Body image: The ins and outs and its link with mental health in adolescents

By Talia Planting

Body image can be defined as the perception, thoughts and feelings a person has about their body2 .

Sometimes, we entwine Our sense of worth with The sense we have of Our body – and often, Our body is not viewed With kindness or love, But with deep shame,

But feelings and fact Are not the same,

The truth is your worth Is innate, irrefutable, Accepting who we are And how we are in this Moment – that is Endlessly beautiful

~ P. Bodi1

One of the important developmental tasks of adolescence is forming a positive view and awareness of one’s body3. This includes experiencing biological changes (growth spurts; developing secondary sexual characteristics); cognitive changes (reflecting on the changes the body is going through and those of peers; regulating their emotions and impulses), and psychological changes (assigning more importance to input from peers and media – including the body ideals portrayed by these influences)3 .

As these changes are more rapid than in adulthood, and are more pronounced in adolescence, it leads to an environment where a developing teenager is left with the choice to accept their own unique body changes or reject them/internalise media portrayals of the ideal body. Part of this includes making the choice to engage in self-care versus participating in harmful behaviours such as excessive exercise or dysfunctional eating3 .

Body image disturbance can be thought of in three ways4:

1. Giving one’s body weight and/or shape disproportionate importance as a contributing factor to self-worth; 2. Disapproving of one’s body weight and/or shape (incongruence between the body one has and idealized body image); and 3. Obsessing over one’s body weight and/or shape. This has been shown to have significant impact on mental health and quality of life4, including an increased association with eating disorders, depression, anxiety and low self-worth2. There is research suggesting this can occur from as young as age six in a diverse range of body shapes and cultural settings2 .

Social factors play a significant role in unhappiness with one’s body; in particular the effect of mass media2. The marketing of unreasonable beauty standards (in some instances further exacerbated by photoshop) is associated with body dissatisfaction and dysfunctional eating in females2 .

Over the past couple of decades there has been an exponential increase in the consumption of ‘new media’ – namely the internet: fashion and beauty websites; entertainment and celebrity websites and social networking sites2 (notably Facebook; Instagram and Twitter2 with additional platforms such as TikTok being added as time goes by).

This has added to a new dynamic in that users of these sites are more active in their engagement with them (choosing which groups/individuals to follow, posting their own photos, videos and messages)2. It has been shown that the more time spent on sites like Facebook – the more the perceived body scrutiny and comparison of one’s appearance, the more the dissatisfaction with one’s body2 .

Body dissatisfaction linked to social media use

Other studies have shown a correlation with more body dissatisfaction relating to those who post pictures of themselves (along with the associated likes, dislikes and comments by others), along with viewing of posted pictures of peers these social networking sites. This can lead to the placement of worth on perceived appearance and negative comparison of one’s body to others2. The more friends one has on these platforms, the higher the association with ideal body image internalisation and increased vigilance of one’s body in comparison with others2 .

An additional risk factor includes the regularity with which teenagers engage in conversations around appearance or ‘fat-talk’, resulting in the internalisation of the ‘ideal’ body, and emphasis on the importance of physical appearance6 . In turn this is associated with a higher likelihood of body dissatisfaction6. Teasing in the context of appearance, by peers, has also been found to have an association with body dissatisfaction6 .

There are two leading theories used to try and clarify the association between mass media use and increased body dissatisfaction. The first being sociocultural theory, which looks at the internalisation of unattainable beauty standards portrayed in mass media and resulting in comparisons of one’s own appearance to these images2 .

The second is objectification theory, which elaborates on the Western notion of the female body being an object that is there to be viewed and appraised based on its exterior form2. This leads to continual self-scrutiny in young girls leading to increased anxiety and shame related to the body, and in some the further development of mental health problems as already mentioned2 .

Within the South African context, it has been found that culture, societal norms and ethnicity play a role in body dissatisfaction, with globalisation and mass media focus on the ‘Western’ ideal of being thin contradicting what may be different definitions of beauty in traditional beliefs5 .

There is evidence suggesting South African adolescents are less satisfied with their body shape leading to an increased risk of food restriction and excessive exercise increasing the chance of developing eating disorders such as Anorexia Nervosa and Bulimia Nervosa5 . Factors important in contributing to a positive body image

Useful resources

South African Depression and Anxiety Suicide Prevention Line

0800 567 567 | www.sadag.org

South African Depression And Anxiety Group Mental Health Line

011 234 4837 | www.sadag.org

Lifeline

0861 322 322 | www.lifeline.org.za

Destiny Helpline for Youth & Students

0800 414 243 Keeping the above in mind, the following factors have been found to be important in contributing to a positive body image in adolescents3: • Acceptance of one’s unique body characteristics (this includes perceived shortcomings), and the understanding that beauty is subjective and there is value in the diversity of body shape. • Appreciation of the functions the body allows one to perform – such as satisfaction in different physical activities. • Mental resilience when experiencing messages that threaten one’s developing body image. This incorporates acknowledging these threats and responding with self-care and the refocusing on one’s good qualities when confronted. • Associating with peers who share similar values and don’t fixate on negative body image messages.

Specific interventions aimed at addressing body dissatisfaction in adolescent females were found to be more effective when using an interactive style; this allowed for expression of opinions and open discussion amongst peers that allowed for a collaborative exploration of solutions that they could take ownership of within peer groups6 .

If there is concern about an unhealthy preoccupation with body image and harmful behaviours such as restrictive eating, excessive exercise, use of substances to manage weight, etc, it is advisable to seek professional advice and support in addressing the problem and preventing further deterioration and health risks. 

The Counselling Hub

021 462-3902 (landline) or 067 235-0019 (mobile) www.counsellinghub.org.za

References: 1. Inherit the Dawn; Author, P. Bodi ; Publisher, P. Bodi, 2021 ; ISBN, 1651005583, 9781651005583 2. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Holland, Grace; Tiggemann, Marika. ISSN: 1873-6807 , 1740-1445 , 1873-6807; DOI: 10.1016/j.bodyim.2016.02.008. Body image. , 2016, Vol.17, p.100-110 3. The Positive Body Image among Adolescents Scale (PBIAS): Conceptualization, development, and psychometric evaluation among adolescents from Belgium. Maes, Chelly ; Trekels, Jolien ; Tylka, Tracy L ; Vandenbosch, Laura. AMSTERDAM: Elsevier Ltd. Body image, 2021-09,

Vol.38, p.270-288 4. Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents. Mitchison, Deborah ; Hay, Phillipa ; Griffiths, Scott ; Murray, Stuart B ; Bentley,

Caroline ; Gratwick‐Sarll, Kassandra ; Harrison, Carmel ; Mond, Jonathan. United States: John

Wiley and Sons Inc. The International journal of eating disorders, 2017-02, Vol.50 (2), p.118-126 5. Body Image Satisfaction, Eating Attitudes and Perceptions of Female Body Silhouettes in Rural

South African Adolescents. Pedro, Titilola M ; Micklesfield, Lisa K ; Kahn, Kathleen ; Tollman,

Stephen M ; Pettifor, John M ; Norris, Shane A; Tovée, Martin J. United States: Public Library of

Science. PloS one, 2016, Vol.11 (5), p.e0154784-e0154784 6. An evaluation of a body image intervention based on risk factors for body dissatisfaction: A controlled study with adolescent girls. Richardson, Shanel M ; Paxton, Susan J. Hoboken: Wiley

Subscription Services, Inc., A Wiley Company The International journal of eating disorders, 2010-03, Vol.43 (2), p.112-122 Dr Talia Planting is a Specialist General Psychiatrist practicing at Life Vincent Pallotti hospital in Cape Town. She is dedicated to better understanding mental illness and how to manage it to obtain mental health. This includes a patient-centred approach with focus on the biological, psychological and social aspects of care.

Her main areas of interest include mood, anxiety disorders and neuropsychiatric disorders in adults, along with child and adolescent mental health.