The Management of Body
THOMAS F. CASH
Body image is a clinically important, multifaceted psychological concept that refers to persons’ perceptions, attitudes, and experiences about the body, especially its appearance (see Chapter 72). It has clear effects on psychosocial functioning and quality of life; individuals who are dissatisfied with their appearance are susceptible to impaired self-esteem, social self-consciousness and anxiety, depression, eating disturbances, and sexual difficulties. Body image disturbances may be viewed on a continuum from relatively benign discontent to experiences of intense preoccupation and distress. The latter may reflect severe clinical conditions, such as somatic delusional disorder, body dysmorphic disorder, anorexia nervosa, bulimia nervosa, and gender identity disorder (see Chapter 21).
In the United States, body image dissatisfaction has increased, certainly among women and perhaps among men. Concurrently, the population has become heavier. Women’s body image concerns, especially displeasure with weight and shape, are so prevalent they have been termed “normative discontent.” Immersed in cultural messages that “looks are everything,” people aspire to physical ideals that are extreme and seldom attainable (see Chapter 19).
Psychological investment in one’s physical appearance comes at a price. The internalization of lofty standards can undermine self-worth as one’s body fails to meet ideals. Body image development is also influenced by familial and peer modeling of values about appearance, and by the interpersonal reactions to one’s body. For example, appearancerelated teasing and criticism can exert lasting deleterious effects on body image. From such experiences, people acquire guiding assumptions or schemas about the psychosocial importance of their looks. Such assumptions are pivotal in the meaning that individuals attach to experiences in everyday life. To manage body image discomfort, people employ a variety of cognitive and behavioral strategies, including avoidant and compensatory actions, as well as efforts to alter the body to conform to personal ideals.
As Rosen has discussed earlier in this volume (Chapter 72), overweight and obese in-