How to recognise symptoms of appearance-related distress.

How to recognise symptoms ofappearance-related distress

How do we recognise symptoms of appearance related distress?

Physical indicatorsSeverityLocation/body site

Other indicatorsFace to face interaction/discussionsObserving behaviourPsychometric methods

Physical severity & adjustment

Anecdotally, severity 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

Moss (2005): Severity analysis

Over 500 participants with body image concerns (e.g., weight, size) and / or visible differences (e.g., scarring, burns) assessed appearance well being.

Moss (2005): Severity analysis

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

Other half of this 500 assessed by plastic surgeon (appearance expert) as to how different they looked from the norm

Moss (2005): Severity analysis

Self assessed severity ratings of appearance differences – does predict well being

Moss (2005): Severity analysis

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

Moss (2005): Severity analysis

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.

Moss (2005): Location analysis

Physical location of body areas poor predictor of well being

Normally non-visible areas as influential as normally visible areas – see graph following.

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

Lower limb

Upper limb

Genitalia

Torso

Neck

Face

Head

Mean 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

istr

ess

Moss (2005) location analysis

Lower limb

Upper limb

Genitalia

Torso

Neck

Face

Head

Mean 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

istr

ess Sexually

significant,Normally kept hidden

Sexually significant,Normally kept hidden

Low numbers, unreliable figure

Moss (2005) location analysis

Moss (2005): Location analysis

Non-visible areas of difference (including size differences, skin conditions, scarring, etc.) can 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 relevant in romantic/sexual relationships

Assessment

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

Appearance focusBehavioural and conversational preoccupation with

appearance

Concealing aspects of body (gestures/clothing)

Checking mirrors/reflection more than necessary

Appearance concern disrupts ability to function (causes lateness, cancellations of appointments, etc).

Observing behaviour

AdvantagesIndividualistic

Can analyse social interaction in depth

DisadvantagesHighly skilled

Time

Which behaviours?

Context specific behaviours missed

Psychometrics – assessment by psychology professionals

Trainers may refer to psychologists for formal assessment

Trainers may need to interpret/understand psychologists’ formal assessments

Psychometrics – assessment by psychology professionals

Is carefully defined - What should we measure?

Has known validity – Assessing what we thing we are assessing

Is reliable – 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?

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 assessment of body image and appearance concerns, it is important to know what the test HAS and HAS NOT assessed.

Valid and reliable assessment

Known constructs used

Quick/easy

Can track change/outcomes

Subjective assessment: Psychometrics

Advantages DisadvantagesWhich

construct/measure?

May oversimplify

Language/literacy skills

Data management

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