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Body Image Disturbance and Psychopathology in Children: Research Evidence and Implications for Prevention and Treatment
Abstract
Body image disturbance has been listed as a diagnostic feature of several psychopathological conditions [1-5]. As body image concerns appear in children as young as 5 years old, it was hypothesized to be an important risk factor for the development of psychopathology, such as Eating Disorders (ED) in adolescence. Results of the current review of the literature support this hypothesis and suggest that young children can (1) estimate as accurately as adults their body size, and (2) show similar cognitive distortions, cognitive biases, and the negative emotions associated with their body image. There is some evidence that children can (1) display severe symptoms of body image distortion such as is present in body dysmorphic disorder (BDD), (2) demonstrate negative stereotypes toward obesity and (3) internalize thin ideal body image. Research suggests that some of the key factors involved in children's body satisfaction is parental perception and direct comments from peers. Body dissatisfaction can predict body image related psychopathology later in development. In conclusion, intervention and prevention of eating disorders with children under the age of 7 is arguably a viable strategy, and cognitive and behavioural training could involve parents, teachers, mental health practitioners as well as the child him/herself. This training and education should cover early manifestation of body image disturbance and their associated risk factors.
... Findings on the attitudes of 5-year-old children towards appearance (Kim, Kim and Kim, 2012) and body stigmatisation in preschool children (Kirkpatrick and Sanders, 1978;Stager and Burke, 1982) also noted that body size stigmatisation appears at 5 years of age. Tremblay and Limbos (2009) found that negative body image is present in the pre-adolescent period and can be seen in children as young as 5-7. ...
... In the last decade, a qualitative study on the body image of 5 years old children (Park and Lee, 2010) and a study on sociocultural attitudes toward body image in 5-year-old children (Kim et al., 2012) were the only studies found. The scarcity of studies on the body image of preschool children can be explained by the low reliability of the cognitive appraisal of a preschool child (Tremblay and Limbos, 2009). The current study thus focuses on using adequate measurements to assess the body satisfaction of preschool children by identifying perceptions and expectations of their body. ...
Bipedalism:
As a result of the rift and plateau formation in East Africa 6-7 mya, a primate made an adaptive
response to this development. And this primate hunted and gathered food in shallow waters on
two legs. This shallow water made a selective pressure on that primate to walk bipedally.
Mental Overturning:
When about 2 mya the body erection reached a certain angle, the embryo made an adaptive
response to this vertical body. The embryo turned upside down. This is the mental overturning
that started the growth of the cranium as well as the brain.
Mental Threshold:
After chasing its enemy, the chimp throws a stick and stones. It does not say to itself: ''This
stick and stones have served me effectively; I’d better keep them for another occasion''.
However, there will be a time when such a thought will occur with the development of the
brain capacity (500-550 cc)
... It is well documented that body dissatisfaction is a main diagnostic feature of several mental disorders (APA, 2013;Tremblay and Limbos 2009 e.g., Eating disorder, Bulimia). Research demonstrates that exposure to idealized images contributes to body image dissatisfaction in women, (Fardouly et al. 2017;Fuller-Tyszkiewicz et al. 2019;Izydorczyk and Sitnik-Warchulska 2018;Tremblay and Limbos 2009) but the mechanism underlying the relationship between body image satisfaction and exposure to a thin idealized image is still misunderstood. Exposure to idealized body images increases body image dissatisfaction and the risk for depression in adults. ...
... Exposure to idealized body images increases body image dissatisfaction and the risk for depression in adults. In addition, body checking and body image exposure (to themselves or ideal body image) are associated with negative emotions in men and women with higher body dissatisfaction (Tremblay and Limbos 2009). More recent data confirms these effects of thin idealized media image exposure (Yu 2014) as well as self-exposure through social media selfies on dissatisfaction with body image (Rhodes Lonergan et al. 2019). ...
Evidence suggests that dissatisfaction with body image in women can be enhanced by exposure to media’s idealized images. The theory of social comparison and the avoidance hypothesis offer contradictory explanations of this relationship. We compare these two theories using a haptic virtual reality environment. We ask 42 female participants to interact with one of four types of virtual humans (VH) randomly assigned to them. The interaction task involves giving a virtual hug to a normal weight or overweight male or female VH. We verify the hypothesis that participants’ satisfaction with particular body parts and their anti-fat attitudes will determine the choice of the body area of the VH they will virtually touch. Our results show that: (1) touching VH lower torso is predicted by less anti-fat attitude, and avoidance of the upper torso and upper limb areas, and (2) touching VH shoulder and upper limbs areas is predicted by concerns with own stomach area and avoidance of VH lower torso and stomach waist areas. Our results tend to support the avoidance hypothesis as well as other research findings on anti-fat attitudes.
... Adolescence and young adulthood, spanning from ages 17 to 25 years, are critical stages of life during which numerous psychological, physical, neurobiological, behavioral, and social changes take place (Paus et al., 2008;Wood et al., 2018). These changes occur in concert with exposure to numerous sociocultural factors (e.g., appearance comparisons, teasing, social exclusion) that commonly perpetuate body dissatisfaction, a consistent predictor of eating disorders and other mental illnesses (Prnjak et al., 2021;Tremblay & Limbos, 2009). Paralleling this perpetuation of body dissatisfaction is the ubiquitous growth of SMU, which has undeniably become an integrated part of many young people's lives. ...
Adolescence and young adulthood are vulnerable periods in which mental health challenges often emerge. Cross-sectional research has shown that high social media use (SMU) is associated with poor body image in youth, a known predictor of eating disorders; however, high-quality experimental evidence is scarce, limiting the ability to make causal inferences. The present study experimentally examined the effects of reducing smartphone SMU on appearances and weight esteem in youth with emotional distress. A randomized controlled trial was conducted where 220 participants (17-25 years; 76% female, 23% male, and 1% other) were assigned to either an intervention (SMU limited to 1 hr/day) or control (unrestricted access to SMU) group. SMU was monitored via screen time trackers and submitted daily during 1-week baseline and 3-week intervention periods. Baseline and post-intervention measurements were taken to assess changes in appearance and weight esteem. Compared to the controls, the intervention group yielded significant increases in both appearance (p=.022) and weight esteem (p=.026). The intervention group significantly increased in appearance esteem (from M = 2.95 to 3.15, p<.001, dz = 0.33) and weight esteem (from M = 3.16 to 3.32, p<.001, dz = 0.27), whereas the control group did not significantly change (appearance: M = 2.72 to 2.76, p = .992, dz = 0.13; weight: M = 3.01 to 3.02, p = .654, dz = 0.06) from baseline to post-intervention. No effects of gender were detected. Findings suggest that reducing SMU on smartphones may be a feasible and effective method of improving body image in a vulnerable population of youth. Public Policy Relevance Statement A brief 4-week intervention using screen time trackers showed that reducing social media use (SMU, experimental group) yielded significant improvements in appearance and weight esteem in distressed youth with heavy SMU, whereas unrestricted access to social media (control group) did not. Reducing SMU is a feasible method of producing a short-term positive effect on body image among
... It is also relevant to acknowledge the negative implications of body image on mental health. For instance, psychiatric disorders had the greatest association with negative body image and body dissatisfaction can predict body-image-related psychopathology later in development [37,38]. For instance, depressive symptoms are related to the wish to be thinner; in other words, body dissatisfaction is associated with increased depressive symptoms [39]. ...
The aim of this study is to analyze the factorial structure of the Multidimensional Body–Self Relations Questionnaire—Appearance Scales (MBSRQ-AS) to determine the adjustment of the study structure proposed in the Spanish short version in a young, non-clinical Chilean population and to evaluate the possible influence of sex, age, and BMI on body image measurement. The sample consisted of 614 Chilean youth (259 male and 355 female) between 15 and 28 years old (M = 18.81; SE = 2.46), from the Metropolitan Region, and four regions of the coast and south-central zone of the country. The average Body Mass Index (BMI) was 22.5 kg/m2 (SD = 3.16). The model fit was evaluated by confirmatory factor analysis (WLSMV) using the following: a model with a single general factor, a model with the five factors of the original version, a five-factor ESEM model, and a MIMIC model analyzed including sex, age, and BMI. The results show that the MIMIC sex, age, and BMI model presents an acceptable fit, observing that four factors, Appearance Orientation (AO), Body Areas Satisfaction (BAS), Overweight Preoccupation (OP), and Self-Classification Weight (SCW), are affected significantly for the sex variable, one for age, Appearance Evaluation (AE), and four for BMI (AE, BAS, OP, and SCW). In conclusion, MBSRQ-AS replicates the five-dimensional structure in a non-clinical sample of young Chileans; however, their scores are not invariant as they depend on sex, age, and BMI.
... Weight control behaviors are precipitated by body weight perception (Wang et al. 2009). Body weight perception refers to the personal measurement of one's body as "underweight," "normal weight," or "overweight" regardless of actual body mass index (BMI) (Tremblay and Limbos, 2009); this discrepancy is also known as body image distortion (Liechty, 2010). Most unhealthy dieting and exercise habits derive from the way people view themselves. ...
The questionnaire was comprised of three major sections regarding demographic characteristics, BMI classifications, body weight attitude, and attempts at body weight control. Statistical analysis was done using a Chi-square and T-test to compare differences between groups. A higher percentage of Saudi participants were overweight (86.8% versus 13.2%) or obese (83% versus 16.96%) versus other nationalities. A higher percentage of females were overweight (60.5% versus 39.5%) or obese (63.4% versus 36.6%) versus males. About 28.4% of normal weight individuals saw themselves as overweight, 40% of underweight persons saw themselves as normal weight, 79.5% of obese persons saw themselves as overweight, while 5.4% of obese and 15.5% of overweight individuals saw themselves as normal weight. Weight misperception was higher in females than males. About 79.8% of overweight, 85.7% of obese, and 45.5% of normal weight persons, female, tried to lose weight during the COVID-19 lockdown period. Inaccurate self-perception of body weight was commonly high across all age groups and gender (though slightly higher in females) during the COVID-19 lockdown period and could have a negative effect on the overall health of Saudi Arabians.
... Weight control behaviors are precipitated by body weight perception (Wang et al. 2009). Body weight perception refers to the personal measurement of one's body as "underweight," "normal weight," or "overweight" regardless of actual body mass index (BMI) (Tremblay and Limbos, 2009); this discrepancy is also known as body image distortion (Liechty, 2010). Most unhealthy dieting and exercise habits derive from the way people view themselves. ...
The questionnaire was comprised of three major sections regarding demographic characteristics, BMI classifications, body weight attitude, and attempts at body weight control. Statistical analysis was done using a Chi-square and T-test to compare differences between groups. A higher percentage of Saudi participants were overweight (86.8% versus 13.2%) or obese (83% versus 16.96%) versus other nationalities. A higher percentage of females were overweight (60.5% versus 39.5%) or obese (63.4% versus 36.6%) versus males. About 28.4% of normal weight individuals saw themselves as overweight, 40% of underweight persons saw themselves as normal weight, 79.5% of obese persons saw themselves as overweight, while 5.4% of obese and 15.5% of overweight individuals saw themselves as normal weight. Weight misperception was higher in females than males. About 79.8% of overweight, 85.7% of obese, and 45.5% of normal weight persons, female, tried to lose weight during the COVID-19 lockdown period. Inaccurate self-perception of body weight was commonly high across all age groups and gender (though slightly higher in females) during the COVID-19 lockdown period and could have a negative effect on the overall health of Saudi Arabians.
Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Distorted body image perception, dissatisfaction and preoccupation with weight and shape are often key factors in the development and maintenance of these disorders. Although the pathophysiological mechanism of body image disorder is not yet fully understood, aberrant biological processes may interfere with perceptive, cognitive and emotional aspects of body image. This study focuses on the neurobiological aspects of body image disturbance. The sample consisted of 12 adolescent girls diagnosed with AN, nine girls with major depressive disorder (MDD) and 10 without psychiatric diagnoses (HC, the healthy control group). We applied a block-design task in functional magnetic resonance imaging using participants' original and distorted overweight and underweight images. After imaging, the participants scored the images for resemblance, satisfaction and anxiety levels. The findings of this study demonstrate that overweight images elicited dissatisfaction and increased occipitotemporal activations across all participants. However, no difference was found between the groups. Furthermore, the MDD and HC groups showed increased activations in the prefrontal cortex and insula in response to underweight images compared to their original counterparts, whereas the AN group exhibited increased activations in the parietal cortex, cingulate gyrus and parahippocampal cortex in response to the same stimuli.
Background
Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults.
Objective
In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students.
Methods
Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up.
ResultsThe intervention group for female participants reported significant reduction in body dissatisfaction (P
Background:
Elevated depressive symptoms are observed in a significant number of youth with inflammatory bowel disease (IBD) and have been linked to illness stigma and social isolation. Body image dissatisfaction is an understudied variable in the pediatric IBD literature that may be related to both stigma and social difficulties. It is suspected that, due to the stigmatizing nature of IBD, some youth may feel self-conscious about their body image, which contributes to decreased feelings of social belongingness and ultimately depressive symptoms. The current study tested an illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms serial mediation model, in which IBD stigma was hypothesized to indirectly influence youth depressive symptoms through the sequential effects of stigma on body image dissatisfaction and thwarted social belongingness.
Methods:
Youth with IBD (N = 75) between 10 and 18 years old were recruited from a pediatric gastroenterology clinic and completed psychosocial measures. Disease severity was assessed by a physician global assessment. Current medications and BMI data were collected.
Results:
Analyses revealed significant direct effects among the modeled variables and a significant serial indirect path for illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms, controlling for sex, BMI and prednisone medication.
Conclusions:
Youth who perceive greater IBD stigma are more likely to experience increased body image dissatisfaction due to their IBD, which may engender feelings of social estrangement and ultimately elevated depressive symptoms. Depressive symptoms and the psychosocial challenges faced by youth should be routinely monitored as part of comprehensive IBD management.
The Mirror Paradigm (MP) is an innovative technique that explores the influences of body representation, affect regulation, and nonverbal mirror behavior in children, adolescents and adults. The critical element of the MP is the use of a full-length mirror in front of which the interviewee is asked to answer questions about how they think and feel about their body, including perception, parental and sociocultural influences and the mind-body connection. Though research on MP is limited and focused mainly on adults, its many advantages are recognized. This narrative review aims to summarize its broad applicability, strengths and weakness and potential uses in both research and clinical settings.
The review of the literature was performed through a research on PsycArticles, PsycInfo, Psychology Behavioral Sciences Collection, PubMed and Web of Science Scopus databases, plus Google Scholar and ResearchGate, including pertinent and providing quantitative or qualitative data documents. Of 505 documents, 7 articles were eligible for this review (1.4% of initial records).
Results revealed three main application of the MP: 1) Body image, where MP scores have been significantly correlated to body dissatisfaction assessed through questionnaires; 2) Psychopathology, where MP scores were useful in discriminating individuals with personality disorders and internalizing, externalizing, dissociative, and disordered eating symptoms; 3) Attachment, with nonverbal expressions and narratives about relationships to important others distinguishable between secure, preoccupied, and dismissive speakers as classified in the Adult Attachment Interview. Limitations and future directions are discussed, suggesting the MP as an innovative technique and measure promising for further integration in research and clinical practice.
Three psychophysical methods were used to assess the accuracy of body size estimations in 216 male and female children age 6, 9, or 12. A TV-video procedure was used to project life-size images of the child's body. Overall, children were accurate in estimating their body sizes with no significant differences between genders, age groups, or ethnic groups. Older children were more accurate in detecting distortions in their body sizes. The idealized body size becomes thinner as children become older, especially in young people. Young people also have an increasing discrepancy between perceived and ideal size with progressing age. Body esteem and childhood teasing were related to both children's judgments of their ideal sizes and body dissatisfaction. In addition , concerns parents have about their children's body sizes were related to the child's expressed ideal size and to the response bias children have to report that their bodies are distorted too large. The status of parents' occupations and parents' educational attainment were not a significant predictor of children's body size estimations.
A survey of 303 first- to third-grade children measured relationships between (a) television viewing and interpersonal attraction (IA) to television characters and (b) fat stereotyping, body shape standards, and eating disorder symptomatology. Television viewing predicted an increased tendency among males to stereotype a fat female target and also predicted increased eating disorder symptomatology among participants of both genders. IA to thin television characters was not a consistent predictor of thinness-favoring cognitions and behaviors, but IA to average-weight characters was a significant negative predictor for female participants. Discussion focuses on the need for continued research on the relationship between media exposure, ideal-body stereotype internalization, and eating disorder symptomatology in child populations.
In this study, we investigated the effects of three counseling interventions on women's body image and self-concept. The interventions used were cognitive therapy techniques, cognitive behavior therapy techniques, and reflective therapy techniques. Women experiencing body image problems (N = 79) completed Secord and Jourard's (1953) Body-Cathexis and Self-Cathexis Scales and were classified into either moderate or severe body image disturbance groups. Participants were randomly assigned to a therapy or the control group. Those assigned to the therapies participated in three structured interviews and did homework. Cognitive techniques emphasized changing self-statements, and reflective techniques explored feelings. A double repeated measures multivariate analysis of variance was performed on pre- and postscores on the Body-Cathexis and Self-Cathexis Scales, which had been found to be correlated. All participants improved in body image and self-concept. Therapy was better than no therapy. Cognitive therapy techniques were most effective for body image, and cognitive therapy techniques and cognitive behavior therapy techniques were most effective for self-concept. Participants in both classifications improved significantly on body image.
The authors examined factors prospectively associated with age of onset of partial syndrome eating disorders over a 4-year interval in a community sample (N = 877) of high school-age adolescent girls. Four percent developed a partial syndrome eating disorder over the interval. A measure of weight concerns was significantly associated with onset in a multivariate Cox proportional hazard analysis (p <.001). Girls scoring in the highest quartile on the measure of weight concerns had the highest incidence ( 10% ) of partial syndrome onset, whereas none of the girls in the lowest quartile developed eating disorder symptoms. This finding is consistent with both theoretical and clinical perspectives and may represent a useful step toward the establishment of a rational basis for the choice ofa prevention intervention target.
The purpose of this study was to examine high and low body dissatisfied (BD) men's and women's in-task emotional responses to the acute exposure of sex-specific physique slides of the aesthetic ideal (i.e., ideal slides) and themselves (i.e., self-slides). Participants were 35 male and 30 female university students who reported their immediate in-task emotional responses (i.e., pleasure and arousal) to viewing the self- and ideal slides. It was found that the (a) high BD women reported the least amount of pleasure while viewing the self- and ideal slides; (b) women reported less pleasure while viewing the self-slides than did the men; (c) The high BD group reported less pleasure while viewing the self- vs. the ideal slides than did the low BD group, and (d) the high BD men reported the most arousal of any of the groups while viewing the self- and ideal slides. The differing emotional responses of the men and women and the high and low BD groups to viewing the self- vs. ideal slides are discussed, and future research directions are suggested.
In 2 related investigations, preschool-age boys and girls were assessed on social attribution and social preference measures related to their use of the "beauty-is-good" hypothesis in social choices for attractive and unattractive unfamiliar children and adults. Mothers, fathers, and teachers of these children were asked to report how they expected their children to behave during the social preference experimental task. Preschool children were more likely to use a physical attractiveness-stereotype bias in social attribution judgments than in social preference judgments. However, parents and teachers were found to expect behavior consistent with a beauty-is-good stereotype for both types of dependent measures. Evidence is presented which suggests that mothers and teachers may be stronger socialization agents of the physical attractiveness stereotype than are fathers. Implications for future research are provided.
: This study aimed to replicate with an Australian sample Fallon and Rozin's (1985) finding of gender differences in body dissatisfaction, and to further investigate the developmental origins of such dissatisfaction. There were three age groups of subjects: adult undergraduates, adolescents aged 15–16 years, and children aged 9–10 years. All subjects were presented with a set of nine age-relevant silhouette drawings ranging from very thin to very heavy. Adult women rated their current figure as significantly larger than their ideal and attractive figure, whereas there were no differences in rating for men. In contrast to the finding of Cohn et al., (1987), this pattern was replicated in the adolescent group, such that girls, but not boys, showed substantial body dissatisfaction. In the youngest age group, all the children rated their current figures as larger than their ideal. It was concluded that both adolescent and adult women expressed body dissatisfaction and were subjected to pressures toward thinness not suffered by their male counterparts.