It is probably fair to say we are all feeling the pressure to be, or appear, ‘healthy’. As hard as it is for adults to be mindful in this area, how are our kids coping? Have you noticed your child struggling with body image? Noticed any persistent thoughts your child has about their body?
There is A LOT of information out there about the importance of having a healthy body image. It almost immediately becomes confusing when you start to think about it, and then overwhelming when you think about what you can do about it – for yourself or your kids. But asking questions is the crucial first step, and we have put together a few ideas to help with some of those questions: what to look for in terms of risk; some of the underlying factors that influence our thoughts and behaviours about body image, and; how we can help prevent or reduce the risk of developing unhealthy thoughts and behaviours.
The primary risk factor to consider is age. Since COVID19, body image concerns and the need for support with them have increased in people as young as 11 and 12, according to the Butterfly Foundation. This makes adolescents from 13 onwards the peak group of people at risk of developing potentially harmful behaviours in response to these concerns.
To understand the risks for body image concerns developing into harmful behaviours, we must first define what we mean when we say body image. Body image is all your thoughts, feelings and beliefs about your body, one aspect of which could be body dissatisfaction, the experience of persistent negative thoughts, feelings or beliefs about your body.
Core beliefs about yourself, like body dissatisfaction, can interact with maladaptive ways of thinking, like high levels of perfectionism or low self-esteem, and contribute to the development of disordered eating behaviours, or DE’s – a term encompassing behaviours from restricting food to overindulging to excessive exercise and many others.
This simplified understanding of the development of DE’s gives us a hint of what we need to be on the lookout for – underlying self-beliefs that leave us vulnerable to responding in ways that can be harmful. But these beliefs alone are not enough to increase the likelihood of developing such behaviour, we also need to lookout for those ways of thinking which can and often do interact with them.
It is these ways of thinking that are the key risk factors for body dissatisfaction developing into DE’s. Research has identified several of them as high-risk:
- high levels of perfectionism – trouble starting or finishing tasks because of uncertainty about flaws in the outcome;
- low levels of self-esteem – frequent or intense doubts about ones worth;
- high mood intolerance – the ability to withstand negative or aversive states, recognisable when one is avoiding things, people or activities that make one feel a certain way, and;
- interpersonal difficulties – the ability to make or maintain relationships, recognisable as frequent or persisting fights with others or difficulties fitting in.
If someone with rigid thinking, a severe perfectionist about the way things are to be or be done, were also to experience high body dissatisfaction, they would be much more likely to develop DE’s than someone with only one of these factors. Or consider someone who starts finding self-esteem from their appearance rather than ability, or effort – this interaction between self-esteem and body dissatisfaction increases risk, but could also be addressed, and the risk reduced, if it was recognised and that individual were offered help.
Disclaimer: It’s important to remember all brains are different, and these interactions aren’t one to one – the experience of any of these ways of thinking only indicates a risk of developing DE’s. There will be plenty of people experiencing them that for many reasons never develop any body-, food- or other-related issues.
We now move to our next question: what are the underlying factors influencing body dissatisfaction and the above risk factors?
Although an internal process, body image/dissatisfaction is heavily influenced by external factors like the pressure to meet appearance ideals. When someone takes on appearance ideals, and incorporates them into their concept of themselves, we call this internalisation. Appearance-ideal internalisation coupled with any of the above risk factors can lead someone to think that in order to look perfect, feel better about themselves (generally or in the moment), or be viewed differently by others, they must meet that ideal.
To better understand what’s happening, consider a common (but by no means the only) appearance ideal – thin-ideal internalisation. This is when someone comes to believe that being thin is the optimal appearance. They won’t necessarily act on this, but thin-ideal internalisation could lead to increased body dissatisfaction if someone were to judge themselves as not meeting this standard.
This understanding highlights the answer to our last question, on management. But keep in mind that there are many underlying factors at play, not just appearance ideals. The research tells us, for example, that nutrition affects the brain and that what we eat, along with interactions, social environment, physical environment etc. all contribute to brain health and function, as well as physical health.
In the event of DE’s being developed, the behaviours themselves start to affect the underlying factors which may have led to them in the first place, making changing the behaviour harder still. To understand this complex relationship would take time and a deep understanding of the individual in question.
The following approach is intended for use preventatively – it targets the underlying process above before it turns risk into reality. Given the complexity of the relationship once DE’s have developed, it is paramount to consult a health professional so that all aspects of an individual’s life can be considered.
The good news is, addressing appearance-ideals can reduce body dissatisfaction, negative affect, dieting behaviours and other factors that may lead to disordered eating behaviours (DE’s), thus preventing their development.
Much research has gone into identifying the most effective interventions for the prevention of such behaviours. It has consistently shown that group programs can have a great impact on the later development of DE’s and, generally, suggests that the best performing programs are those that are:
- designed for high-risk individuals (including those targeting internalised appearance-ideals);
- interactive, and;
- run over multiple sessions.
One such program is The Body Project, which targets thin-ideal internalisation to reduce the risk of future development of DE’s.
Young Minds Network is extremely happy to be offering The Body Project from term 2 2023, for girls aged between 14 and 18.
The Body Project has been designed to address the key risks and underlying factors discussed in this article, through what is known as dissonance – the feeling of unease created when someone behaves in a way that is inconsistent with their core beliefs. Humans will almost always act to correct such a feeling and restore balance again, by changing either their behaviour or the belief.
The Body Project engages its participants in activities that require them to speak out against their identified appearance-ideals, creating dissonance as they behave in a way that is inconsistent with their underlying belief. Such activities include developing the ability to recognise where the ideals come from, and helping others, hypothetically or within the group, to confront the harmful nature of such internalised ideals.
This may sound like a simple approach, but dissonance has been shown to effectively change appearance-ideals. These ideals, in turn, have been shown to account for the relationship between programs like The Body Project and changes in body dissatisfaction, negative affect and behaviours like weight control efforts, thus reducing the risk of later development of DE’s.
Finally, The Body Project is not an ‘eating disorder’ program – it is a program designed to help young people challenge and discuss their thoughts and feelings about their bodies, and develop healthy, balanced relationships with diet, exercise and appearance.
With respect to The Body Project and appearance ideals – although not as well reflected in the research, boys/men and individuals that don’t lie on the gender binary are just as susceptible to appearance ideals as girls/women. In future, we hope to run similar groups to help these individuals address their issues with body image, which may be centred around thin-ideals, muscular-ideals, or any others that can lead to the underlying susceptibility outlined above.
If this is something that resonates with your own situation, please get in touch with us.
Understanding and helping your child manage their body image concerns is an essential part of facing or preventing problematic relationships with dieting, exercise and the self. If you have any concerns about your child’s body image, or the risk factors discussed in this article, please call us on (07) 3857 0074 to discuss The Body Project group, or to book an intake appointment with a clinician.
Author: Seton Jubb – Provisional Psychologist
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behavior therapy for eating disorders: A “transdiagnostic” theory and treatment. Behavior Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/s0005-7967(02)00088-8
Liu, S., Fuller-Tyszkiewicz, M., Eddy, S., Liu, X., Portingale, J., Giles, S., & Krug, I. (2022). The effects of appearance-based comments and non-appearance-based evaluations on body dissatisfaction and disordered eating urges: An ecological momentary assessment study. Behavior Therapy, 53(5), 807-818. https://doi.org/10.1016/j.beth.2022.01.002
Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: a meta-analytic review. Psychological bulletin, 130(2), 206.
Stice, E., Rohde, P., & Shaw, H. (2012). The Body Project: A dissonance-based eating disorder prevention intervention. Oxford University Press.
Trompeter, N., Bussey, K., Forbes, M. K., Griffiths, S., Mond, J., Hay, P., … Mitchison, D. (2023). Difficulties with emotion regulation and weight/shape concerns as predictors of eating disorder behaviors among adolescents. J Psychopathol Clin Sci, 132(1), pp. 91-100. doi:10.1037/abn0000801
Well Excel (2023). The Mechanisms Linking Nutrition and Mental Health. Well Excel. https://wellexcel.com/blog/the-mechanisms-linking-nutrition-and-mental-health