Body image: A looming crisis
Body image pertains to the multifaceted psychological experience of embodiment, especially but not exclusively to ones’ physical appearance (Cash, William & Santos, 2005). It comprises one’s body-related self-perceptions and self-attitudes, viz, perceptions, thoughts, feelings, beliefs, and behaviours, which can be positive, neutral and negative, manifesting in adaptive or maladaptive emotional and behaviour experiences. Body image concerns lie on a continuum ranging from body image dissatisfaction (e.g, being dissatisfied with ones muscularity, composition or leanness) to body image disturbance (e.g., excessive concealment, engaging in disorded eating and exercise practices to alleviate perceived flaws). As such, body image is an important facet of our psychological and physical wellbeing as it permeates all facets of our lives.
Historically, attractiveness has been synonymous with success, health, determination, and an array of desirable internal attributes. To this end, society has often overwhelmed individuals in the pursuit to reach culturally-defined physical ideals. The importance placed upon appearance is well documented, originating in Ancient Greek mythology. Olympus’ goddesses vied for beauty and those deemed most aesthetically pleasing were the envy of all. In modern times, society reinforces the salience of appearance in more sophisticated ways, for example, in social media, in which photos are edited to create falsehoods that helps to perpetuate the pursuit in of often unrealistic aesthetic ideals. This year’s mental health week (13-19 May) focus was on “Body image”, in which staggering statistics highlighted the current “crisis of body image”. Statistics indicated that 20% felt ashamed, 34% down, 19% disgusted, and 18% suicidal about their body (Mental Health Foundation, 2019). Such statistics highlight the impact of body image upon psychological and physical health, with an urgent need for change.
A Rational-Emotive perspective of body image
Rational emotive behaviour therapy (REBT; Ellis, 1957), elucidates the cognitive patterns individuals have in the face of adversity. In REBT, it is postulated that irrational beliefs (e.g., demandingness, low frustration tolerance, awfulizing, and self-, other-, or world-depreciation) are an important antecedent or emotional and behavioural dysfunction. In contrast, rational beliefs (e.g., preferences, high frustration tolerance, anti-awfulizing, and self-, other-, or world-acceptance; Ellis & Dryden, 1997) foster functional emotions and behaviours. REBT holds that neurotic disturbances are a by-product of escalating one’s rational, flexible, preferences into irrational, inflexible, demands. As such, people develop their irrational beliefs in line with what they greatly desire. Therefore, REBT’s principle objective is to ameliorate psychological disturbance through cognitive reconstruction of irrational beliefs to rational beliefs. This is achieved via a structured therapeutic process following the ABCDE framework (Dryden & DiGiuseppe, 1990). The process entails identification of irrational beliefs (B) by analysing why the adversity (A) leads to dysfunctional emotions and behaviours (C). Irrational beliefs are then disputed (D) and replaced with rational beliefs, producing functional emotions and behaviours (E) leading the individual to a new rational philosophy.
Therefore, an REBT perspective of body image can be conceptualised in terms of the role of irrational and rational beliefs appertaining to one’s body size/shape and appearance. Adopting the ABCDE model, we can identify the adversities, beliefs and consequences relating to individual’s appearance challenges. To this end, beliefs are activated when appearance related stimuli are inferred, in which individuals may miscalculate their body shape/size and/or engage in social comparisons (via social media or in real life), individuals may then perceive their body negatively (A). Such perceptions (A) may activate irrational beliefs (B) relating to one’s appearance. Consequently, disturbed emotions (Ce) such as, unhealthy anxiety, shame and maladaptive behaviours (Cb) such as, avoidance, excessive checking, or fixing, may emerge. For example, an individual who holds irrational beliefs relating to weight, may, upon weighing on the scales have the thought that he/she must not weigh this much, being overweight is simply terrible, he/she cannot stand it, and due to this he/she is worthless. Consequently, the individual may experience unhealthy negative emotions such as shame, anxiety, or guilt. Additionally, they may engage in fixing, checking or avoidance behaviours including fad diets (e.g., juice diets, detox diets, carb-free diets) and excessive exercise practices.
Initially, the routine may seem somewhat effective; the individual may objectively lose their undesirable excess weight, however, the latent irrational belief will remain present, and over time with the adoption of such routines may be more rigid and engrained within the individuals beliefs systems. Furthermore, even if individuals reach their optimal weight, shape, or size it is likely that this ideal will shift, resulting in a perpetual cycle of pursuing an aesthetic ideal. At their apex, body image concerns can be highly debilitating and manifest to psychological disorders such as body dysmorphic disorder and muscle dysmorphia. Such postulations, are supported by our previous work with exercise addiction (Outar, Turner, Wood & Lowry, 2018), which highlighted that high irrational beliefs was associated with exercise addiction. Negative body image is intimately link with exercise practices being avoidant or excessive, thus, theoretically its plausible that irrational beliefs may impede ones body image. So how can REBT support individuals with negative body image in a climate that propagates the message that physical appearance is the golden ticket to all of the riches of life?
Appearance rationality: A potential solution
Developing rationality begins with the disputation of irrational beliefs, for example through pragmatic, logical and empirical means. Such cognitive reconstructing encourages preferences, anti awfulizing, discomfort tolerance and unconditional self-, other-, world-acceptance (Ellis, 1957). One belief that Ellis refuted time and time again, was the notion of self-esteem (i.e., self-rating). Ellis proposed that when we insist on rating/evaluating ourselves we do so in order to impress people with our great “value” or “worth”. When we subscribe to this pattern of thinking, this leads to behavioural necessities and compulsiveness. To this end, we adopt an approach of contingent self-worth, in which our worth is predetermined by select behaviours which reinforce our sense of self-worth. For example, if an individual believes “I must have six-pack abs, not having so would make me worthless, ugly and useless”, this individual would feel compelled to engage in behaviours that support that aesthetic goal. Moreover, even if they manage to achieve this aesthetic goal, they adopt an approach in which their worth is contingent upon this aesthetic, where lapses are likely to be accompanied by self-depreciation (e.g., “I’m such a failure, and useless”). Consequently, they will often avoid lapses at all costs.
To exacerbate matters, self-ratings are intrinsically illegitimate because accurate self-ratings are virtually impossible (Ellis, 1957). Therefore, Ellis proposes that we abandon our quest for self-esteem as the presence of any level of esteem reflects a global evaluation of oneself, which is irrational and thus unhealthy and maladaptive. Instead, Ellis provides an “Elegant solution” to our self-esteem disturbance, by which we formulate goals and desires in a manner that is flexible and preferential through unconditional self-acceptance (USA). USA provides us with a medium to detach our self-worth from facets of our whole self, in particular those which we value or perceive society values as an important commodity (e.g., appearance), instead we refuse to appraise our whole self, by one facet of our whole and instead acknowledge that as humans we are diverse, complex, multifaceted and in a constant state of flux. For example, individuals would be encouraged to refute demands to subscribe to societal/or self-designed aesthetic ideals (e.g. “I need to have a flat stomach, if I do not I am completely worthless”) and encouraged to adopt preferences (e.g., “I really want to have a flat stomach, however, that does not mean I must, if I do not it will not imply that I am worthless, but rather reflects that I am a human being”). Holding such beliefs provides a platform that acknowledges one’s desires, but not at the expense of ones mental health, and indeed can provide a climate to foster positive body image and adaptive health behaviours.
The future is rational?
The scope for the application of REBT upon body image and body image disorders is vast. At present, there is a large body of literature (e.g., Cash, William, & Santos, 2005) illustrating the efficacy of cognitive therapy (a CBT similar to REBT) to attenuate body image disturbance, which has provided compelling, novel and insightful information. However, REBT, holds a unique stance upon the role of self-esteem and the investment of USA. Challenging one’s irrational beliefs and cognitive distortions can improve body image, however, the long-term goal is to foster positive body image. Indeed, the absence of negative body image does not imply the presence of positive body image.
Therefore, as a first protocol I encourage practitioners working with individuals in a behavioural change or body image capacity who are pursuing an aesthetic ideal, to ensure that they delineate between their worth and appearance. The desire to manipulate ones physical appearance is not maladaptive, nor unjustifiable, however, if we attach our whole worth to our appearance the (impossible) road to achieving it is likely to be riddled with emotional and behavioural dysfunctionality which will impede not only our psychological health but potentially our physical health.
Leon Antonio Outar is a Trainee Sports and Exercise Psychologist, PhD researcher, and Personal Trainer and works in exercise domains, with a range of behavioural change and body image contexts, with expertise in exercise adherence, exercise addiction, body image, eating behaviours, and psychological wellbeing.
Cash, T., F., Santos, M. T., William, E. F. (2005). Coping with body-image threats and challenges: validation of the Body Image Coping Strategies Inventory. Journal of Psychosomatic Research, 58(2), 190-9
Dryden, W., & DiGiuseppe, R. (1990). A Primer on Rational-Emotive Therapy. Champaign, IL: Research Press.
Ellis, A. (1957). Rational psychotherapy and individual psychology. Journal of Individual Psychology, 13, 38–44. doi.org/10.1353/jip.2017.0023
Ellis, A., & Dryden, W. (1997). The Practice of Rational-Emotive Behavior Therapy. New York: Springer Publishing Company.
Outar, L., Turner, M., Woods, A., Lowry, R. (2018). “I need to go to the gym”: Exploring the use of rational emotive behaviour therapy upon exercise addiction, irrational and rational beliefs. Performance Enhancement & Health, 6, 82-93. https://doi.org/10.1016/j.peh.2018.05.001