in athletic and social setting Society tells women to have a small, toned body, but athletes are to have large and muscular bodies Society tells women to have a small, toned body, but athletes are to have large and muscular bodies An athlete’s body is not accepted in the social setting, but accepted in the athletic setting An athlete’s body is not accepted in the social setting, but accepted in the athletic setting Positive and negative effects concerning athletes bodies are setting dependent Positive and negative effects concerning athletes bodies are setting dependent

Family and Social class Disorders can arise from overprotective parenting Disorders can arise from overprotective parenting Socio-economically advantaged women are more concerned with their body Socio-economically advantaged women are more concerned with their body

Pre-pubertal, Adolescent, Young Adult, Midlife and Older Adult Body Image Concerns Children Children Adolescence Adolescence Adult women Adult women Pregnant women Pregnant women

Children Concerns with body image are starting at a younger age Concerns with body image are starting at a younger age children at the age of five are having concerns about their body image children at the age of five are having concerns about their body image Use of diet and exercise to lose weight Use of diet and exercise to lose weight Fear of becoming fat Fear of becoming fat

Adolescence Body image concerns have been shown to increase with age Body image concerns have been shown to increase with age Greatest risk in development of body image and weight concerns Greatest risk in development of body image and weight concerns Issues that impact teens: Issues that impact teens: Peer pressure Peer pressure Teasing Teasing

Adult Women Research has shown that adult women express unnecessary dissatisfaction about their body Research has shown that adult women express unnecessary dissatisfaction about their body Women with higher education and class are more likely to be dissatisfied with their body Women with higher education and class are more likely to be dissatisfied with their body

Pregnant Women Concern about weight and shape decrease during pregnancy and early postpartum period Concern about weight and shape decrease during pregnancy and early postpartum period A woman’s focus goes toward the well-being of their child A woman’s focus goes toward the well-being of their child

Clinical Assessment Tools for Body Image Cognitive Behavioral Approach Cognitive Behavioral Approach Identifying factors that precipitate and maintain body image concerns Identifying factors that precipitate and maintain body image concerns Primary goals: Primary goals: Contextualize body image concerns in way that will increase patient awareness of precipitating and maintaining factors Contextualize body image concerns in way that will increase patient awareness of precipitating and maintaining factors Provide guide for treatment goals and planning Provide guide for treatment goals and planning

Primary goals Cont’ Current/proximal factors are: Current/proximal factors are: Impact of body image concerns Impact of body image concerns Patient’s investment in appearance Patient’s investment in appearance Activating events/triggers Activating events/triggers Cognitive and emotional processing Cognitive and emotional processing Behavioral strategies/self-regulatory behaviors; and Behavioral strategies/self-regulatory behaviors; and Goals and obstacles to treatment Goals and obstacles to treatment

Primary Goals Cont’ Historical/developmental factors: Historical/developmental factors: Socio-demographic factors Socio-demographic factors Cultural/socialization factors Cultural/socialization factors Physical characteristics of attribute Physical characteristics of attribute Personality attributes Personality attributes History of treatment attempts; and History of treatment attempts; and Co-morbidity Co-morbidity

Cognitive Behavioral Model Self-monitoring integral part in assessment Self-monitoring integral part in assessment Patient record any situation that triggers experiences related to body image, appearance-related beliefs and thoughts, and their effects on mood and behavior Patient record any situation that triggers experiences related to body image, appearance-related beliefs and thoughts, and their effects on mood and behavior Allows assessment of treatment progress and outcomes Allows assessment of treatment progress and outcomes

Commonly used Body Image Assessment Scales and Questionnaires Table 1.1 (in book) Table 1.1 (in book) Lists some common scales that have been reported in research literature that have internal consistency rating and test-retest reliability rating of at least 0.70 Lists some common scales that have been reported in research literature that have internal consistency rating and test-retest reliability rating of at least 0.70 Caution recommended in adopting scales without psychometric properties Caution recommended in adopting scales without psychometric properties Judgment must be used in generalizing the standardized sample to your target sample Judgment must be used in generalizing the standardized sample to your target sample

Effective Body Image Education and Management Programs Referenced in the Scientific Literature Body Image Education Body Image Education Positive impact on women’s body image Positive impact on women’s body image Program based on Social Cognitive Theory Program based on Social Cognitive Theory goal is to promote women’s acceptance of their bodies goal is to promote women’s acceptance of their bodies

Management of Body Disturbances Two primary approaches: Two primary approaches: Cognitive-behavioral Cognitive-behavioral Feminist approach Feminist approach Both treatment option for wide variety of clinical population Both treatment option for wide variety of clinical population

The Cognitive-Behavioral Strategy 8 Components 8 Components 1. Comprehensive body image assessment 2. Body image education 3. Body image exposure and desensitization 4. Identifying and challenging appearance assumptions and problems 5. Clients dispute negative appearance assumptions 6. Targets avoidant behaviors and compulsive patterns by self-defeating body image behaviors 7. Development of body image enhancement activities 8. Clients evaluate their progress, set future goals, and strategies

Feminist Approach Differs form cognitive behavioral approach in 3 primary ways: Differs form cognitive behavioral approach in 3 primary ways: 1. Criticizes approaches that focus on treating body image problems by changing a woman’s appearance 2. Egalitarian relationship characterized by therapist self-disclosure, greater informality and nurturance, and patient advocacy 3. Different etiological factors that play a role in the development of body image disturbance.

Conclusion Growing appreciation of complexities in body image Growing appreciation of complexities in body image Concerns about body image range form normal desire to look attractive, to pathological concern with thinness or perfection Concerns about body image range form normal desire to look attractive, to pathological concern with thinness or perfection Ideas of beauty vary across ethnic groups, gender, sexual orientation, age, and culture Ideas of beauty vary across ethnic groups, gender, sexual orientation, age, and culture