What are body image issues?

Simply put, our body image is the way that we perceive our appearance, and it involves the thoughts, feelings and behaviours that we may experience and engage with as a result. The important word in the sentence above is the word ‘perceive’. The reason that this is so important is because our body image is not objective. Instead, it is a subjective perception, meaning that we can view our body accurately, but we can also misinterpret how we look.

In simple terms, body image can be split into two different parts: appearance evaluation and appearance investment.

Appearance evaluations are what we think of our appearance (e.g. ‘I like what I look like or ‘I hate my stomach’). Of course, this may be specific to different parts of the body – one person can like their legs but hate their skin for example.

Appearance investment, however, refers to the amount of importance we place on our appearance and is a separate concept. Simply put, appearance investment is whether or not we think it is important to look a certain way and the amount of energy we put into engaging in behaviours to adapt or maintain our appearance.

In the world that we live in today, particularly in Western culture, specific appearances are valued highly (for example being muscular and lean, having smooth skin etc.) and this can lead to people investing highly in their appearance as they view it as something that will make them likeable and worthy. Typically, high levels of body image investment can predict body image issues because if we view it as really important to appear a certain way, we are more likely to obsess over our body, worry when we feel unhappy with our appearance, and engage in behaviours to alter our appearance.

How do body image issues arise?

Next, let’s have a look at how body image issues arise and what they may look like day-to-day. Before I proceed with this, I want to make an important distinction between having a ‘negative body image’ and having Body Dysmorphic Disorder (BDD).

Having a negative body image might involve disliking your looks and wanting to change them, comparing your body with others and having high levels of appearance investment.

People with Body Dysmorphic Disorder will also experience all the above to a high degree but in addition, they will perceive their body inaccurately. For example, someone with BDD may believe that they have very spotty or red skin when in reality, this is not the case. Or they may believe that they are particularly thin or fat when in reality, the opposite is true.

Whilst having a poor body image and having BDD can both cause distress and are both worthwhile trying to improve, having BDD may require formal diagnosis. If you are concerned that BDD is affecting you then it is certainly worthwhile discussing this with your GP. A formal diagnosis and a thorough treatment protocol with a specialised therapist may be a requirement rather than ideal.

What constitutes body image issues?

You may be wondering what defines having a body image issue. This is a good question because most people living in Westernised cultures invest in their appearance to some extent. This is thanks to diet culture and its relentless messaging to control your body through dieting, exercise, plastic surgery and skin care products, to name a few methods.

So, let’s look at the thoughts, feelings and behaviours that may arise for people who have a body image issue. Before you go on, please know that the intensity and frequency of these thoughts, feelings and behaviours and the effect that they have on your quality of life and wellbeing are really what define a ‘body image issue’.

Thoughts:

We can split this section into beliefs and thoughts. Beliefs are ways that we view the world or ourselves (e.g. ‘I am not good enough’ or ‘I am incapable’). Thoughts are more transient experiences that can often feel as though they pop into our head in the moment. We can generate more specific thoughts too. Our thoughts are very much influenced by the deeper beliefs that we hold.

Examples of beliefs someone with a negative body image/BDD may have:

- I must look perfect to be accepted and loved.

- My value as a person is determined by my appearance.

- Physically attractive people have it all.

- I should always do what I can to look my best.

- My flaws are noticeable, and everyone is judging me.

- I cannot be happy or successful until I look a certain way.

Example of thoughts that someone who has a negative body image/BDD may experience:

- Everyone is looking at my perceived flaw.

- I look so ugly.

- I need to cover up my (insert body part).

- Everyone else here has a better body than me.

- I don’t think I should go to this party tonight because I will be exposed.

- I need to check my appearance in the mirror again.

- I can’t go out looking like this.

Feelings:

Often when a particular situation arises, it triggers certain thoughts based on our ingrained beliefs. These thoughts can cause us to experience a certain emotion.

For example, if I see someone with more muscular arms than me and hold the belief that people who are more muscular are more respectable, this can lead me to think that I need to grow my arms more and that I should cover up my arms until they have grown more. These thoughts can lead me to experience feelings such as embarrassment, self-consciousness or anxiety.

Below is a list of feelings that someone who has a negative body image/BDD may experience. Please note that people without a negative body image/BDD will still feel this way from time to time and that it is more to do with the frequency and intensity of these emotions as to whether or not they are problematic and causing a problem for you. Please also note that these feelings will arise in various different situations for different people like the scenario described above.

- Self-conscious

- Shame

- Anxiety

- Depressed

- Envious

- Hopeless

- Lonely

- Helpless

- Obsessed

- Vulnerable

- Inferior

Behaviours:

Cognitive Behavioural Therapy (CBT) posits that thoughts, beliefs, feelings, and behaviours are all interconnected and affect each other. Typically, we may behave a certain way based on how we are feeling.

For example, if I were to see my reflection in the mirror and thought I looked less muscular than I anticipated, I may feel high levels of shame, which might encourage me to then devise a new exercise regime or plan on increasing my protein intake. Alternatively, it might make me behave by covering the area of my body I perceive to be problematic. Here are some behaviours that someone with a negative body image/BDD might engage with:

Appearance checking:

- Comparing your body to others.

- Frequently/impulsively looking at your body in the mirror.

- Pinching body fat.

- Weighing yourself.

- Asking others for reassurance about your appearance.

Appearance fixing:

- Lengthy/frequent/compulsive grooming routines.

- Constantly restricting food to lose weight or bulking to try to gain muscle.

- Picking at skin frequently.

- Frequently buying new clothes to cover up ‘flaws’.

- Tensing muscles when someone walks past.

- Plastic surgery

Appearance avoidance:

- Wearing baggy clothes to cover up ‘flaws’.

- Not leaving the house.

- Not going to social situations.

- Keeping a t-shirt on at the beach to avoid embarrassment.

- Putting on makeup to cover ‘flaws’.

- Not allowing your partner to see you naked.

Concluding thoughts

If you resonate with any of the above thoughts, feelings and behaviours and you feel as though your appearance is getting in the way of you living a peaceful, meaningful and joyful life, then I would advise reaching out for help. This could be by booking an appointment with your GP; reaching out to Been There to find a Mentor; using a self-help programme (I recommend The Body image Workbook by Thomas Cash and the Positive Body Image Workbook by Wood-Barcalow, Tylka and Judge); or investing in therapy if possible.

Remember, you are most definitely not alone and there are many proven methods to help you start to feel more peaceful and accepting of your body. With the right help, healing is possible for you too.