Exacting Beauty

Full Title: Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance
Author / Editor: J Kevin Thompson, Leslie J. Heinberg, Madeline Altabe, and Stacy Tantleff-Dunn
Publisher: American Psychological Association, 1999

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Review © Metapsychology Vol. 8, No. 41
Reviewer: Sundeep Nayak, M.D.

There has been a
228 per cent increase in cosmetic procedures between 1997 and 2002. During the
same time period, there has been a 2446 per cent increase in American women
undergoing injection with Botulinum toxin type A (Botox®). The most popular
surgical procedures today are liposuction, breast augmentation, eyelid surgery,
breast reduction, and nose reshaping. Popular television programming reflects
new attitudes to radical transformational surgery, be it surreal ("The
Swan") or bizarre ("Extreme Makeover"). Exacting Beauty
critically examines the history and mystery of body image, applying theory,
research, clinical application and analysis to the individuality of body image
experience.

The specific focus
on self-perceptions of appearance began after the Second World War, perhaps
starting with earlier works that measured self-ratings of attractiveness in
married couples, and the first scales designed to assess self-rating of
subjective appearance. It was not until decades later that scientific works
linked aspects of body image disturbance to the central features of anorexia
nervosa and other eating disorders. Eating disorders are almost exclusively a
female phenomenon (90-95%) but lesbians are the least concerned about physical
appearance, whereas gay men and heterosexual women showed significantly higher
concern for physical attractiveness. In 1985, the now classic phrase normative
discontent was first used to describe the widespread dysphoria that women have
regarding their appearance. In 1986, a nationwide survey showed that only seven
per cent of women expressed little concern with their appearance. The first
English language article on body dysmorphism disorder (BDD) was published in
1970 and the disorder was first included in the DSM-III-R in 1987. Recent
advances in the description, assessment, and treatment of BDD indicate that it
will become one of the most active areas in the entire field of body image in
the next millennium.

Exacting Beauty
systematically presents works starting with a very thoughtful introduction that
includes definitions of body image in relative order of precision.
Explanations, hypotheses, and, ultimately, well-constructed theories of body
image disturbance are crucial to the development of the field beyond its
current stage. The book chooses contemporary and illustrative research and
clinical reports in an effort to expose the importance of body image for many
individuals of both genders and a wide array of ethnic and cultural
backgrounds.

Many surprising
and hitherto not widely publicized conclusions are presented:

1.
Men may often be dissatisfied because of a low weight or, more likely,
their goal of gaining weight reflects a desire to add muscle mass.

2.
Black female and male students were less interested than other groups in
losing weight and more interested in gaining weight.

3.
One in five women indicate that at least once in her life, a man has
said he wished her breasts were a different size (Plus, a startling 58 per cent
have been taunted or teased because of their breasts)

4.
Women in Texas request bigger implants than those in any other state
(the states with the most operations are Florida, Texas, and California)

5.
94% of female characters on television programming favored by middle
school age girls were below average in weight. 14% of commercials airing during
Saturday morning cartoons were related to enhancing one’s appearance.

6.
Exposure to soap operas and movies predicted body image dissatisfaction,
and exposure to music videos predicted drive for thinness, whereas amount of
time spent watching sports was negatively correlated with one’s body image
dissatisfaction.

Children are less
likely to befriend an endomorphic (overweight) child. Prejudice against obese
children has been demonstrated in diverse samples of adults, including physicians,
nurses, psychologists, physical and occupational therapists, and social
workers. These professional routinely rate obese children as less likeable than
children with a variety of physical handicaps, disfigurements, and deformities.
Society sees a backlash against the body myth idea and factions decided it was
time to fight prejudices, stereotypes, and discrimination against obese
individuals. One such group is the National Association to Advance Fat
Acceptance (NAAFA) which produces a bimonthly newsletter devoted to this cause.
A number of investigations have examined the influence of the mass media more
globally, specifically teen and women’s fashion magazines. Anorexia nervosa seems
to follow the subscriptions to Vogue: if Vogue gets to your
country, anorexia nervosa will eventually follow. Latinas born in the United
States identified an even smaller ideal body size than did their White
counterparts, whereas those who immigrated chose a significantly larger ideal.

Body image
disturbance does not exclude the male form. Steroid use is one isolated area in
the field of body image that has generally examined male samples. Sixty percent
of men with considerable baldness reported negative social and emotional
effects owing to their hair loss: these results are more pronounced in younger
men, those with earlier onset of baldness, and those who were single and
uninvolved in intimate relationships.

More research is
required to examine the roles of peers, parents, romantic partners, and
strangers in making an impact on body image disturbance. Evaluating the
attractiveness of others or gossiping about someone’s weight fluctuations, for
example, may seem harmless. However, these seemingly ordinary behaviors are
subtle ways of communicating the importance placed on looks and create or
exacerbate the body image anxiety of others. Whatever the direction the coming
decades takes, we will learn more about what happens in the mind as individuals
process moment-by-moment events. Whatever the historical causes of body image
disturbance, it exists and is maintained by cognitive processes that occur in
far too short a time period to dismiss with analysis and modification. These
are the exact challenges we face.