Just as the cognitive perception of the body, which is closely linked to muscular and kinesthetic sensations, secures the integrity of the body inside space, the psychological image of the body seals the bond of individuals with time (Bruchon-Schweitzer, 1986-1987, Dolto, 1984). However, the feeling of temporal continuity, although a condition of health and well-being, may also be at the root of developmental problems (Alvin, 1982; Birraux, 1990; Spyckerelle et al., 1991). Indeed, each time important modifications occur in the body (even natural ones, as in adolescence), the psychological perception of the body must be modified as well. The resistance to change, the need to maintain the permanence of the internal representation of the body and the inability to elaborate a new self-image, may result in a discrepancy between the imaginary/ideal self, and the real self (Canestrari, 1980; Magri, & Muscianesi-Picardi, 1980; Lebovici, 1987; Maidi, 1987; Tomkiewicz, 1981).
Body image lies at the heart of adolescence. Adolescents' search for an identity and a gender role is the consequence of a dialectic between the well-known body of childhood, which is fantasized and elaborated from a succession of life events, and the unknown, mysterious, sexually mature body, brought about by puberty changes (Birraux, 1990). Adaptation to the bodily changes of puberty exerts a strong influence on adolescents' social adjustment, psychological well-being, and health behaviors. Many studies of body image in adolescence have analyzed the extent to which boys and girls manage to adjust to the bodily transformations of puberty, and to overcome the personal and relational difficulties which may ensue from these changes (Ferron et al., 1993).
The length and pace of puberty exert a significant influence on the experience of the evolution of body image (Frank & Cohen, 1979; Gaddis & Brooks-Gunn, 1985; Kelly & Menking, 1979; Kumar & Chansoria, 1984). A delay in the starting up of this maturing process does not seem to cause serious psychological and relational difficulties, except when the principal symptom of this delay is considerable retardation of height growth (Apter et al., 1981; Dwyer & Mayer, 1969). On the other hand, early onset of the physiological changes may be linked, among boys, to involvement in delinquent behaviors, and among girls, to the emergence of important adjustment problems (Algan, 1980; Duke-Duncan et al., 1985; Dwyer & Mayer, 1969; Susman, Nottleman, & Inoff-Germain, 1985).
Stereotypes about the male and female body images which are the most aesthetically appreciated in Western societies seem to be interpreted and integrated in a very strict way by most adolescents (Rierdan & Koff, 1980). Since early childhood, boys express a preference for the mesomorph type of male figure (Lerner, Karabenick, & Meisels, 1975; Staffieri, 1967). When they reach adolescence, they aspire toward it and judge themselves negatively if their physical appearance falls short of this ideal (Jovanovic, Lerner, & Lerner, 1989; Lerner & Korn, 1972). Through the media, girls are subject to highly valued images of an extremely thin female body, and very often react negatively to the natural modifications of their figure due to puberty (Brenner & Hinsdale, 1978; Staffieri, 1972). Among some girls, the desire to change their looks associated with a drop in their self-esteem, may herald the onset of eating disorders (Casper & Offer, 1990; Davies & Furnham, 1986; Lundholm & Littrell, 1986; Richards et al., 1990). In some cases, these disorders may evolve to a real pathology, such as anorexia or bulimia (Fowler, 1989; Grant & Fodor, 1986; Ledoux & Choquet, 1991).
The fact that boys globally express more satisfaction and pride in their changing body than do girls, is closely related to another basic difference in the way the genders experience puberty. In order to have a positive adjustment to the morphological changes they undergo, boys evaluate themselves on such factors as body efficiency and physical ability. Girls assess the changes in their body based on whether they are becoming more or less physically attractive. They are faced with several contradictory models of social acceptability: the athletic woman with firm muscles; the seductive woman with a slender figure; and the motherly woman with soft curves (Garnier et al., 1980; Musa & Roach, 1973; Shaw & Kemeny, 1989; Silverstein et al., 1986; Wiggins, 1973). These conflicting "injunctions" sometimes lead to psychosomatic ailments (Garrick, Ostrov, & Offer, 1988; Lerner, Orlos, & Knapp, 1976; Lerner & Karabenick, 1974).
Parents often have difficulty in helping their adolescent children through this period of dramatic changes. Some studies of the evolution of family relationships at the time of adolescence have shown that parents have difficulty accepting their children's evolvement to social and sexual maturity (Offer, Ostrov, & Howard, 1982). This change can entail greater complexity in parents-adolescents interactions, and sometimes an increase in psychological tension within the family comes just when adolescents are experiencing many and most noticeable body changes (Bledsoe & Wiggins, 19743; Faw & Goldsmith, 1980; Rodriguez-Tome, 1989).
Cross-cultural studies have shown that body image depends more on gender differences than on cultural differences among adolescents who have different ethnic origins but live in the same country (Austin, Champion, & Tseng, 1989; Dolan, Lacy, & Evans, 1990; Healey & De Blassie, 1974; Toro et al., 1989). On the other hand, comparison of some components of body image in adolescents who live in different countries have shown some particularities which are related to social and cultural factors. These are related to attitudes toward sexuality, perceptions of health, and elements of body image which are associated with boys or girls (Agrawal, 1978; Ammaniti, Ercolani, & Tombelli, 1991; Offer, Ostrov, & Howard, 1977).
Interesting as these findings may be, it should be noted that most of these studies involved the use of questionnaires, scales, or inventories which limited the responses to the theoretical concerns of the researchers. The present investigation used one-on-one interviews with adolescents which encouraged free expression of the whole range of perceptions linked to body changes at puberty. By focusing attention on what the subjects actually said, we were able to go beyond the limited perception of the difference between the imaginary/ideal body and the real body, and to reach the symbolic dimension of body image.
The first objective of this investigation was to collect information about the adolescents' experience of puberty changes in order to identify the emotional and relational components of body image. The second objective was to determine whether the experience of body changes depends on individuals' cultural context, or whether it can be generalized.
In order to obtain a comprehensive view of the positive or negative opinions, feelings, and events which are linked to the evolution of body image in adolescence, the age groups chosen were those in which boys and girls experience major bodily changes (Jeanneret et al., 1983). In order to assess the level of dependency of body image on gender or cultural environment, samples of adolescents of both sexes and from two countries, France and the United States, were used.
In France the subjects for the preliminary investigation (completed in 1991) consisted of 80 middle- or upper middle-class adolescents who came to the Center for Preventive Medicine of Nancy for a medical check up. These adolescents who were randomly chosen, consented to participate in the study, and were a priori healthy. This sample was comprised of 40 boys and 40 girls between the ages of 13 and 17.
In the United States the subjects for the preliminary investigation (completed in 1993) consisted of 60 middle- or upper middle-class students who were attending high school in a suburb of Chicago. These adolescents were randomly chosen, gave their consent to be interviewed, and had no known health problems. This sample was comprised of 30 boys and 30 girls between the ages of 13 and 17.
Regarding their social, demographic, and ethnic characteristics, these two samples cannot be considered as representative of the entire adolescent populations of the countries where the investigations were conducted; generalization of the results would require confirmation of their validity among different groups of adolescents. However, the samples have enough common traits on a social, economic, and developmental level to be used in comparative research of a psychological factor such as body image. Moreover, the adolescents in this investigation can constitute a representative sample of their compatriots of the same age and socioeconomic background.
The themes chosen for the interviews were those which would induce the expression of personal perceptions, attitudes, and beliefs about body image at adolescence. The relevance of the themes was tested through several preliminary group discussions with adolescents and in reference to the literature on this subject. These themes are: (1) The totality of the changes experienced by the adolescent (in the past and/or currently) which are likely to affect body image at puberty, and also the impressions, feelings, reactions, preceding, accompanying or following the occurrence of these changes, their development and their outcomes. (2) The nature of the coping mechanisms used in order to adjust to body transformations, and the degree of social and psychological integration of these bodily changes. (3) The perceptions specifically linked to different parts of the body. (4) The dependence on social stereotypes (as defined by the adolescent) regarding one's external appearance, their opinions about physical appearances promoted by the media, and the possible existence of an ideal model. (5) The self-assessment of personal knowledge of the body changes, and any unanswered questions. (6) The characteristics of the life style that is related to physical health and appearance, notably, physical activity and eating habits. (7) The possibility of talking about these issues with adults, in particular with the father/mother, and perception of the parental experience of the adolescent's body changes. (8) The mental representation of one's body image in the future, and the hopes, fears, and global expectations regarding the adult body.
Semi-directed interviews were used in order to be able to analyze content which would be as exhaustive and precise as possible. Thus the adolescents were first invited to express themselves freely about the general theme of the research, and then questioned about topics which had not been spontaneously brought up.
According to the adolescents' statements about their body, and according to the principal tendencies displayed in the expression of their personal thoughts, the most important cultural differences between American and French adolescents are based on their beliefs about the possibility of making the real body coincide with the ideal body, and on the way body image is included in relational experiences.
As for the individual dimension of body image, 75% of U.S. adolescents refuse to acknowledge any predisposition; they are convinced that personal characteristics empower them to obtain a body that represents an image of perfection. These characteristics are willpower, courage, self-confidence, and adherence to specific rules. Dissatisfaction with their appearance can sometimes lead to self-disparagement and intense guilt feelings. They also adopt, or are tempted to adopt, behaviors which may be harmful to their health, such as exotic and unbalanced diets or enervating athletic training. On the other hand, this perception has more positive consequences, such as confidence in the effectiveness of some preventive measures, or more generally, an optimistic vision of the future and an almost unlimited faith in one's ability to improve.
The perception of an ideal body was also evident in the French adolescents. However, this perception was not seen as being possible to attain; 75% felt that their bodily limitations as well as their physical appearance were predetermined and thus could not be extensively modified solely through willpower or particular behaviors. Thus, only glaring signs of physical carelessness are considered as blameworthy. The efficacy of preventive measures is questioned by 50% of the adolescents who have limited trust in their ability to go beyond a natural level of personal fulfillment. For example, in the American sample, 80% of boys and 90% of girls are convinced of the effectiveness of special diets or exercise programs, which less than half of the French sample believed to be the case. With regard to hair and face care, 75% of the American sample claimed that they spend time on their appearance daily (hair-styling, using skin-care products, shaving or applying make-up), whereas only 25% of French boys and 50% of the girls say they have equivalent habits. In most cases, the French adolescents' perception implies an affirmation of their individuality through acceptance of their own physical appearance as well as that of others. French adolescents are much more inclined (four out of five) to predict their development on the basis of the physical appearance of close family members (while two out of five U.S. adolescents are so inclined.)
Cultural diversity also appears in less general characteristics. Most of the boys of the two countries (six in ten) are satisfied with their height and weight, but more than one boy in four dislikes his facial features, and one boy in two is bothered by a skin problem. American boys are more prone than French boys to believe that their body in general has a good shape (three in four vs. one in two), and are less critical of specific parts of their body (one quarter of American boys vs. one half of French boys.)
Girls of both countries are more satisfied with their height and less satisfied with their weight than are boys. However, although the same proportion of American and French girls express the fear of being and staying too short (one quarter), American girls are more likely than French girls to describe themselves as too fat (one half vs. one quarter). One third of the girls of both countries have a negative opinion of their face, but this dissatisfaction is not verbalized in the same way: among American adolescents, it takes the form of wanting to have a more dramatic look - almond-shaped eyes, thicker lips, and pronounced cheekbones. Among French girls the dissatisfaction appears to be focused more on a preference for a "baby" face - long eye lashes and large eyes, clear complexion, fair hair.
One quarter of the American boys noted that some part of their body gave them pain, in particular, the back, arms or legs. This complaint is generally related to aftereffects of injuries caused by participation in sports. French boys were less likely (one in ten) to mention this kind of problem. The same difference is evident among girls. More than half of the American girls talked about headaches, cramps or digestive troubles caused by their periods; only two French girls in ten reported this kind of repetitive pain.
As for the relational dimension of body image, differentiating the two countries is the perception and use of the body as an instrument for integration into social networks. American adolescents generally find models for their admiration, or whom they aspire to look like, outside their family or the circle of their closest friends. Comparison with their peers allows them to assess their physical development and appearance. Being attractive is considered extremely important to their social integration whether it be with friends, lovers, or professionals. Almost three quarters of the U.S. sample as compared with less than one quarter of the French, believe that they would be much happier and find life easier if they had a flawless body - that they would be more popular among their peers, that they would be immediately accepted, admired, and loved by others. Three quarters of the U.S. girls strongly believe that their personal worth is assessed by the way they look. As a result, they admit that they would do almost anything to attain what they consider the ideal of physical perfection. It is also interesting to note that the pain of having difficulty being loved and accepted by others because of one's physical appearance is more widespread in the U.S. sample; two U.S. adolescents in ten mentioned that there are times when they felt they were excluded from a group of peers because they did not fit in physically, while less than one French adolescent in ten reported having experienced the same kind of rejection. According to U.S. adolescents, this perception may be at least partially shared by their parents, who reportedly consider their children's physical appearance as likely to be or become one of their essential social assets. Moreover, these adolescents describe their parents as favorable to their attempts to test their attractiveness, notably by dating.
Six French boys and eight girls in ten claim to get comfort and reassurance from friends in times of concern about their physical development and appearance. Among their friends, and also within their family, they find the models who are likely to inspire them to make proper decisions regarding health behaviors, or to provide them with information about the evolution of their physical appearance. French adolescents (50% as compared to 33% of U.S. adolescents) are convinced of their parents' interest in the feelings they have about their body, and in their physical well-being. However, according to these adolescents, this solicitude may have several drawbacks; first, it may be linked to parents' difficulty in accepting their children's separation from the family, and second, it may constitute a basis for control (allegedly excessive) of how they use their new maturity, in particular, through strict regulation of their social life.
In sum, in view of the general pressures faced by adolescents and the added pressure of concern about body image (primarily through the media) it is important for professionals to provide them with support in establishing a healthful, positive image.
The author wishes to thank Professor Daniel Offer of Northwestern University Medical School for his constant support and interest in this work, and the Center for Preventive Medicine of Nancy and the Wheaton-Warrenville South High School for their most helpful cooperation during data collection, in particular, Prof. Dr. J. P. Deschamps and Mr. C. Baker. This research was funded by the Caisse Nationale d'Assurance Maladie of France and by a grant from the Fulbright foundation.
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