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The role of body shame and body image avoidant behaviors in deliberate selfharm

Authors:
Antonios Dakanalis Αντώνιος Ντακανάλης at Università degli Studi di Milano-Bicocca
Antonios Dakanalis Αντώνιος Ντακανάλης
Fabio Madeddu at Università degli Studi di Milano-Bicocca
Fabio Madeddu
Clerici G.
Clerici G.
Clerici G.
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Giuseppe Riva at Università Cattolica del Sacro Cuore
Giuseppe Riva
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Abstract

Objective: Dysfunctional view of or negative attitude toward the body may facilitate deliberate self-harm (DSH) because the body is experienced as a hated object. Objectification theory posits that the growing objectification of the body in Western media (i.e. the experience of being viewed and/or treated by others as merely a body, with beauty highly valued) leads individuals to self-objectify or take on an observer's perspective on their own body; they therefore learn to treat themselves as objects to be looked at and evaluated on the basis of physical appearance. Self-objectification (SO) has been found to be closely associated to body shame (BS) and body image avoidant behaviour (BIAB). The aim in the current perspective study was to investigate the mediating role of BS and BIAB between SO and DSH among adolescent boys and girls at ages 13 and 15. Methods: Data from 322 Italian adolescents (46% boys), who completed self-report measures at baseline after one and two years were analysed via a latent variable longitudinal structural equation modelling approach. Previous scores were controlled for. Results: Both the measurement and the structural model were good fits for the data. The relationship between SO and DSH was fully mediated by BS and BIAB. A multiple-group comparison analysis did not reveal differences across gender groups. Conclusion: Data suggest that a) DSH behaviour may not be as gender-based as originally believed, and b) prevention and treatment programs may want to address negative body feelings and related behaviours as one way to potentially reduce DSH.
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13 -The impact of laparoscopic adjustable gastric banding on body
image disturbance, self-esteem and psychological well-being:
An Italian follow-up study
A. Dakanalis
a,b
,M.AssuntaZanetti
a
,F.Madeddu
c
,M.Clerici
d,e
,G.Riva
f,g
a
Department of Humanistic Studies, Section of Psychology, University of
Pavia, Italy,
b
Clinical and Health Psychology Unit, San Raffaele Hospital,
Milan, Italy,
c
Department of Psychology, University of Milano-Bicocca, Milan,
Italy,
d
Department of Neurosciences and Biomedical Technologies, University
of Milano-Bicocca, Milan, Italy,
e
Psychiatry, S. Gerardo Hospital, Monza, Italy,
f
Faculty of Psychology, Catholic University, Milan, Italy,
g
Applied Technology
for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
Objective: The effectiveness of post-surgical weight loss in improv-
ing body image disturbance, self-esteem and psychological well-
being in morbidly obese patients, remains to date unclear. The
current preliminary study intends to investigate pre and post-
operative changes in psychological well-being, self-esteem and body
image.
Methods: 125 patients (65% Female; M age = 32.68; MBMI = 43.9)
scheduled for laparoscopic adjustable gastric banding (LAGB) from
three Italian hospitals completed the Body Uneasiness Test (BUT),
the Psychological General Well-Being Index Short Version and the
Rosenberg's Self-Esteem Scale before and 12 months after surgery.
Results: Irrespective of BMI reduction, LAGB has a positive impact on
psychological well-being and self-esteem. Instead the improvement in
the distress related to body image depends on the pre-operative degree
of severity (Global Severity Index of BUT): all patients with a body image
disorder in the pre-operative stage (35%, measured using the cut-off
value of BUT) continue to show this even 13 months after the operation.
Conclusion: The results confirm that weight reduction leads to an
improvement in psychological well-being and self-esteem. Never-
theless, the improvement in the distress related to body image was
found only in patients without BID. This study outlines the high
prevalence of BID in LAGB setting and suggests therefore the
importance of a preoperative clinical evaluation.
http://dx.doi.org/10.1016/j.jpsychores.2013.03.027
14 -The role of body shame and body image avoidant behaviours
in deliberate self-harm
A. Dakanalis
a,b
,F.Madeddu
c
,M.Clerici
d,e
,G.Riva
f,g
,
M. Assunta Zanetti
a
a
Department of Humanistic Studies, Section of Psychology, University of
Pavia, Italy,
b
Clinical and Health Psychology Unit, San Raffaele Hospital,
Milan, Italy,
c
Department of Psychology, University of Milano-Bicocca,
Milan, Italy,
d
Department of Neurosciences and Biomedical Technologies,
University of Milano-Bicocca, Milan, Italy,
e
Psychiatry, S. Gerardo Hospital,
Monza, Italy,
f
Faculty of Psychology, Catholic University, Milan, Italy,
g
Applied Technology for Neuro-Psychology Lab, Istituto Auxologico
Italiano, Milan, Italy
Objective: Dysfunctional view of or negative attitude toward the
body may facilitate deliberate self-harm (DSH) because the body is
experienced as a hated object. Objectification theory posits that the
growing objectification of the body in Western media (i.e. the
experience of being viewed and/or treated by others as merely a
body, with beauty highly valued) leads individuals to self-objectify or
take on an observer's perspective on their own body; they therefore
learn to treat themselves as objects to be looked at and evaluated on
the basis of physical appearance. Self-objectification (SO) has been
found to be closely associated to body shame (BS) and body image
avoidant behaviour (BIAB). The aim in the current perspective study
was to investigate the mediating role of BS and BIAB between SO and
DSH among adolescent boys and girls at ages 13 and 15.
Methods: Data from 322 Italian adolescents (46% boys), who
completed self-report measures at baseline after one and two years
were analysed via a latent variable longitudinal structural equation
modelling approach. Previous scores were controlled for.
Results: Both the measurement and the structural model were good
fits for the data. The relationship between SO and DSH was fully
mediated by BS and BIAB. A multiple-group comparison analysis did
not reveal differences across gender groups.
Conclusion: Data suggest that a) DSH behaviour may not be as
gender-based as originally believed, and b) prevention and treat-
ment programs may want to address negative body feelings and
related behaviours as one way to potentially reduce DSH.
http://dx.doi.org/10.1016/j.jpsychores.2013.03.028
15 -Psychiatric disorders encountered during bone marrow
transplantation
A. Dakanalis
a,b
, M. Assunta Zanetti
a
, M. Clerici
c,d
a
Department of Humanistic Studies, Section of Psychology, University of
Pavia, Italy,
b
Clinical and Health Psychology Unit, San Raffaele Hospital,
Milan, Italy,
c
Department of Neurosciences and Biomedical Technologies,
University of Milano-Bicocca, Milan, Italy,
d
Psychiatry, S. Gerardo Hospital,
Monza, Italy
Objective: Bone marrow transplantation (BMT) is a complex medical
procedure used in the treatment of a variety of haematological
disorders. Successful achievement of BMT requires patients to
tolerate isolation for several weeks and follow several regulations
and instructions to survive treatment. This study aimed at examining
the prevalence of AXIS I disorders encountered during BMT.
Methods: Patients with history of previous psychiatric illness,
organic cases associated with physical illness or drugs side effects,
and those with age less than 18 years were excluded from the study.
The sample was composed of 136 patients undergoing for BMT (66%
Male; M age = 36.28) at the BMT unit of two Italian hospitals. All
patients were assessed with the validated Italian versions of
Structured Clinical Interview for the DSM-IV criteria (SCID-I).
Results: 54 of the 136 patients (39.7%) warranted a DSM-IV
psychiatric diagnosis with SCID-I evaluation. Gender, age, education,
haematological/oncological diagnosis, type of transplantation (autol-
ogous vs. allogeneic), and duration of illness were not significantly
different between patients with or without AXIS I psychiatric
diagnoses. The most frequent diagnoses were within the affective
spectrum disorders, followed by anxiety spectrum disorders. The
remaining diagnoses were within the somatoform spectrum disor-
ders. The most prevalent disorders were major depression (28%),
panic disorder without agoraphobia (9%) and generalised anxiety
disorder (8%).
Conclusion: The results highlight the importance of psychiatric
assessment and intervention during the isolation period of BMT.
Future studies need to evaluate the utility of standardised self-reports
(ie. Hospital Anxiety Depression Scales) for screening purposes.
http://dx.doi.org/10.1016/j.jpsychores.2013.03.029
16 -Biological embedding of child stress through inflammation
A. Danese
Institute of Psychiatry, King's College London, United Kingdom
Objective: Stressful childhood experiences, such as maltreatment,
have been linked to negative psychiatric and medical outcomes. In a
series of human studies, I have tested whether inflammation could
contribute explaining these clinical effects.
Abstracts / Journal of Psychosomatic Research 74 (2013) 539–562 543
... The influence of body surveillance as a stable moderator is further highlighted by the fact that only this variable interacted with body dissatisfaction to predict unique variance in eating disorder symptomatology (measured by the Eating Attitudes Test-26; Garner, Olmstead, Bohr, & Garfinkel, 1982) when all predictors and interactions were examined within the same analysis. In line with objectification theory (Fredrickson & Roberts, 1997) and recent experimental evidence (Shafran, Lee, Payne, & Fairburn, 2007; Smeets et al., 2011), these findings suggest that among highly body dissatisfied women, those who regularly monitor their body may minimize the dangers of using harmful eating and shape control practices in an attempt to reduce the perceived body imperfections and more closely approximate the society's stereotype of attractiveness (Calogero, Tantleff-Dunn, & Thompson, 2010; Dakanalis & Riva, 2013). Among the few studies that, to date, have investigated moderators of body dissatisfaction, only one has focused on protective factors and examined four variables thought to have the potential to buffer the deleterious effects of body dissatisfaction and thus reduce the levels of women's eating disorder symptomatology (Brannan & Petrie, 2011). ...
... More specifically, the body dissatisfaction-eating disorder symptomatology relationship was found to be reduced in women who are " protected " by high self-esteem (Brannan & Petrie, 2011). Among body dissatisfied women, those who have a strong and positive overall self-worth might be more able to preserve their self-image, instead of engaging in harmful eating behaviours in an attempt to approximate the unrealistic beauty ideals portrayed in the media (Aubrey, 2006; Dakanalis & Riva, 2013; Jones & Buckingham, 2005; Stice, Spangler, & Agras, 2001; Twamley & Davis, 1999). ...
... The examination of the main and moderating effects of the above variables on eating disorder symptomatology among undergraduate females, who live in an affluent Western non-English speaking country (where the body cult surrounding the ultra-slim and perfect body is deeply imbedded in the culture; Dakanalis, Di Mattei, Prunas et al., 2012; Ruggiero, Prandin, & Mantero, 2001; Tiggemmann, Verri, & Scaravaggi, 2005), is particularly relevant in the light of the evidence that body and eating-related disturbances are highly influenced by the sociocultural environment where people live (see Dittmar, 2005; Holmqvist & Frisén, 2010; Jaeger et al., 2002; Soh, Touyz, & Surgenor, 2006). In Italy, in addition to high levels of thin ideals in the media (CENSIS, 2006; Dakanalis & Riva, 2013; Mondini, Favaro, & Santonastaso, 1996), females are socialized in a culture that is often described as " obsessed " with beauty, flair and the visual aesthetic (Dakanalis, Clerici, et al., in press; Jaeger et al., 2002). This obsession is argued to be " integral to Italian self-image and identity and find their social expression in the concept of 'fare bella figura', that is, the importance of making a good impression and always looking one's best " (Tiggemann et al., 2005, p. 295). ...
Psychosocial moderators of the relationship between body dissatisfaction and symptoms of eating disorders: A look at a sample of young Italian women
Article
Full-text available
  • Jan 2013
Introduction Plusieurs variables psychosociales peuvent affecter la force de la relation entre l’insatisfaction à l’égard de l’image corporelle et la symptomatologie des troubles des conduites alimentaires chez les femmes. Objectifs Inspirée par les recherches de Tylka (2004) et de Branann et Petrie (2011), la présente étude a examiné la surveillance de son corps et l’estime de soi, ainsi que trois variables additionnelles théoriquement significatives (l’anxiété d’interaction sociale, l’internalisation des idéaux véhiculés par les médias, un style d’attachement marqué par de l’anxiété) en tant que variables modératrices potentielles de la relation entre insatisfaction à l’égard de son corps et troubles alimentaires. Méthode Cette étude transversale porte sur un échantillon de 538 jeunes femmes italiennes qui ont rempli une série de questionnaires auto-administrés. Résultats Une régression hiérarchique modérée indique que l’estime de soi réduit les effets négatifs de l’insatisfaction corporelle, tandis que l’anxiété liée aux interactions sociales, la surveillance de son corps, l’internalisation des idéaux véhiculés par les médias et un style d’attachement marqué par de l’anxiété intensifient la relation primaire entre l’insatisfaction corporelle et la symptomatologie des troubles des conduites alimentaires. Conclusion Plusieurs facteurs de risque et de protection se sont avérés interagir avec l’insatisfaction à l’égard de son corps, influençant ainsi la relation de celle-ci avec la symptomatologie des troubles des comportements alimentaires chez les femmes. Les implications pratiques, ainsi que les pistes de recherches, sont discutées.
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... The former is related to persistent negative feelings and thoughts about one's body when it is not consistent with sociocultural standards [19], while perfectionism is often associated with unrealistically high expectations and overly critical self-assessments [20]. With reference to the abovementioned outcomes, earlier studies indicated that: (a) body dissatisfaction and body image avoidant behaviours are strongly related to body shame [21][22][23][24]; and (b) the greater the maladaptive perfectionism, the higher the negative body image [25,26]. Referring to point b above, it is worth noting that research so far has not focused directly on the relationship between perfectionism and body shame, and as we know, unrealistic expectations held by children and adolescents and an overly critical attitude toward oneself may significantly disturb their psychological functioning [27,28]. ...
... Referring to point b above, it is worth noting that research so far has not focused directly on the relationship between perfectionism and body shame, and as we know, unrealistic expectations held by children and adolescents and an overly critical attitude toward oneself may significantly disturb their psychological functioning [27,28]. However, it can be concluded that a negative cognitive attitude toward one's body may promote the tendency to avoid dealing with one's body as well as increase negative emotions toward one's body (including fear and shame), and that the at-risk group may be people with a strong perfectionist tendency (for whom it is extremely important to meet societal expectations and achieve set standards in many areas of life) [1,[21][22][23][24][25][26]. Importantly, however, most of the abovementioned studies have been conducted in adults and have not considered the dyadic perspective in explaining child and adolescent functioning. ...
Dyadic Predictors of Child Body Shame in a Polish and Italian Sample
Article
Full-text available
The present study aimed at assessing the predictors (related to the functioning of a parent-child dyad) of child body shame. Therefore, in the main analysis we examined relationships among child body shame, child perfectionism, child body dissatisfaction, parent body shame, parent per-fectionism, and parent body dissatisfaction. In our main hypothesis we assumed that higher levels of the abovementioned parent functioning-related variables would be associated with higher child body shame after accounting for the effects of the foregoing child functioning-related variables. The analysis finally included complete data from 420 participants, i.e., a 115 Polish and 95 Italian parent-child dyad. Participants completed: (a) child: the Objectified Body Consciousness Scale for Youth, the Child-Adolescent Perfectionism Scale, the Children's Body Image Scale/the Figure Rating Scale; (b) parent: the Objectified Body Consciousness Scale, the Frost Multidimensional Perfectionism Scale, and the Contour Drawing Rating Scale. The results of a correlational analysis show that in both the Polish and Italian samples, the higher the level of child body shame, the higher the level of the following variables: child perfectionism, child body dissatisfaction, parent perfectionism, and parent body dissatisfaction. Interestingly, the only insignificant relationship in both samples is the association between body shame in both members of the child-parent dyad. Moreover, all steps of the regressions were significant in both Polish and Italian samples. It turned out that only in the Italian sample were all predictors significantly associated with a child's body shame (in the Polish sample there was no significant association between child's body shame and parent's perfection-ism). To sum up, the above studies show the importance of considering the functioning of the parent child dyad in understanding child body shame. These findings suggest that parents' attitudes toward their bodies and their beliefs about an ideal self should be taken into account when planning interventions to improve children's and adolescents' attitudes toward their bodies. This is so because it is possible for children to internalize their parents' beliefs about how to look and how critical one should be of themselves, which can result in strong body shame when they are not perfect enough against the internalized ideal. Therefore, it is also necessary to make parents aware that children's attitude toward their body is often a reflection of parents' attitude toward the body.
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... He speculates that it was probably because "trichotillomania is very noticeable, and in that sense that it bothers other people (her parents, of course, but probably, at least in a casual way, anyone who sees her)." Indeed, there is plenty of evidence that visible and noticeable changes in appearance are strongly related to body shame, avoidant behaviors, wounded self-esteem, and sometimes even to self-harming behaviors (e.g., Kellett & Gilbert, 2001;Dakanalis et al., 2013). Indeed, it is possible that Dr. Ziv-Beiman was very conscious of this wound in self-image when she presented Dana's treatment as a case of "nonfocus" on TTM. ...
Treating Individuals With Multiple Problems: On Roads Not Taken
Article
Full-text available
  • Sep 2015
Comments on the article by S. Ziv-Beiman (see record 2015-39481-001 ), which discusses the dilemmas around the treatment of Dana, a patient with resistant trichotillomania. To the author's mind, integrative treatment is built on three main propositions. The first is of goal setting: clearly defining the goals which are tightly related to the case formulation. A second proposition is that of collaboration between the patient and the therapist. A third proposition is the reliance on empirically available evidence. How do these general principles relate to the clinical dilemma in the case of Dana? The main clinical dilemma is this case was when do we accept the patient’s unwillingness to focus on what seems to be a serious and debilitating problem (problem A) and focus on other problems (B, C, or D) instead? The solution to this dilemma in the case of Dana relates to two central issues: first, the consistent exploration of Dana’s future, life plans, and fantasies. Second, rethinking “symptoms” as psychic pain. The comment concludes by discussing trichotillomania distress, shame,. and interpersonal relationships. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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Objectified Body Consciousness (OBC) in Eating Psychopathology
Article
Full-text available
Objectified body consciousness (OBC) appears to play a crucial role in eating and body-related disturbances, which typically emerge during adolescence. The 24-item OBC Scale (OBCS) has been employed in eating disorder (ED) research and school-based adolescent samples, but evidence for its psychometric proprieties exists only in adult (nonclinical) populations. We evaluated (a) the construct validity and reliability of the 24-item OBCS with data collected from 1,259 adolescent girls and boys from the community (Study 1) and 643 adolescents of both genders with an ED (Study 2) and (b) whether the instrument functions similarly and equivalently measures the underlying construct(s) across gender and samples (i.e., test of measurement equivalence/invariance; Study 3). Results upheld the three-factor structure and measurement equivalence/invariance of the 24-item OBCS across gender and samples. OBCS subscale scores were internally consistent and stable over a 4-week period. OBCS subscales discriminated community participants with high and low ED symptom levels with fair accuracy, as well as community participants from those with an ED. They were also associated with five constructs closely related to both OBC and ED psychopathology. Latent mean comparisons across samples and gender were performed and discussed. Implications and directions for future research are also outlined.
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Psychosocial moderators of the relationship between body dissatisfaction and symptoms of eating disorders: A look at a sample of young Italian women
Article
Full-text available
  • Sep 2013
  • EUR REV APPL PSYCHOL
Introduction. – Various psychosocial variables may affect the strength of the relationship between body image dissatisfaction and women's eating disorder symptomatology. Objective. – Informed by Tylka (2004) and Brannan and Petrie (2011) research, the current study examined body surveillance and self-esteem as well as three additional theoretically relevant variables (social interaction anxiety, internalization of media ideals and attachment anxiety) as potential moderators of this relationship. Method. – A cross-sectional design was used. A sample of 538 young Italian women completed self-report questionnaires. Results. – Hierarchical moderated regression indicated that self-esteem buffered the deleterious effects of body dissatisfaction, whereas social interaction anxiety, body surveillance, internalization of media ideals and attachment anxiety intensified the primary body dissatisfaction-eating disorder symptomatology relationship. Conclusion. – Several risk and protective factors were found to interact with body dissatisfaction to influ-ence its relation to women's eating disorder symptomatology. Practical implications and directions for future research are discussed.
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