Body image is a person's impressions, thoughts, feelings, and opinions about his or her body. A person's perception of body image may be influenced by his or her mood, self-esteem, and relationships with other peers.
“Am I fat?” “Why don't I have curly hair?” “Why haven't I had a growth spurt yet?” “Why doesn't anyone else in my class have diabetes?” “Will I ever be strong enough to play on the football team?”
Most teenagers have similar questions and concerns about their bodies. They think a lot about their appearance, which seems in a constant state of change during adolescence. All individuals have an “image” of their body and appearance and how well it fits in with what they consider normal, acceptable, or attractive. For adolescents, body image is a big part of their total self-image.
Too much focus on physical appearance can create body image problems, especially for females. Even those of normal healthy body weight can feel fat when comparing themselves to very thin models and movie stars. Studies have found that 80 percent of 10-year-olds are afraid of being fat. By middle school, 40 to 70 percent of girls are dissatisfied with two or more parts of their body, and body satisfaction plummets between the ages of 12 and 15.
In one study of college students, 74.4 percent of the normal-weight women stated that they thought about their weight or appearance “all the time” or “frequently.” The study found that 46 percent of the normal-weight men surveyed responded the same way.
These attitudes and behaviors are showing up at younger ages. One study found that 42 percent of elementary students in grades one through three want to be thinner, and 37 percent of students in grades three through six have already tried to lose weight. Dissatisfaction with body image and the quest for perfection can lead to feelings of failure, unhealthy dieting, and serious eating disorders.
Teenagers' bodies undergo so many changes that it is easy to understand why they may be preoccupied with their appearance and their body image. Both boys and girls experience growth spurts and sexual development. Girls' breasts and hips enlarge, their body hair grows, and menstruation * begins. Boys' muscles and body hair grow, their voices get deeper, and their testicles and penises get larger. Their facial features may change, and hormones may cause skin problems. It takes a while to get used to their new image or appearance. Teenagers are very susceptible to criticism, teasing, or negative comments. Some teenagers lose confidence in their appearance if they receive negative or insulting comments about their looks, racial or ethnic features, physical abilities, or body changes associated with puberty * . With all of the focus on the body's appearance, teenagers may need to be reminded to give equal value to other important aspects of themselves, such as personality, inner strengths, mental aptitudes, and artistic and musical talents, which, along with body image, contribute to overall self-image.
Jack feels self-conscious about his lack of body hair, while his friend Ben thinks that he has too much. Both boys feel a bit uncomfortable when they first get on the court for basketball practice because their uniforms reveal their legs, upper chest, and armpits. Terry feels self-conscious about having some acne * and did not want his girlfriend to take his picture at the class picnic. Anna finds that her legs seem to be growing faster than the rest of her body, and her feelings were hurt when someone teased her by calling her a beanpole. Nick is sure he has not grown at all this year and does not like being shorter than most of the girls in his seventh grade class. Luckily, the awkward body changes of adolescence almost always even out eventually.
Some self-criticism involves aspects of appearance that have nothing to do with puberty. Megan dislikes the freckled skin on her arms. Darlene wishes her hair were straight instead of curly, while Angela wishes she had Darlene's waves. Andrea does not like her nose, and Paula wishes her lips were different. Jeanne thinks her complexion is too fair, and Derek thinks he is too dark-skinned.
Learning to like one's own body, coming to accept its imperfections, and growing to appreciate its unique beauty means having a healthy body image. Developing a healthy body image is an important task of adolescence.
Some people continue to have problems with body image long after adolescence is over. Body dysmorphic (dis-MOR-fik) disorder (BDD) is a condition that involves extremely negative body image. BDD goes beyond self-criticism of one's features, concern with one's appearance, or poor body image. People who have BDD become overly preoccupied with what they see as flaws in their physical appearance, and they are often the only ones to perceive their features or characteristics as flaws. They may pick out tiny imperfections that others may not even notice and worry over these imperfections in a way that is out of proportion to their importance. Their self-criticism can leave them very distressed and too self-conscious to fully enjoy life. People with BDD are plagued by critical thoughts about their appearance and have a distorted body image that causes them to believe that they are ugly.
Some experts estimate that BDD affects 1 to 2 percent of adults in the United States. Both males and females can have BDD. People with BDD often stay at home and often become depressed * or isolated, and many experience anxiety * . Some have unnecessary plastic surgery * or go to great lengths to change or hide aspects of their appearance. Preoccupation with their appearance can leave them distracted and unable to enjoy activities with family and friends. Experts say that people with BDD often engage in the following behaviors:
People's body images are strongly affected by what they see on television and in the movies. Magazines are filled with pictures of beautiful young women and lean, muscular young men. Teenagers are influenced by these images and may wish to look like their favorite models or stars. However, the degree of physical perfection that media images convey is largely an illusion created by professional makeup and styling, special lighting, and computerized alterations in photographs. When people compare themselves to these perfect-looking images, they are likely to be disappointed with their own appearance. Feeling the need to look perfect, or to have a perfect body, can lead to body image problems.
Body image problems affect both boys and girls, but they tend to bother girls more deeply than boys. One reason is that in U.S. culture, girls' and women's value is traditionally linked closely to physical appearance. Boys' appearance, while important, is not generally seen as their most important feature. Boys, however, often feel pressure to be tall, muscular, and strong.
Some teenagers are satisfied with how they look and feel confident about their appearance. Others are more self-critical and feel they come up short when comparing themselves to others. Extreme dissatisfaction with body image can lead to depression, social isolation, or eating disorders * .
Sometimes body image can become distorted, and people may mistakenly believe themselves to be fat or ugly. These distorted or mistaken ideas can cause them to feel extremely distressed, self-critical, and overly preoccupied with their physical imperfections. Someone who has a constant and distressing preoccupation with minor bodily imperfections may have BDD, an extremely distressing, obsessive preoccupation with perceived flaws in one's appearance.
Although it may not be recognized and diagnosed until a person is older, BDD usually begins before the age of 18. BDD usually starts during adolescence when the body undergoes many changes and when teenagers are forming ideas about what is acceptable or desirable in physical appearance. Media images that emphasize perfection, as well as a person's own extremely high expectations or perfectionism about appearance, can be factors in the development of BDD. Harsh critical comments or ridicule about appearance by family or friends can be destructive to a person's body image and may make a person more likely to develop BDD.
In addition to social influences that may cause body image to be negative or distorted, biological factors may make certain people more likely to develop BDD. Many experts believe that BDD is linked to obsessive-compulsive disorder (OCD), which causes people to become extremely preoccupied with certain distressing thoughts. OCD also causes people to feel compelled to perform certain repetitive actions. BDD involves extreme preoccupation with appearance, harsh self-critical thoughts, and repeated checking or attempts to fix appearance.
Because people with BDD are plagued by insecurity and self-consciousness and tend to isolate themselves, sometimes they alone know that they have this problem. Seeking treatment by a mental health professional can help relieve their distress. Treatment of BDD often involves psychotherapy that focuses on understanding the person's negative thoughts and opinions about his or her appearance, making needed adjustments in distorted thinking patterns about body image, and decreasing avoidance and repetitive thoughts and behaviors. Medications are sometimes used to relieve distress and to reduce anxiety or depression that can accompany BDD.
In some cases, a person's preoccupation with his or her appearance may actually be a symptom of another underlying disorder, such as an anxiety disorder * , an eating disorder, or OCD. Evaluation by a mental health professional can determine whether someone's BDD symptoms are connected to another problem. When that is the case, the person is treated for the other problem as well.
Experts say that teenagers can help prevent BDD by getting help with body image concerns early. While it is normal for adolescents to feel self- conscious about their changing looks, it is also important that they learn to like and accept their body and appearance. In time, many adolescents find that the very features they once wished were different are actually the ones that make their looks uniquely attractive. Concerns about appearance that get in the way of enjoying activities or being with friends or that cause distress, anxiety, or depression may be a sign of body image problems. By paying the right kind of attention to such concerns early, mental health professionals can help prevent body image problems from becoming more serious.
Some people develop an intense fear of gaining weight even though they do not have BDD. They may begin to diet or exercise excessively, lose weight rapidly, and refuse to eat enough food to maintain a healthy weight. A person with this pattern may have an eating disorder called anorexia nervosa * . People with anorexia develop a distorted body image and see themselves as fat when they are not. Even though they may get dangerously underweight and malnourished, they continue to feel fat and refuse to eat.
Bulimia * is another eating disorder that involves body image problems. People with bulimia have a distorted body image that causes them to be self-critical and to feel fat, and they place too much importance on weight and body shape. People with bulimia have episodes of out-ofcontrol overeating, or binges, and then try to make up for them by making themselves vomit, taking laxatives, or exercising to excess to avoid gaining weight. People with excessive body image problems may need assistance from several mental health professionals, including a physician, a psychotherapist * , and a nutritionist.
There are certain changes people can make in their appearance or physical capabilities, but having a good body image does not require a perfect body. People develop a healthy body image by taking care of their body, appreciating its capabilities, and accepting its imperfections. Positive body image is linked to an awareness that appearance is only one part of a person's identity or character as well as to a mature sense of what really matters and what does not in evaluating an individual.
Most teenagers can control their appearance to some extent; for example, they may choose haircuts or clothing that reflect how they see themselves. By doing so, they can create an outer image that pleases them. Eating healthful food and getting plenty of exercise can help teenagers develop strong, fit bodies of which they can be proud. Cutting down on junk food helps them stay trim, and physical activities help them develop strength, coordination, and new capabilities. Healthy behaviors contribute to attractive appearance on the outside and add to positive inner feelings about body image.
See also Anorexia Nervosa • Anxiety and Anxiety Disorders: Overview • Bulimia Nervosa and Binge Eating Disorder: Overview • Depressive Disorders: Overview • Obesity
Dunkle, Elena. Elena Vanishing: A Memoir. San Francisco: Chronicle, 2015.
Lack, Caleb, ed. Obsessive-Compulsive Disorder: Etiology, Phenomenology, & Treatment. Fareham, UK: Onus Books, 2015.
Neziroglu, Fugen, Sony Khemlani-Patel, and Melanie T. Santos. Over-coming Body Dysmorphic Disorder: A Cognitive Behavioral Approach to Reclaiming Your Life. Oakland, CA: New Harbinger, 2012.
Stein, Dan, Naomi Fineberg, and Samar Reghunandanan. Obsessive-Compulsive and Related Disorders. 2nd ed. Oxford: Oxford University Press, 2015.
Anxiety and Depression Disorders of America. “Body Dysmorphic Disorder (BDD).” http://www.adaa.org/understanding-anxiety/relatedillnesses/other-related-conditions/body-dysmorphic-disorder-bdd . (accessed November 22, 2015).
National Organization of Anorexia Nervosa and Associated Disorders. http://www.anad.org/get-information/about-eating-disorders/binge-eating-disorder/ (accessed November 22, 2015).
National Eating Disorders Association (NEDA). 165 W 46th St., Suite 402, New York, NY 10036. Toll-free: 800-931-2237. Website: http://www.nationaleatingdisorders.org (accessed November 22, 2015).
National Women's Health Resource Center. 157 Broad St., Suite 200, Red Bank, NJ 07701. Toll-free: 877-986-9472. Website: http://www.healthywomen.org (accessed November 22, 2015).
* menstruation (men-stroo-AYshun) is the discharge of the blood-enriched lining of the uterus. Menstruation normally occurs in females who are physically mature enough to bear children. Most girls have their first period between the ages of 9 and 16. Menstruation ceases during pregnancy and after menopause. Because it usually occurs at about four-week intervals, it is often called the monthly period.
* puberty (PU-ber-tee) is the period during which sexual maturity is attained.
* acne (AK-nee) is a condition in which pimples, blackheads, whiteheads, and sometimes deep lumps occur on the skin.
* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
* anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
* plastic surgery is the surgical repair, restoration, or improvement in the shape and appearance of body parts.
* eating disorder is a condition in which a person's eating behaviors and food habits are so unbalanced that they cause physical and emotional problems.
* anxiety disorders (ang-ZY-etee dis-OR-derz) are a group of conditions that cause people to feel extreme fear or worry that sometimes is accompanied by symptoms such as dizziness, chest pain, or difficulty sleeping or concentrating.
* anorexia nervosa (an-o-REK-seuh ner-VO-suh) is an emotional disorder characterized by dread of gaining weight, leading to self-starvation, dangerous loss of weight, and malnutrition.
* bulimia (bu-LEE-me-uh) is an eating disorder in which a person has episodes of out-ofcontrol overeating, or binges on food.
* psychotherapist (sy-ko-THER-uhpist) is a mental health professional who works with people to help them change thoughts, actions, or relationships that play a part in their emotional or behavioral problems.