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Related Topics
Exacting BeautyReview - Exacting Beauty
Theory, Assessment, and Treatment of Body Image Disturbance
by J Kevin Thompson, Leslie J. Heinberg, Madeline Altabe, and Stacy Tantleff-Dunn
American Psychological Association, 1999
Review by Sundeep Nayak, M.D.
Oct 4th 2004 (Volume 8, Issue 41)

There has been a 228 per cent increase in cosmetic procedures between 1997 and 2002. During the same time period, there has been a 2446 per cent increase in American women undergoing injection with Botulinum toxin type A (Botox®). The most popular surgical procedures today are liposuction, breast augmentation, eyelid surgery, breast reduction, and nose reshaping. Popular television programming reflects new attitudes to radical transformational surgery, be it surreal ("The Swan") or bizarre ("Extreme Makeover"). Exacting Beauty critically examines the history and mystery of body image, applying theory, research, clinical application and analysis to the individuality of body image experience.

The specific focus on self-perceptions of appearance began after the Second World War, perhaps starting with earlier works that measured self-ratings of attractiveness in married couples, and the first scales designed to assess self-rating of subjective appearance. It was not until decades later that scientific works linked aspects of body image disturbance to the central features of anorexia nervosa and other eating disorders. Eating disorders are almost exclusively a female phenomenon (90-95%) but lesbians are the least concerned about physical appearance, whereas gay men and heterosexual women showed significantly higher concern for physical attractiveness.  In 1985, the now classic phrase normative discontent was first used to describe the widespread dysphoria that women have regarding their appearance. In 1986, a nationwide survey showed that only seven per cent of women expressed little concern with their appearance. The first English language article on body dysmorphism disorder (BDD) was published in 1970 and the disorder was first included in the DSM-III-R in 1987. Recent advances in the description, assessment, and treatment of BDD indicate that it will become one of the most active areas in the entire field of body image in the next millennium.

Exacting Beauty systematically presents works starting with a very thoughtful introduction that includes definitions of body image in relative order of precision. Explanations, hypotheses, and, ultimately, well-constructed theories of body image disturbance are crucial to the development of the field beyond its current stage. The book chooses contemporary and illustrative research and clinical reports in an effort to expose the importance of body image for many individuals of both genders and a wide array of ethnic and cultural backgrounds.

Many surprising and hitherto not widely publicized conclusions are presented:

1.                  Men may often be dissatisfied because of a low weight or, more likely, their goal of gaining weight reflects a desire to add muscle mass.

2.                  Black female and male students were less interested than other groups in losing weight and more interested in gaining weight.

3.                  One in five women indicate that at least once in her life, a man has said he wished her breasts were a different size (Plus, a startling 58 per cent have been taunted or teased because of their breasts)

4.                  Women in Texas request bigger implants than those in any other state (the states with the most operations are Florida, Texas, and California)

5.                  94% of female characters on television programming favored by middle school age girls were below average in weight. 14% of commercials airing during Saturday morning cartoons were related to enhancing one's appearance.

6.                  Exposure to soap operas and movies predicted body image dissatisfaction, and exposure to music videos predicted drive for thinness, whereas amount of time spent watching sports was negatively correlated with one's body image dissatisfaction.

Children are less likely to befriend an endomorphic (overweight) child. Prejudice against obese children has been demonstrated in diverse samples of adults, including physicians, nurses, psychologists, physical and occupational therapists, and social workers. These professional routinely rate obese children as less likeable than children with a variety of physical handicaps, disfigurements, and deformities. Society sees a backlash against the body myth idea and factions decided it was time to fight prejudices, stereotypes, and discrimination against obese individuals. One such group is the National Association to Advance Fat Acceptance (NAAFA) which produces a bimonthly newsletter devoted to this cause. A number of investigations have examined the influence of the mass media more globally, specifically teen and women's fashion magazines. Anorexia nervosa seems to follow the subscriptions to Vogue: if Vogue gets to your country, anorexia nervosa will eventually follow. Latinas born in the United States identified an even smaller ideal body size than did their White counterparts, whereas those who immigrated chose a significantly larger ideal.

Body image disturbance does not exclude the male form. Steroid use is one isolated area in the field of body image that has generally examined male samples. Sixty percent of men with considerable baldness reported negative social and emotional effects owing to their hair loss: these results are more pronounced in younger men, those with earlier onset of baldness, and those who were single and uninvolved in intimate relationships.

More research is required to examine the roles of peers, parents, romantic partners, and strangers in making an impact on body image disturbance. Evaluating the attractiveness of others or gossiping about someone's weight fluctuations, for example, may seem harmless. However, these seemingly ordinary behaviors are subtle ways of communicating the importance placed on looks and create or exacerbate the body image anxiety of others. Whatever the direction the coming decades takes, we will learn more about what happens in the mind as individuals process moment-by-moment events. Whatever the historical causes of body image disturbance, it exists and is maintained by cognitive processes that occur in far too short a time period to dismiss with analysis and modification. These are the exact challenges we face.

Read more in:

 

q                   Blum VL: Flesh Wounds – The Culture of Cosmetic Surgery. 356 pp. California University Press. September 2003

q                   Claiborn J, Pedrick C: The BDD Workbook – Overcoming Body Dysmorphic Disorder and End Body Image Obsessions. 200pp. New Harbinger Publications. September 2002

q                   Connor S: The Book of Skin. 304 pp. Reaktion. October 2003

q                   Gilman SL: Making the Body Beautiful. 424 pp. Princeton University Press, January 2001

q                   Phillips KA: The Broken Mirror – Understanding and Treating Body Dysmorphic Disorder. 368 pp. Oxford University Press. April 1998

q                   Wolf, N: The Beauty Myth – How Images of Beauty are Used Against Women. 368 pp. Perennial. September 2002

 

© 2004 Sundeep Nayak

 

Dr. Nayak is an Assistant Professor of Clinical Radiology in the University of California School of Medicine San Francisco and his interests include mental health, medical ethics, and gender studies. A voracious reader and intrepid epicure, he enjoys his keyboards too much. He is addicted to watching Nip/Tuck.


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