Severe body image concerns under-recognized in teens

Jun 7, 2006 11:34 GMT  ·  By

Adolescents with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses. Moreover, in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), suggesting that such concerns may be related to the experience of past physical or sexual abuse.

Researchers at Bradley Hospital, Butler Hospital and Brown Medical School assessed the prevalence and clinical correlates of body image concerns including: body dysmorphic disorder (BDD), eating disorders (ED) (such as bulimia or anorexia), and other clinically significant concerns over shape/weight in adolescent in-patients at Bradley Hospital, the nation's first psychiatric hospital for children and adolescents.

Classic BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect, like a crooked nose or imperfect complexion. Weight-related BDD, however, is classified as distressing and impairing preoccupations with one's weight and shape - ie: thinking one's thighs are too fat or one's waist is too big.

The study found that one third of in-patient adolescents had problematic body image concerns, and that these patients were more ill than other adolescent in-patients in a number of important domains. Specifically, those with BDD and shape/weight preoccupations had significantly higher levels of depression, anxiety, and suicidality than other patients with no body image concerns. Those with eating disorders had significantly higher rates of depression than those without body image concerns.

"These findings underscore just how central feelings about one's appearance tend to be in the world of teenagers and how impairing these concerns can be", says lead author, Jennifer Dyl. "This is important because distressing and impairing body image concerns appear to be very prevalent among adolescents with psychiatric illnesses, and are related to a higher degree of distress and impairment", adds co-author Jennifer Kittler.

Interestingly enough, the authors found that the majority of the adolescents in the study were not actually overweight. "We found that 6.7 percent of patients on the adolescent inpatient unit at Bradley Hospital met criteria for classic (non-weight-related) BDD, but that a much higher percentage (22.1 percent) exhibited distressing and impairing concerns with their weight and shape", says Kittler.

Body image concerns under-recognized in teens

These findings are especially concerning for treatment providers and parents, the authors say, because the majority of adolescents in this study were not receiving psychiatric treatment specifically targeted towards their body image problems. They were most commonly being treated for mood disorders, anxiety disorders, and posttraumatic stress disorder and these body image preoccupations may well have been contributing to the events leading to their hospitalization.

"We have indeed seen a number of teens entering the hospital whose negative feelings about their appearance is a major influence on suicidal thoughts and even suicide attempts, a fact which is often initially not recognized by parents and even professionals", says Dyl.

The authors conclude that severe body image disturbances among adolescents are likely to be under-recognized and under-treated, and may be related to other forms of psychological distress (including depression and suicidality). They also note that since many adults presenting in psychiatric settings often report that preoccupation with their appearance first began in adolescence, it is all the more important to recognize and begin to treat body dysmorphic disorder and other body image concerns in the teenage years, to prevent the problem from becoming a chronic condition.

"Helping teens verbalize their negative feelings and concerns about their appearance is the first step in getting them to value themselves as individuals and recognize the importance of other non-weight, or non-appearance-based qualities and activities as contributors to their self-esteem and self-worth", Dyl explains.

Cartoon: Evan Shelley / Daily Nexus

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