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StatPearls . Treasure Island (FL): StatPearls Publishing; 2021 Jan-.


Continuing Education Activity

Body image is a complex construct. Body image distortion and body dissatisfaction are common in both clinical and nonclinical populations. Distortions in body image are painful and can influence physical and psychological health. Many factors play roles in body image distortion and dissatisfaction. This activity reviews the definition, etiologies, correlates, evaluation, complications, and management of body image in both clinical and nonclinical settings, and also highlights the essential points needed by members of an interprofessional team managing the care of individuals with body image-related conditions.

Describe body image, body image distortion, body dissatisfaction, and body image correlates.
Outline standard tools for evaluation and assessment of body image distortion.
Review approaches to the treatment and management of body image distortion.
Summarize the importance of collaboration and communication amongst the interprofessional team to improve outcomes for patients with body image distortion.
Access free multiple choice questions on this topic.


Body image is the subjective picture of individuals of their own body, irrespective of how their body actually looks.<1><2> Body image is a complex construct comprising thoughts, feelings, evaluations, and behaviors related to one’s body.<3> Body image misperception is common in the general population and is also a core component of several serious diseases, including body dysmorphic disorder, anorexia nervosa, and bulimia nervosa.<4><5> Distortions in body image are unpleasant and can have tragic results.<6> Poor body image can affect physical and psychological health and can influence self-esteem, mood, competence, social functioning, and occupational functioning. The understanding of the neurotypical distortions in healthy cognition and perceptual distortions in clinical conditions is essential to address body image concerns and enable suffering individuals to lead more contented and productive lives.<4> In this activity, we outline the role of body image in psychological and physical functioning and describe features of various body image-related conditions and disorders.

Historical Perspective

Early in the 1900s, there were considerable efforts by neurologists to understand unusual forms of body perception reported by patients with brain injury, or phantom limb experience in amputees. The early concepts of body image indeed were rooted in neuropathology. Head, in 1920, first defined body image as a unity of past experiences created in the cerebral sensory cortex. Schilder, who was a neurologist, proposed a biopsychosocial approach to body image, highlighting the need to examine its neurological, psychological, and sociocultural components. Newell noted that body image is dynamic and changes with age, mood, or even clothing. Krueger suggested that body image is the representation of identity derived from both external and internal body experiences.<7>


What is body image, and why is it important?

Body image is one of the components of personal identity. Body image is the figure that one has on their anthropometric measurements, contours, and shape of the body; and also the feelings correlated to these factors that affect the satisfaction with the body or specific parts of the body.<8> Indeed, body image represents how we think, feel, perceive, and behave regarding our bodies.<9>

Body image is a multidimensional concept. The complexity of body image can be appreciated by looking at its components. These components apply to people with healthy and unhealthy perceptions of their bodies and include:

Related but different terms are often used interchangeably in the literature concerning the state of consciousness in which there is an altered body image perception, including body image distortion, body image misperception, body image disturbance, negative body image, altered body image, and body dissatisfaction. The problem of variable terms is intensified by the fact that some studies focus on psychiatric or medical patients, some deal with nonpatients, and others deal with both groups.

Body image distortion is a multidimensional symptom, comprising various components of body image. Components that most widely accepted are the cognitive, the perceptive, and the affective. The cognitive component is from thoughts and beliefs concerning body shape and appearance, and the mental representation of the body. The perceptive component involves the identification and estimation of the body, and it indicates the accuracy of the individuals" evaluation of their body size, shape, and weight compared to their actual proportions. Finally, the affective component includes feelings that individuals develop towards their body and satisfaction or dissatisfaction of individuals about their body.<5>

Thereupon, body image disturbance can manifest as disturbance of percept (i.e., distortion) and concept (i.e., body dissatisfaction). Perceptual disturbance involves the failure to evaluate the size of one’s body accurately. Body dissatisfaction includes attitudinal or affective perception of one’s body and negative feelings and cognitions. Body image disturbances are thought to also manifest on a behavioral level, such as body avoidance, body checking, or dieting.<10>

Negative body image characteristically demonstrates a dissatisfaction of body or body parts, preoccupation with appearance, and engaging in behaviors such as frequent mirror checking, self-weighing, or avoidance of public situations. Negative body image often gets measured as body dissatisfaction.<3> Body dissatisfaction is attributable to a discrepancy between the perception of body image and its idealized image.<8>

Body Image Development

There are some debates as to when body image development begins.

Price believes that primitive sense of body image originates in the uterus with spontaneous movements of the fetus and corresponding feedback from sensory and proprioceptive input. Body image is a learned phenomenon from experiences during both pre-natal and post-natal development in which cross-cortical connections and mirror neurons play prominent roles.<11> Complex interactions between neurophysiological, socio-cultural, and cognitive factors contribute to body image development and maintenance.<6> Different factors such as gender, fashion, peer groups, educational and familial influences, evolving socialization, and physical alterations (hair growth, acne, breast development, menstruation) put children into unknown territory with vulnerable body images.<7>

Primary socialization takes place early in life, and a sense of self-recognition is assumed to develop by the age of two. Children in the toddler years become aware of their gender. They also discover social norms, such as competitiveness and athleticism for men (strong legs, muscles, large arms), and beauty or smallness for females (glossy hair, perfect skin, tiny waist, no hips). When children become aware of their body appearance, they attempt to manipulate their parents to receive admiration and approval. This need for approval grows upon starting school, exhibiting a need for social acceptance. Cash assumes body image as a learned behavior. Smolak proposes that children mainly focus on appearance in the context of the toys they play with, such as Barbie dolls. As children grow and socialize, they begin comparing themselves with other children, especially concerning appearance (e.g., little children desire to be bigger). By the age of 6, body shape becomes increasingly prominent consideration (especially muscle and weight). Smolak reported that among school children aged 6 to 12 years old, 40–50% demonstrated dissatisfaction with some part of their body size or shape.<7>

Adolescence indicates the transition from childhood to adulthood and is associated with physical and social changes.<7> Adolescence is a critical period in body image development. Body image in adolescents is also under the influence of parents. The parent-adolescent relationship has a significant impact on the development of adolescents’ body dissatisfaction. Parents send sociocultural or critical messages and messages about body appearance ideals to their children. When Individuals feel secure regarding their relationships, they are more satisfied with their body and less likely to think in ways that they have to adhere to appearance ideals to receive others’ acceptance. Researches have shown that adolescents with better parent-adolescent relationships are less likely to experience body dissatisfaction.<12> Although in younger children, the influence of families on body image development is more significant than friends, the role of parents decreases as children get older and peer responses become more important than families. Body image in people aged 14 to 27 is greatly affected by their peers.

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<7> A critical event or series of events such as teasing and rejection may lead to body image misperception. Studies have found that the more frequent being teased about body size and weight while growing up, the more likely to experience body image distortion and body dissatisfaction during adulthood.<13>