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Appearance-related concerns and distress are experienced by a significant proportion of people with visible disfigurements, and are also reaching epidemic proportions in the general population. In the light of these developments, this book includes: A comprehensive summary and critical evaluation of research and understanding concerning the psychology of appearanceA historical review of research to dateA review of the methodological challenges for researchers in this areaAn overview of current understanding of appearance-related concerns and distress in the general population and among those with acquired or congenital disfigurements such as burns, clefts of the lip and/or palate, scarring and acneExploring the psychosocial factors which are protective and those which exacerbate distress,The Psychology of Appearanceoffers a vision of a comprehensive approach to support and intervention and addresses the following questions: Are attractive people at an advantage in life?What are the challenges presented by having a visibly different appearance?What are the psycho-social factors playing a part in individual differences in levels of adjustment and distress in relation to appearance?How can interventions meet the needs of those affected? The Psychology of Appearanceprovides essential reading for psychology students, health and clinical psychologists, health professionals, employers and policy makers interested in the ramifications of appearance concerns.

This chapter contains sections titled: Introduction What is body image? How is body image constructed in the brain? Body‐image disturbance in eating disorders The neuroscience of body‐image distortion in anorexia nervosa Conclusion References

Body image disturbance (BID) is a core symptom of anorexia nervosa (AN), but as yet distinctive features of BID are unknown. The present study aimed at disentangling perceptual and attitudinal components of BID in AN. We investigated n = 24 women with AN and n = 24 controls. Based on a three-dimensional (3D) body scan, we created realistic virtual 3D bodies (avatars) for each participant that were varied through a range of ±20% of the participants' weights. Avatars were presented in a virtual reality mirror scenario. Using different psychophysical tasks, participants identified and adjusted their actual and their desired body weight. To test for general perceptual biases in estimating body weight, a second experiment investigated perception of weight and shape matched avatars with another identity. Women with AN and controls underestimated their weight, with a trend that women with AN underestimated more. The average desired body of controls had normal weight while the average desired weight of women with AN corresponded to extreme AN (DSM-5). Correlation analyses revealed that desired body weight, but not accuracy of weight estimation, was associated with eating disorder symptoms. In the second experiment, both groups estimated accurately while the most attractive body was similar to Experiment 1. Our results contradict the widespread assumption that patients with AN overestimate their body weight due to visual distortions. Rather, they illustrate that BID might be driven by distorted attitudes with regard to the desired body. Clinical interventions should aim at helping patients with AN to change their desired weight.

Social media use is associated with body image concerns, disordered eating and body change behaviors in adolescents. This study aimed to examine these relationships within a biopsychosocial framework and test an integrated model. A sample of 681 adolescents (49% female), mean age = 12.76 years (SD = 0.74), completed a questionnaire assessing social media use, depression, self-esteem, body mass index, social media and muscular ideal internalization, appearance comparison, body dissatisfaction, disordered eating, and muscle-building behaviors. Path analysis was used to test the hypothetical model, which after modification revealed good fit to the data, although gender differences emerged. The findings suggest that biopsychosocial frameworks are useful for conceptualizing relationships between social media use and body image, eating, and muscle building outcomes.

(1) Summary: Many studies have evaluated the association between traditional media exposure and the presence of body dissatisfaction and body image disorders. The last decade has borne witness to the rise of social media, predominantly used by teenagers and young adults. This study’s main objective was to investigate the association between how often one compares their physical appearance to that of the people they follow on social media, and one’s body dissatisfaction and drive for thinness. (2) Method: A sample composed of 1331 subjects aged 15 to 35 (mean age = 24.2), including 1138 subjects recruited from the general population and 193 patients suffering from eating disorders, completed an online questionnaire assessing social media use (followed accounts, selfies posted, image comparison frequency). This questionnaire incorporated two items originating from the Eating Disorder Inventory Scale (Body Dissatisfaction: EDI-BD and Drive for Thinness: EDI-DT). (3) Results: We found an association between the frequency of comparing one’s own physical appearance to that of people followed on social media and body dissatisfaction and drive for thinness. Interestingly, the level of education was a confounding factor in this relationship, while BMI was not. (4) Discussion: The widespread use of social media in teenagers and young adults could increase body dissatisfaction as well as their drive for thinness, therefore rendering them more vulnerable to eating disorders. We should consequently take this social evolution into account, including it in general population prevention programs and in patients’ specific treatment plans.

We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents. Data were taken from a survey of 3618 Australian adolescents (11.172-19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, , 38(6), 548-557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder. The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6-3.0%] among boys and 1.4% (95% CI 0.9-2.0%) among girls. Prevalence was not associated with gender ( = 0.031) or socioeconomic status (SES) (partial 0.001), but was marginally associated with older age (partial = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity ( = 0.259) and a weight-lifting regime that interfered with their life ( = 0.286), whereas girls with MD were more likely to report discomfort with body exposure ( = 0.380). While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.

Body image distortion and/or dissatisfaction may occur primarily due to body fat accumulation and/or distribution. The aim of this study was to evaluate the frequency of body image perception and (dis)satisfaction categories in adult men and women according to the adiposity classification. This is a cross-sectional study (n = 514; 33-79 years; 265 women) that is part of a prospective cohort (Pró-Saúde study). Adiposity measurements were determined by two methods: anthropometry, used to calculate the body mass index (BMI) and dual-energy X-ray absorptiometry (DXA), to estimate body fat percentage. Participants were grouped as \"no excess adiposity\" and \"excess adiposity\", considering BMI and body fat percentage (>30% for men, >40% for women). Perception and (dis)satisfaction with body image were evaluated using the Kakeshita scale, composed by 15 silhouettes, developed for the Brazilian population. Degree of distortion (perceived BMI - real BMI) and dissatisfaction (perceived BMI - desired BMI) were calculated. A high proportion of men (58.6%; 74.3%), and especially of women (82.6%; 86.8%), presented body size overestimation and dissatisfaction due to excess weight, respectively. A relevant fraction of the women (32.6%) and men (30.8%) who were dissatisfied due to excess weight did not present excess adiposity, especially if classified by DXA. Variability in degree of distortion was hardly explained by anthropometric and DXA variables in women (<5%) and men (∼22%). Both anthropometric and DXA measurements accounted for ∼30% and ∼50% of the variability in degree of dissatisfaction among women and men, respectively. Our results suggest a high frequency of body image distortion in Brazilian adult individuals, as well as dissatisfaction with excess weight, especially among women with excess adiposity. The findings indicate that anthropometric measurements explain much of the variability in degree of body image dissatisfaction in men, with no apparent advantage of the use of more refined DXA measurements.

Background This study examined the relationships among female’s nutrition knowledge levels, diet practices, healthy eating obsessions, body perceptions, and social media usage. Subjects and methods The study included 613 voluntarily participating females aged 18–60 years. Data including demographic information, anthropometric measurements, whether they follow a diet or not, and ORTO-R, Body Shape Questionnaire (BSQ-34), Bergen Social Media Addiction Scale (BSMAS), and General and Sport Nutrition Knowledge (GeSNK) Scale scores were collected. Results The participants’ mean age was 28.47 ± 9.38 years. Mean scores were 17.5 ± 5.1 for the ORTO-R scale, 89.2 ± 40.2 for the BSQ-34, 38.6 ± 12.5 for the GeSNK, and 17.3 ± 6.1 for the BSMAS. Statistically significant differences were found among the participants’ total ORTO-R, BSQ-34, and GeSNK scores according to body mass index (BMI) and education level. Statistically significant relationships were also found among total ORTO-R, BSMAS, BSQ-34, and GeSNK scores. ORTO-R scores were positively correlated with BSMAS ( r  = 0.475, p  < 0.05) and BSQ-34 ( r  = 0.685, p  < 0.05) scores, while they were negatively correlated with GeSNK scores ( r  = -0.117, p  < 0.05). There was a positive correlation between BMI and BSQ-34 scores ( r  = 0.380, p  < 0.001) and between BMI and ORTO-R scores ( r  = 0.130, p  < 0.001), while there was a negative correlation ( r  = -0.176, p  < 0.001) between BMI and GeSNK scores. Conclusions Social media is a fast, important, and effective tool for the sharing of information. Thus, social media may be effective in strengthening individuals’ nutrition knowledge, nutrition obsessions, body perceptions. Therefore, it would be beneficial to provide training for individuals to use social media consciously and providing nutritional literacy will be effective.

During pregnancy, women's bodies undergo rapid body weight and size changes within a relatively short period. Pregnancy may therefore, be associated with an increased vulnerability for developing body image dissatisfaction linked to adverse health outcomes for the mother (e.g., depression, eating disorders) and child (e.g., impaired self-regulation, childhood obesity). The present study aims to examine the prevalence and trajectories of body image dissatisfaction during pregnancy and postpartum and its relationship to pre-pregnancy BMI. This is the first study that investigates prevalence rates of body image dissatisfaction not only ante- but also postpartum, and that compares trajectories of women with normal weight and overweight. A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 136) answered paper-pencil or online questionnaires at four time points (18th-22nd and 33rd-37th week of gestation, 3 and 6 months postpartum). Body image dissatisfaction was assessed using the German version of the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Both questionnaires are considered reliable and valid measures of several aspects of body image, and the BSQ allows for calculating prevalence rates by providing cut-off values. Using not just one but two body image questionnaires, trajectories of body image dissatisfaction can be compared. Pre-pregnancy BMI was assessed retrospectively via self-reported weight and height. The proportion of women reporting elevated levels of body image dissatisfaction was 6.6% (n = 9) in the second trimester, 2.9% (n = 4) in the third trimester, 11.0% (n = 15) three months postpartum, and 10.3% (n = 14) six months postpartum. Repeated measures ANOVA revealed that body image dissatisfaction significantly decreased from pre-pregnancy to pregnancy, remained stable during pregnancy, and returned to pre-pregnancy levels three to six months postpartum. Mixed between-within ANOVA showed that the overweight/obese group reported significantly higher levels of body image dissatisfaction at each measurement point except during the third trimester than women in the normal weight group. Significant but small interaction effects between time and pre-pregnancy BMI were found. The results revealed that approximately every tenth woman is affected by body image dissatisfaction after childbirth. Women with a higher BMI level before pregnancy are particularly at risk of experiencing body image dissatisfaction. Healthcare providers should screen for body image dissatisfaction, in particular after childbirth, and inform affected women about possible adverse health outcomes and treatment options. Study limitations concern the drop-out rate of 51.4% and the retrospective and self-reported assessment of pre-pregnancy BMI. Future studies should include additional assessment points in the first trimester and more than six months postpartum and try to include a matched control group of non-pregnant women to compare prevalence rates and trajectory of body image dissatisfaction.