A systematic review of self-help for disfigurement: Effectiveness,usability, and acceptability

Self-help has been found to be efficacious in treating mood disorders, however, little is known about its use, effectiveness, or user satisfaction, in reducing distress associated with disfigurement. This review describes the content and focus of self-help interventions available in this area. A systematic search and appraisal protocol facilitated identification of studies, extraction of data, and appraisal of quality. Clinical trials were included if the primary method of intervention delivery was via self-help. Other types of study were included if they investigated user perspectives of a self-help intervention. Eleven studies covering a range of populations met the inclusion criteria. There is tentative support for the use of self-help to manage anxiety associated with disfigurement but little is known about the management of other psychosocial difficulties. Further research and intervention development is required to examine the effectiveness, acceptability, and utility of self-help in managing the appearance related distress associated with disfigurement.     

The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment

Although the role of the objectively and subjectively rated severity of appearance problems is often debated, the impact of severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to self-consciousness of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment. Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe objective severity was most related to poor adjustment.     

Body image interventions in cognitive-behavioural therapy of binge-eating disorder: a component analysis

The present study sought to investigate effects of body exposure in the treatment of binge-eating disorder (BED). Cognitive-behavioural therapy with a body exposure component (CBT-E) was compared with CBT with a cognitive restructuring component focused on body image (CBT-C). Twenty-eight patients diagnosed with BED were randomly assigned to CBT-E or CBT-C, both delivered in a group format. Negative automatic thoughts about one's body, dysfunctional assumptions about shape and weight, and body dissatisfaction were assessed using experimental thought-sampling techniques, a clinical interview (Eating Disorder Examination), and self-report questionnaires. At posttreatment and at 4-month follow-up, CBT-E and CBT-C were equally effective in improving body image disturbance on all indicators assessed. Both CBT-E and CBT-C produced substantial and stable improvements in the specific and general eating disorder psychopathology. Results suggest that both treatment components are equally effective in the treatment of BED.     

Body image and health locus of control among male patients with incisional hernias

Incisional hernias form after surgery through incision sites and can enlarge over time. Relations between body image (BI) and health locus of control (HLC) were investigated in male patients undergoing evaluation for incisional hernia repair (n = 32) and non-hernia controls (n = 34). Analyses revealed that patients with incisional hernias reported significantly less satisfaction with general appearance and appearance of the mid-torso than non-hernia controls. Although HLC beliefs did not vary by group, post hoc analyses revealed several significant relations between BI factors and HLC beliefs. Results suggest that poor BI is a significant area of concern among patients with incisional hernias.     

Body image distortions in healthy adults

Distortions of body image have often been investigated in clinical disorders. Much of this literature implicitly assumes healthy adults maintain an accurate body image. We recently developed a novel, implicit, and quantitative measure of body image — the Body Image Task (BIT). Here, we report a large-scale analysis of performance on this task by healthy adults. In both an in-person and an online version of the BIT, participants were presented with an image of a head as an anchoring stimulus on a computer screen, and told to imagine that the head was part of a mirror image of themselves in a standing position. They were then instructed to judge where, relative to the head, each of several parts of their body would be located. The relative positions of each landmark can be used to construct an implicit perceptual map of bodily structure. We could thus measure the internally-stored body image, although we cannot exclude contributions from other representations. Our results show several distortions of body image. First, we found a large and systematic over-estimation of width relative to height. These distortions were similar for both males and females, and did not closely track the idiosyncrasies of individual participant's own bodies. Comparisons of individual body parts showed that participants overestimated the width of their shoulders and the length of their upper arms, relative to their height, while underestimating the lengths of their lower arms and legs. Principal components analysis showed a clear spatial structure to the distortions, suggesting spatial organisation and segmentation of the body image into upper and lower limb components that are bilaterally integrated. These results provide new insight into the body image of healthy adults, and have implications for the study and rehabilitation of clinical populations.     

Body image and cystic fibrosis: a critical review

A slight frame and poor appetite are common among patients with cystic fibrosis (CF) yet healthy body weight has been related to a better prognosis. A review of studies exploring body image (BI) among adults and adolescents with CF was conducted. Seven electronic databases were searched for potential papers. They located 128 references, of which 24 were read in full and 12 included in the review. Accepted papers suggested females with CF had a better BI compared to males, but this could compromise survival, given their preference for a low body weight. Males may be more motivated to adhere to nutritional advice because they favor a larger form. Practitioners should broach the topic of BI at clinic appointments to ensure this does not have a detrimental impact on self-management, although more research is required to guide professionals in this task.     

Body image disturbance and relationship satisfaction among college students

Two hundred and eighty-two college undergraduate and graduate students, including 81 males and 201 females, responded to an on-line survey measuring relationship satisfaction, body image distortion and body dissatisfaction, self esteem, and thoughts about weight loss. A modified Kansas Marital Satisfaction Scale (KMSS) queried respondents about their relationship satisfaction as well as their perception of their partner’s satisfaction with the relationship. Respondents checked one of 17 figural drawings indicating their perceived and ideal size as well as judgments of perceived and ideal size of their partner. Females had greater body image size distortion and body dissatisfaction, lower self esteem, and more frequent thoughts about weight loss. Males were more dissatisfied with their partner’s size. Respondent’s body size distortion predicted perceived partner relationship satisfaction, with greater size distortion predicting less perceived partner relationship satisfaction. Greater perceived partner relationship satisfaction predicted increased respondents’ relationship satisfaction. Perceived partner’s dissatisfaction with respondent’s body size only approached significance as a predictor of respondent’s relationship satisfaction. However, the strength of this variable as a predictor warrants further examination of its potential role in relationship satisfaction.     

Body image importance and body dissatisfaction among indigenous Australian adolescents

Despite their elevated risk of health problems and a propensity to be more overweight or underweight relative to the other members of the Australian population, there has been no previous investigation of body image concerns among Indigenous Australians. In this study we investigated the level of body image importance and body image dissatisfaction among 19 rural Indigenous adolescents (7 males, 12 females) and 28 urban Indigenous adolescents (15 males and 13 females). Our hypotheses that there would be gender differences in body image importance and body image satisfaction were not generally supported. However, males placed more importance on muscle size and strength than females, and rural participants placed more importance on weight than urban participants. Comparison to existing data obtained from Caucasian adolescents suggested that Indigenous youth may be less concerned and dissatisfied with body weight and shape. These results are discussed in relation to findings from studies of non-Indigenous adolescents, and Indigenous health issues. The limitations of the current study and the need for further studies are also discussed.     

Body image and cosmetic medical treatments

Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors—the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.     

Shopping for clothes: Body satisfaction, appearance investment, and functions of clothing among female shoppers

The present study aimed to investigate the link between clothing and body experience in women of different ages. Participants were 162 female clothes shoppers between the ages of 18 and 55 who completed questionnaire measures of body image, functions of clothing, self-esteem, and enjoyment of clothes shopping. It was found that clothing was worn primarily for assurance and fashion by women of all ages. On the other hand, BMI and body dissatisfaction were related to the use of clothing for camouflage purposes and to a more negative clothes shopping experience. Both components of appearance investment were related to choice of clothes for fashion and assurance. However, the self-evaluative salience component was negatively related, while the motivational salience was positively related, to enjoyment of clothes shopping. It was concluded that although clothing is an under-researched aspect of body image, it represents an important part of women's appearance management, whatever their age.     

Assessing body image in patients with systemic sclerosis (scleroderma): validation of the adapted Satisfaction with Appearance Scale

People with scleroderma often experience disfiguring appearance-related changes in socially visible and interpersonally salient areas. Although disfigurement can lead to body image dissatisfaction, this phenomenon has not been well investigated due to the lack of a disfigurement-specific measure. The Satisfaction With Appearance (SWAP) scale, previously developed in burn survivors, was adapted and administered to 254 participants with scleroderma to evaluate its psychometric integrity and its validity for use in a different medical population that experiences changes in appearance. Principal component analysis revealed two factors – Subjective Dissatisfaction and Perceived Social Impact – rather than the four found in burn victims. Excellent estimates of internal consistency and temporal stability and strong evidence for the reliability of the two-factor solution were found. The resulting factor structure in a scleroderma population suggests that differing medical conditions may create alternate constellations of BID, reflects the need for body image researchers to assess psychometrics across medical populations and may have clinical implications for BID interventions.     

Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population

Despite numerous measures of facets of the body image construct, no single assessment broadly measures a continuum of body image disturbance. Accordingly, this study developed the Body Image Disturbance Questionnaire (BIDQ), derived from the Body Dysmorphic Disorder Questionnaire. Participants were 220 college women and 75 college men who completed an online survey containing this new assessment and established measures of body image and psychosocial functioning. Results confirmed that the Body Image Disturbance Questionnaire was internally consistent and free of impression-management response bias. For both sexes, the measure converged appropriately with other body image indices (evaluation, affect, investment, and impact), was positively correlated with depression, social anxiety, and eating disturbance. Scores on this assessment also predicted psychosocial functioning above and beyond body dissatisfaction as a predictor. Greater body image disturbance was observed among women than men, among heavier than lighter women, and among White than African American women. Limitations and future research implications are discussed.     

Culture and body image: Body perception and weight concern in young Asian and Caucasian British women

The comparatively lower prevalence of eating disorders among Asian and Afro-Caribbean than Caucasian women in the UK has often been attributed to cultural differences in pressures for slimness. However, there have been no attempts to evaluate cultural differences in ideals for female physique directly among women in the at risk age groups. In the present study, cultural influences on body image were evaluated by comparing the body size ideals, body image and dieting concerns in a sample of 274 young white and Asian British women. The results indicate that Asian women are less likely to describe themselves as too fat, were less dissatisfied with their body size, less likely to want to lose weight and less restrained. However, Asian women were slimmer than white women and, after controlling for the difference in body size, the effects were reduced. The hypothesis that any body satisfaction differences could be explained by differences in ideal body size between the two groups were not supported; Asian women favoured even slimmer ideal body sizes than white women. Alternative explanations in terms of cultural differences in evaluation of fatness are discussed.     

Women's exposure to thin-and-beautiful media images: body image effects of media-ideal internalization and impact-reduction interventions

Exposure to media images of thin-and-beautiful women negatively affects the body image and mood states of young women. However, not all women are equally susceptible to these effects. The present experimental investigation with 123 young college women evaluated the moderating effects of the extent of internalization of media ideals. It also examined the preventative impact of two brief interventions (i.e., media literacy information with and without a dissonance-induction procedure). Results indicated that relative to a control group, the exposure to thin-and-beautiful media images adversely influenced the state body image of participants with high internalization levels. Media-literacy psychoeducation prior to the media exposure prevented this adverse effect. Adding a pre-exposure dissonance-induction procedure did not significantly enhance the preventative effects relative to psychoeducation alone. These results and their implications for the treatment and prevention of body image disturbances are discussed in the context of the empirical literature on the media's effects on body image.     

Body representations and cognitive ontology: Drawing the boundaries of the body image

The distinction between body image and body schema has been incredibly influential in cognitive neuroscience. Recently, researchers have begun to speculate about the relationship between these representations (Gadsby, 2017, 2018; Pitron & de Vignemont, 2017; Pitron et al., 2018). Within this emerging literature, Pitron et al. (2018) proposed that the long-term body image and long-term body schema co-construct one another, through a process of reciprocal interaction. In proposing this model, they make two assumptions: that the long-term body image incorporates the spatial characteristics of tools, and that it is distorted in the case of Alice in wonderland syndrome. Here, I challenge these assumptions, with a closer examination of what the term “long-term body image” refers to. In doing so, I draw out some important taxonomic principles for research into body representation.     

Body image and size perceptions of Mexican American women

Purpose was to examine in Mexican American women the influences of age, weight, socioeconomic status and acculturation level on body image, perceptions of attractive and acceptable female shapes, and tolerance for overweight and obesity. Participants were 276 Mexican American women. Age, body mass index, socioeconomic status, and acculturation level were measured. The Figure Rating Scale was used to assess body image, preferences for body size, and perceptions of underweight to obese and acceptable body sizes. Significant effects for acculturation level and current weight were found. Women who were more Anglo oriented showed greater preference for thinner figures. As compared to normal weight women, obese women chose larger figures as ideal, realistic, attractive, and thinnest acceptable. Findings point to the impact of acculturation and obesity on body image and size perceptions. Health professionals working with Mexican Americans should consider each individual's current weight and level of acculturation.     

A qualitative study of body image and appearance among men of Chinese ancestry in Australia

Little is known about the body image of non-White men living in Western countries, even though it has been suggested that they may be more at risk of body image concerns, especially if they internalize Western ideals. This study focused on identifying the main body image and appearance themes among 15 men of Chinese ancestry in Australia using semi-structured interviews and grounded theory. Moderate muscularity was the preferred ideal and height dissatisfaction was shown to be the primary concern. The majority was not invested in achieving muscularity and had a “holistic” approach to their body image that included concerns about hairstyling and clothing. In addition, the men were influenced by both Asian and Western ideals, and this included comparison targets with both Asian and Western men. Further studies are needed to assess the extent of men's body image and appearance concerns, and the role played by Asian and Western influences.     

Body image and suicidal ideation in adolescents

Data from 231 adolescents (mean age = 15.7, SD = 1.39) were collected from a public school setting in the United States. Participants completed several measures, including those assessing depression, hopelessness, past suicidal behavior, body image, and current suicidal ideation. It was hypothesized that depression, hopelessness, past suicidal behavior, and body image (a risk factor seldom examined) would significantly predict current suicidal ideation and that there would be gender differences for body image. Regression analyses indicated that all risk factors including body image were significant predictors of current suicidal ideation for the whole sample. For both males and females, body image offered a unique contribution to the measurement of suicide ideation above and beyond the other risk factors, with body attitudes/feelings being the strongest predictor. Results encourage the inclusion of body image as a variable in risk models for adolescent suicidal ideation, as it likely accounts for additional variance above and beyond traditional risk factors.     

Testing a Model of Disfigurement: Effects of a Skin Camouflage Service on Well-being and Appearance Anxiety

This paper outlines and tests a model of disfigurement that integrates psychological and sociological viewpoints on appearance anxiety. Thirty-two clients who attended the British Red Cross Skin Camouflage Service for assistance in covering skin blemishes completed questionnaires designed to assess aspects of the model just before and four months after their appointment. As predicted, the results indicated that attendance at the Service had beneficial effects in reducing self-reported avoidance and increasing confidence. Well-being as measured by the General Health Questionnaire improved for those who found the camouflage cream effective in covering blemishes. Also as predicted, more fundamental aspects of appearance anxiety as measured by the Appearance Schema Inventory and Fear of Negative Evaluation were relatively unaffected by the use of camouflage creams. The results suggest that the model can be used to understand the social and cognitive processes involved in dealing with disfiguring conditions and to inform assessment of the effects of medical and psychological interventions.     

Body image and explicit and implicit anti-fat attitudes: the mediating role of physical appearance comparisons

Prejudice against overweight people is rife. However, there is a paucity of research on the underlying reasons for it. In two studies the relationship between body image, the tendency to make physical appearance-related comparisons (PACS), and both explicit and implicit anti-fat attitudes was examined. In Study 1 (n = 227) people with a high tendency to make physical appearance-related comparisons (high PACS scorers) reported lower self-appearance evaluation, but higher appearance orientation and explicit anti-fat attitudes. The PACS fully mediated the relationship between appearance orientation and explicit anti-fat attitudes. Study 2 (n = 134) found that the PACS also mediated the relationship between appearance orientation and implicit anti-fat attitudes. Thus, individual differences in factors such as body image and the tendency to make appearance-related comparisons, appear to play a central role in both explicit and implicit anti-fat attitudes.