How to recognise symptoms ofappearance-related distress

How do we recognise symptoms of appearance related distress?

Does it relate to physical indicators, e.g.Severity & extent of the ‘difference’ in appearance?Location/body site affected?

Other indicators …..Face to face interaction/discussionsObserving behaviourPsychometric methods

Severity & extent of the ‘difference’ & adjustment

Anecdotally, the severity of a difference in appearance is associated with poor adjustment

But . . .

Who is most self conscious of their appearance?

Who is most self conscious of their appearance?

WE CAN’T POSSIBLY KNOW FROM THESE PHOTOGRAPHS

Physical indicators: Severity & location

In a study by Moss (2005), over 500 participants with body image concerns (e.g., weight, size) and / or visible differences (e.g., scarring, burns) rated their levels of wellbeing in reltion to their appearance.

The impact of the severity of a difference in appearance

Half of these 500 participants self-assessed how different they looked from the norm

The other half were assessed by plastic surgeon (appearance expert) as to how different they looked from the ‘norm’

Moss (2005): Severity analysis

The Self assessed severity ratings of appearance differences – did predict levels of well being, however

Surgeon assessed severity ratings of appearance differences – did not predict well being

How different someone THINKS they look predicts well being

How different someone ACTUALLY looks does NOT predict well being

Examples:• Alan feels unable to socialise with his peers. When in

conversation, he often covers his mouth with his hands, and if possible, avoids talking at all. He is self-conscious “because of my bad habit of keeping my mouth open my bottom lip has become really fat.” Others do not perceive his mouth as looking different.

• Bob is a shop assistant in his town. He enjoys meeting regular customers and new people. He is aware of scarring on his lips following an infection, and sometimes gets asked about it. However, he is used to this, and does not consider this a very significant part of his life.

Examples:• Carol has a birth mark about 3cm in diameter on her neck. She is

terribly concerned that this is noticeable to everyone she meets, and that they will imagine that this is a “love bite”, and assume she is promiscuous. As a result of this, she avoids others as far as possible, and if she needs to leave the house, always wears a scarf (which she continually re-adjusts)

• Diana was scalded by steam as a child when she opened the radiator in her parents’ car. She has extensive visible scarring on her arms and neck. However, she has grown up accepting the attention this sometimes generates, and is practiced at fielding questions. Her work as a teacher, and personal relationships have not been unduly affected by her feelings about appearance.

Body site/physical location of a ‘difference’ in appearance

Moss (2005) found that the physical location of the affected body site(s) is a poor predictor of well being

Areas which are not normally visible to others (eg those hidden by clothes are as influential as normally visible areas – see graph on next slide).

In female samples, sensitivity about abdomen/breasts is most associated with poor well being

Lower limb

Upper limb

Genitalia

Torso

Neck

Face

Head

Mea

n D

AS

24

60

55

50

45

40

35

30

Taller column indicates more distress associated with sensitivity about this body part

Appe

aran

ce d

istre

ssMoss (2005) location analysis

Lower limb

Upper limb

Genitalia

Torso

Neck

Face

Head

Mea

n D

AS

24

60

55

50

45

40

35

30

Taller column indicates more distress associated with sensitivity about this body part

Appe

aran

ce d

istre

ss Sexually significant,Normally kept hidden

Sexually significant,Normally kept hidden

Low numbers, unreliable figure

Moss (2005) location analysis

Non-visible areas of difference (including size differences, skin conditions, scarring, etc.) can sometimes be associated with MORE distress than normally visible areas

Non-visible areas introduce the problem of carrying a “secret”

When, and to whom, is the “secret” revealed?

Especially an issue in relation to romantic/sexual relationships

Other methods of recognising appearance-related distress

Face to face discussion?

Observing behaviour?

Psychometric assessment?

Appropriate for vocational trainers

Appropriate for psychologists

Face to face discussionACTIVITY – identify potential advantages/disadvantages

of face-to-face assessment

Advantages Disadvantages

Face to face discussion

AdvantagesFlexibility

Depth - can cover variety of times and domains

Individualistic

DisadvantagesHighly skilled

Time

Unreliable assessment

Subject to bias

Observing behaviour

Anxiety symptomsSocial avoidanceNervousnessBlushingSocial awkwardness

Not necessarily the case that these are caused by appearance anxiety

Observing behaviour

Is there an unusually high preoccupation with appearance, eg reflected in…Behaviours and conversation

Concealing aspects of body (gestures/clothing)

Checking mirrors/reflection more than necessary

Appearance concerns disrupting the person’s ability to function (causes lateness, cancellations of appointments, avoidance of social situations, anxiety about interviews etc).

Observing behaviourAdvantages

Focus on individual

Can analyse social interaction in depth

DisadvantagesRequires high level of

skill

Time consuming

Which behaviours?

Context specific behaviours may be missed

Psychometrics – assessment by psychology professionals

Trainers may refer people to psychologists for a more formal assessment

Trainers may be supplied with a formal assessment by a psychologist and may need to interpret/understand this

Psychometrics – assessment by psychology professionals: Advantages

Is carefully defined – Clarity needed about what is being measured

Has known validity – Assesses the aspect we think we want to assess

Is reliable – Measurement is likely to be consistent over time

What are we measuring when

we measure body image?

Activity:

Think about what your appearance means to you, and how it affects your thoughts, feelings, and behaviours.

What questions would you need to be asked to enable you to communicate this to someone else?

Challenges of psychometric assessment

When assessing appearance concern using psychometric methods, there are a plethora of scales, often measuring very similar sounding things

Body image

Weight satisfaction

Size perception accuracy

Body satisfaction

Appearance satisfaction

Appearance evaluation

Body esteemAppearance orientation

Body concern

Body dysphoria

Body dysmorphia

Body schema

Body perception

Body distortion

(Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999)

When interpreting psychometric assessments of body image and appearance concerns, it is important to know which aspects a measure HAS and HAS NOT assessed.

Valid and reliable assessment

Known constructs used

Quick/easy

Can track change/outcomes

Psychometric assessment

Advantages DisadvantagesWhich constructs to

measure?

May oversimplify

Language/literacy skills

Data management

Gender differences

Men tend to evaluate and discuss the body as one entity

"I like, sort of my, the whole bit that is relatively slim, and it's all together so to speak, nothing’s out of place.. areas I don’t like, um, my stomach especially, when it flops over the trousers” (Man, 33)

"I’m happy with it, yeah.. it’s an overall thing” (Man, 39)

• Women conceptualise the body as many distinct parts

• "I have quite a naturally flat stomach, which I like a lot, and I’ve got my stomach pierced because I like the way it looks with that… I’m pleased with my stomach and I try to do sit-ups just to keep it looking okay... I don’t mind my back, I think that looks alright, I’m not very keen on my legs because I think they look very stumpy. Um.. and I think they’re also, they don’t seem to have a lot of shape… they just look like sticks, matchsticks (laughing).. um I like my arms I think they’re fine um.. my bum’s alright (laughing) a bit dimply sometimes and I’d probably choose to have bigger boobs if I could” (Woman, 24)

Activity:

Who might need to recognise “symptoms” of appearance distress?

Is the word “symptoms” a problem? What associations/subtexts does it convey?

Summary

• Physical characteristics are poor predictors of appearance self-consciousness

• Face-to-face or observational methods provide one way of assessing self-consciousness

• Psychologists may use more systematic, psychometric methods