While I was writing my latest book “Adultish: The Body Image Book for Life,” I had an opportunity to interview Abby (24 years old), who told me, “Growing up, I can’t remember a time I when I wasn’t thinking about my body or what I was eating. I thought I was the only one consumed by this self-consciousness and it was so isolating.”
Body image is often defined as how we think and feel about our appearance in general, but it is much more than this. Our body image is a central facet of our identity, guiding how we interact with others — with avoidance or confidently? — and our health behaviors — eating to support our health or skipping meals? Body image is also integral to our mental health.
Day-to-day, body image is linked with our mood, self-esteem and outlook on life. Across days, poor body image is associated with mental health conditions, including body dysmorphic disorder, eating disorders, depression, anxiety and substance use disorders.
[READ: Eating Disorders and Body Image Issues in Boys and Men.]
How Poor Body Image Affects Mental Health
Body image is multifaceted and consists of cognitive, perceptual, affective and behavioral factors. In other words, body image includes how people think about their bodies, how they perceive them, their feelings about them and behaviors that result. I often describe body image as how comfortable we feel in our own skin.
One recent report indicated that over 40% of adolescent girls and boys experienced moderate to clinically significant body dissatisfaction, whereas other research indicated that approximately 70% of adolescents experience body dissatisfaction.
Among adults, one large study found that 30% to 40% of women and men negatively evaluated their appearance, but other research that I’ve conducted has shown that up to 90% of women are dissatisfied with their appearance.
Body dysmorphic disorder
Body dysmorphic disorder (BDD) is a body image disorder. People with BDD are preoccupied with their bodies’ defects and flaws. They are compulsive about tending to their appearance and may go to extremes to alter their appearance, such as obtaining extensive cosmetic surgery. At the heart of BDD is the inability to see oneself as others do and being extremely critical of one’s body. People with BDD may experience self-doubt, anxiety and depression as a result of their preoccupation with their bodies.
When people with BDD try to alter their appearance to cope with their preoccupations, they do not tend to feel better. Instead, they often experience additional distress.
Although extreme, patients with BDD make it clear that body image concerns are linked with mental illness and are not necessarily about appearance, but deeper psychological issues.
Eating disorders
Poor body image is a strong predictor of most eating disorders, although it is not always present. The Diagnostic and Statistic Manual of Mental Disorders describes criteria for anorexia nervosa to include, “disturbance in the way in which one’s body weight or shape is experienced; undue influence of body weight or shape on self-evaluation …”
Bulimia nervosa is similarly characterized, however binge-eating disorder and other eating disorders, such as avoidant/restrictive food intake disorder, are not.
It’s important to appreciate that body image concerns are not necessarily linked with body size. In other words, a person may be excessively concerned about their body size and restrict themselves from eating certain foods or amounts of food and yet they may be a relatively slender person. Thus, although body image concerns are associated with eating disorders, the link can be complicated and difficult to untangle.
Depression
Body dissatisfaction is associated with depression, although it has always been somewhat unclear as to which is the chicken and which is the egg. Most studies examining body image and depression seem to conclude that it doesn’t really matter which comes first, because the association is likely reciprocal; feeling bad in general probably exacerbates body dissatisfaction and body dissatisfaction probably contributes to feeling bad in general.
Alli Spotts-de Lazzer, a psychotherapist with over 17 years treating patients with eating disorders told me, “when we feel bad about our bodies, we tend to feel bad about ourselves. Add stigma and fear that our bodies won’t be accepted or aren’t safe in our society, and it is no wonder that there is an association between depression and body image.”
One recent review of relevant research found that combining treatment for body dissatisfaction and depressive symptoms may be advantageous. Another intervention found that focusing adolescents on how their body functions, not how it appears, may lead to reductions in both body image concerns and depression symptoms.
[READ: What Is Body Inclusivity? Health Benefits of Body-Inclusive Fitness]
Anxiety
Anxiety specifically about one’s body is associated with general anxiety for both men and women. Further, people who experience more dissatisfaction with their bodies are likely to also experience more anxiety overall. The reasons for the link between body image and anxiety are not entirely clear. It seems most likely that when people feel uncomfortable with themselves, they are more likely to feel that the world is a more frightening place. In contrast, a sense of personal security that accompanies feeling comfortable in one’s own skin can make the rest of the world a lot more approachable.
According to Deborah Sepinwall, a clinical psychologist with 20 years of experience treating patients with both anxiety and disordered eating, “anxiety can be protective and adaptive or excessive and erroneous. When the latter occurs, instead of recognizing the faulty processes at work, we get hooked and hijacked by these overblown and inaccurate thoughts. This can lead to misperceptions of our bodies and appearances, which may further exacerbate anxiety.”
Substance use disorders
The link between substance abuse and body image may not seem at all obvious. Some scientists have suggested that body dissatisfaction may contribute to a lack of self-respect and self-care, which in turn may enable habits such as smoking, drinking and drug use. When people don’t feel that their body is valuable — or they’ve been taught by others that it is not valued — they may be less committed to taking care of it and maintaining healthy habits.
A more direct link between substance use and body image emerges when people use substances to try to alter their bodies, in particular, their muscularity. This is more common among boys and men than girls and women, but the use of supplements and even drugs such as anabolic steroids has become increasingly common in recent years; some research suggests that about 6% of the population uses steroids. Of course, people use steroids to improve their athletic performance, but steroid use has been linked with body image and muscularity concerns. This means that some people take these drugs just to alter the appearance of their bodies. However, some research suggests that steroid use may not improve body image over time.
[READ: Yoga for All Bodies.]
Bottom Line
Although body image concerns are associated with other mental health problems, they don’t often warrant a clinical diagnosis. Still, they are associated with a variety of other mental health issues. Thus, treating body image concerns may improve or even prevent other mental health concerns.
Abby shared that her body dissatisfaction permeated her life and contributed to the development of an eating disorder. However, therapy helped her to address these interrelated challenges. She told me, “It’s surprising, but I feel really great about my body now. I didn’t expect to get to this place, where I feel joyful about my relationship with my body.”
For Abby, addressing her body image concerns led her to feel joyful about her life.
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Body Image and Mental Health originally appeared on usnews.com
