How to recognise symptoms of appearance-related distress

1. How to recognise symptoms ofappearance-related distress  

2. How do we recognise symptoms of appearance related distress? Physical indicators Severity Location/body site Other indicators Face to face interaction/discussions Observing behaviour Psychometric methods

3. Physical severity & adjustment Anecdotally, severity associated with poor adjustment But . . .

4. Who is most self conscious of their appearance?

5. Who is most self conscious of their appearance? WE CAN’T POSSIBLY KNOW FROM THESE PHOTOGRAPHS

6. 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.

7. 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

8. Moss (2005): Severity analysis Self assessed severity ratings of appearance differences – does predict well being

9. Moss (2005): Severity analysis Surgeon assessed severity ratings of appearance differences – did not predict well being

10. Moss (2005): Severity analysis How different someone THINKS they look predicts well being How different someone ACTUALLY looks does NOT predict well being

11. 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.

12. 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.

13. 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

14. Moss (2005) location analysis Appearance distress Taller column indicates more distress associated with sensitivity about this body part

15. Moss (2005) location analysis Sexually significant, Normally kept hidden Sexually significant, Normally kept hidden Appearance distress Low numbers, unreliable figure Taller column indicates more distress associated with sensitivity about this body part

16. 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

17. Assessment Face to face discussion? Observing behaviour? Psychometric assessment? Appropriate for vocational trainers Appropriate for psychologists

18. Face to face discussionACTIVITY – identify potential advantages/disadvantages of face-to-face assessment Advantages Disadvantages

19. Face to face discussion Advantages Disadvantages Highly skilled Time Unreliable assessment Subject to bias Flexibility Depth - can cover variety of times and domains Individualistic

20. Observing behaviour Anxiety symptoms Social avoidance Nervousness Blushing Social awkwardness Not necessarily the case that these are caused by appearance anxiety

21. Observing behaviour Appearance focus Behavioural 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).

22. Observing behaviour Advantages Disadvantages Highly skilled Time Which behaviours? Context specific behaviours missed Individualistic Can analyse social interaction in depth

23. Psychometrics – assessment by psychology professionals Trainers may refer to psychologists for formal assessment Trainers may need to interpret/understand psychologists’ formal assessments

24. 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

25. What are we measuring when we measure body image?

26. 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?

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

28. Weight satisfaction Body dysphoria Body distortion Body concern Body image Appearance satisfaction Body schema Appearance evaluation (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999) Body satisfaction Body dysmorphia Body esteem Body perception Appearance orientation Size perception accuracy

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

30. Subjective assessment: Psychometrics Advantages Disadvantages Which construct/measure? May oversimplify Language/literacy skills Data management Valid and reliable assessment Known constructs used Quick/easy Can track change/outcomes

31. 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)

32. 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’salright (laughing) a bit dimply sometimes and I’d probably choose to have bigger boobs if I could” (Woman, 24)

33. Activity: Who might need to recognise“symptoms” of appearance distress? Is the word “symptoms” a problem? What associations/subtexts does it convey?

34. 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