I wanted to be a therapist since I was in junior high school. Before I decided to make the investment and return to school for my latest degree, I often thought about the types of clients I would want to help. I often thought about helping women cope with anxiety and overcome trauma to strengthen their sense of self.  I imagined that my clients would be complex, interesting, deserving people with various experiences and objectives.  I had no idea that most of my (female) clients would suffer from a surprisingly negative self-image, and still felt tremendous pressure to conform to unreasonable standards of appearance. While this bums me out, it is something concrete and workable in a therapeutic relationship.

Body image

What is body image? Body image is one’s assessment of self related to physical appearance based on one’s thoughts, beliefs, feelings, attitudes and perceptions. Another way to describe body image is how one feels in their own body. According to The National Eating Disorder Association, children begin to internalize messages related to their body at an early age and that these are a large part of the foundation for how we perceive ourselves throughout our lives.  While it is common for people to internalize negative comments about appearance, leading to a poor self-image, it is also true that significant input on one’s appearance generally, even when the messages are positive, can also have a negative result on self-esteem and identity over time.  More specifically, when a child is given more attention and positive feedback about their looks than about other aspects of their identity, they may infer that their appearance is of greatest importance, and therefore focus on appearance to excess.

Body Image and Gender

I think many people would not be surprised to hear that women tend to have a more negative perception of their body image than do men.  The National Library of Medicine published a 2023 article by Seyed Alireza Hosseini and Ranjit K. Padhy titled “Body Image Distortion”, and referred to the results of a particular study on body dissatisfaction and gender:

The prevalence of body dissatisfaction in children and adolescents of developed countries varies between 35% and 81% in girls and from 16% to 55% in boys.  [emphasis added]

https://www.ncbi.nlm.nih.gov/books/NBK546582/

While no group of people is automatically exempt from poor body image, more females suffer from this problem than males.  Does this diminish men’s needs in this area?  No.  However, given the higher prevalence in females which is my primary clinical focus, most of my comments will pertain to those who identify as girls and women. 

Historically, women have been judged largely on their appearance and attractiveness to men in order to “earn” their place in society.  While women are now arguably more able to make choices about how to live their lives, as they have an option to work to provide for their own needs rather than be dependent upon a male family member, the belief that a women’s looks are the most important part of her identity remains. It is pervasive and insidious messaging: women are judged upon their appearance rather than their competence. I recall when former US Secretary of State Hillary Clinton was running the the office of President of the United States; I heard so many people complaining about her clothes (!#@?), and that this was their reason for not supporting her candidacy.

Factors that contribute to body image

Many factors are thought to contribute to one’s satisfaction/dissatisfaction with body image. Here are a few factors:

Teen girls

While I work primarily with adults, I have had the pleasure of meeting and working with a number of girls, most of which were teens.  These kids were actually pretty great, and I think they will be amazing adults.  I had not expected that virtually ALL of these young female clients would have such an unhealthy relationship with food and a serious belief that they were extremely unattractive.  I often recommended that they seek treatment by a nutritionist, as they appeared underweight, and I suspected that they probably did not eat enough most days. 

Perhaps it won’t surprise you to hear that many people blame social media for the apparent increase in teens with negative body image.  According to a 2020 study by The American Psychological Association, vulnerable teens experienced a statistically significant improvement in their reported satisfaction with their weight and overall appearance by reducing social media use by 50%. At least this study suggests that reducing exposure to social media actually helps, at least during the duration of the data collection period. An article published by The Cleveland Clinic discussed more specifically how the use of filters and photo editing apps negatively impacts body image, potentially leading to depression, low self-esteem, and even body dysmorphic disorder.  Facial plastic and reconstructive surgeon Dr. Patrick Byrne discusses his view of how seeing one’s face on social media can become an obsession:

“For the first time in human history, we’re carrying around devices that we use to take and share photographs,” [says Byrne]. “That has led to an obsession with appearance as it appears on a screen, which has fundamentally changed the challenges people face.”

https://health.clevelandclinic.org/social-media-and-body-image

So what?

By various measures, a negative body image is a pretty pervasive problem, especially among females.  It’s probably not a new problem, although more recent aspects of society, such as the prevalance of social media, might exaserbate the problem.  However, a poor body or self image is often a precursor to more serious problems, including:

body dysmorphic disorder obsessive compulsive disorder

eating disorders depression

poor self-esteem generalized anxiety

social anxiety self-harm

Does it look more serious now?

Questions?

References 

“Reducing Social Media Use Improves Appearance and Weight Esteem in Youth with Emotional Distress,” by Helen Thai, BA, McGill University; Christopher Davis, PhD, Wardah Mahboob, MA, Sabrina Perry, BA, and Alex Adams, BA, Carleton University; and Gary Goldfield, PhD, Children’s Hospital of Eastern Ontario. Psychology of Popular Media, published online Feb. 23, 2023.; https://www.apa.org/news/press/releases/2023/02/social-media-body-image

 How Social Media Can Harm Your Body Image, July 20, 2023.  https://health.clevelandclinic.org/social-media-and-body-image

Yvette Brazier, medically reviewed by Marney A. White, PhD, MS, Psychology, Updated on May 25, 2023.  What Is Body Image? Medical News Today. https://www.medicalnewstoday.com/articles/249190#definition

 Hosseini SA, Padhy RK. Body Image Distortion. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546582/