Who is at high risk of body dissatisfaction?

Bullying has been in the news, not least because it was Anti Bullying Week in the UK last week, so it's a good time to revisit this great post from Kirsty Lee from 2018 (and check out https://everydaylookism.bham.ac.uk/) 

Do you feel dissatisfied with one or more parts of your body or appearance? If so, you are not alone. In fact, body dissatisfaction is so widespread that it has been given the label of normative discontent. Although girls and women are most affected by body image issues, boys and men are increasingly dissatisfied with their body. Negative feelings about our bodies are therefore common, which is a problem in itself and raises important questions about why this is so prevalent across society. However, for some people, normative discontent turns into abnormal preoccupation. By abnormal, I mean negative beliefs, thoughts, and behaviour that affect the ability to function on a daily basis, significantly reduce quality of life, and increase the risk of early mortality.

As with most things in life, body dissatisfaction exists on a continuum, so who is most likely to be on the high end of the scale? Unsurprisingly, people who receive negative comments about their appearance are more likely to report higher levels of body dissatisfaction. But what about the impact of general aggression or bullying, i.e., the intentional and repeated abuse of power? My postdoctoral advisor, Dr. Tracy Vaillancourt, and I just published the results of a seven-year study across childhood and adolescence that shows reciprocal links between body dissatisfaction and being the target of peer bullying. Being bullied consistently led to high levels of body dissatisfaction, and high levels of body dissatisfaction increased the risk of being bullied. Although the effects were seen in both sexes, they were stronger among girls.

We also found that among teens who were bullied, body dissatisfaction led to an increased risk of becoming overweight or obese. Body dissatisfaction is a risk factor for eating disorders, so the teens in our study may have resorted to binge eating as a way to relieve their emotional distress from being bullied, which subsequently led to excess weight gain. When most people think of an eating disorder they might picture an emaciated woman or the words anorexic or bulimic spring to mind, but binge eating disorder is actually the most prevalent type of eating disorder (approximately 3% of the population). The disorder is characterized by excessive over eating without any compensatory restricting (i.e., minimizing calorie intake) or purging (e.g., vomiting or laxative consumption) behaviour that are core features of anorexia nervosa and bulimia nervosa. We need to do more research on the potential pathways, but our findings align with other research showing that abuse and trauma in childhood are associated with excessive weight gain in adulthood and that emotion regulation plays a key role in binge eating behaviour. 

Other research shows that youth who are bullied by their peers are more likely than their non-bullied contemporaries to be preoccupied with weight loss and are at increased risk of symptoms of bulimia and anorexia. All types of eating disorders are highly stigmatized because it is assumed that the person is responsible for the condition. This is one potential reason why in another of our studies we found that youth with high levels of disordered eating behaviour were more likely to get bullied. Overall it seems that people who have experienced traumatic events, especially peer or parental abuse, are most likely to be highly dissatisfied with their bodies and engage in harmful eating behaviour or body change strategies, including cosmetic surgery. Likewise, vulnerable individuals who are particularly unhappy with their appearance are more likely to be targets of bullying.

Although most of us wish that some part of our body was different, some children and adults who are bullied are left with a feeling that they are fundamentally flawed, leading to drastic attempts to alter their appearance that can result in fatal consequences, either because of the health issues and suicide risk associated with purging and highly restrictive eating behaviour, or because of the health issues associated with being overweight or obese, like heart disease, diabetes, and cancer. We need to do more to address the societal values and expectation on appearance that impact the masses, but we need to pay extra attention to those whose appearance concerns are a result of abuse and trauma and cast a malignant shadow on their everyday lives.

Kirsty Lee is an Assistant Professor of Psychology at the University of Warwick. Her research focuses on the causes and consequences of aggression and victimisation during adolescence and how these relate to self-promotion, body change strategies, and mental health