1. Psychological impacts of appearance dissatisfaction 2013-1-NOl-LEOOS-06154

2. Overview Why people may be self-conscious – reminder Impact Emotional - feelings Cognitive - thoughts Behaviours 2013-1-NOl-LEOOS-06154

3. Psychological impact 2013-1-NOl-LEOOS-06154

4. Psychological impact The three dimensions to consider 2013-1-NOl-LEOOS-06154

5. Emotional impacts – what is felt Anxiety – especially social anxiety “a fear of exposure to social situations...... fear, confusion, pounding heart, sweating, shaking, blushing, muscle tension, upset stomach.” 2013-1-NOl-LEOOS-06154

6. Emotional impacts – what is felt Depression “sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.” More common in weight/size differences than other visible differences 2013-1-NOl-LEOOS-06154

7. Emotional impacts – what is felt Shame Internalised and/or externalised shame 2013-1-NOl-LEOOS-06154

8. Emotional impacts – what is felt Internalised Shame “acceptance that one has personal attributes (e.g. body shape, size or textures) that are inferior/unattractive, and will result in rejection” 2013-1-NOl-LEOOS-06154

9. Emotional impacts – what is felt Externalised Shame “awareness that once is a member of a stigmatised group” 2013-1-NOl-LEOOS-06154

10. Emotional impacts – what is felt Isolation – physical and emotional distance Felt sense of isolation, and a real distance – Strangers – Colleagues – Friends – Family 2013-1-NOl-LEOOS-06154

11. Emotional impacts – what is felt Sense of belonging is a key human need. 2013-1-NOl-LEOOS-06154

12. Emotional impacts – what is felt Feeling “Abnormal”/ “Other” Not belonging On the outside, looking in 2013-1-NOl-LEOOS-06154

13. Emotional impacts – what is felt Physical Aggression Verbal Aggression Anger Hostility Sometimes observed as reaction to having different appearance 2013-1-NOl-LEOOS-06154

14. Emotional impacts – what is felt Aggression Often masks underlying fear and anxiety Anxiety may not be conscious 2013-1-NOl-LEOOS-06154

15. Cognitive impacts – what it thought Fear of negative evaluation I expect you to think badly of who I am or what I look like 2013-1-NOl-LEOOS-06154

16. Cognitive impacts – what is thought Increased salience – preoccupation with own/others’ appearance (esp. sensitive “features”) The way I look is often in my thoughts Someone high in appearance salience will take time and trouble with their appearance (this can be a positive thing), but also become preoccupied with the way they look. High salience predicts poor outcomes when combined with a negative evaluation of appearance. 2013-1-NOl-LEOOS-06154

17. Cognitive impacts – what is thought Interpretation of ambiguity In social situations, I expect you to be reacting to the way I look (even if you actually might not be) 2013-1-NOl-LEOOS-06154

18. Cognitive impacts – what is thought Interpretation of ambiguity E.g., when someone is passed in the street by a friend with no acknowledgement:- a)friend might be highly distracted, in a hurry, etc. – or b)may be actively ignoring the person. Self-conscious person most likely to think (b) 2013-1-NOl-LEOOS-06154

19. Cognitive impacts – what is thought Attention to social threat stimuli I will scan the social world to check out the possibility of people staring at me, talking about me, noticing me 2013-1-NOl-LEOOS-06154

20. Understanding staring Staring, “double takes”, furtive glances Poor adjustment – assumes malicious reasons (e.g., disliking appearance, disgust, etc.) 2013-1-NOl-LEOOS-06154

21. Understanding staring Staring, “double takes”, furtive glances Positive adjustment – assumes benign reasons (e.g., curiosity, natural attention to noticing difference etc.) 2013-1-NOl-LEOOS-06154

22. Awareness of own self Trigger: an audience, mirror, camera Negative feeling (anxiety, depression) Self-focus Awareness of feeling Intensity of feeling 2013-1-NOl-LEOOS-06154

23. Behavioural impacts – what is/n’t done Social avoidance – Restaurants, bars – Shops – Public transport – Work/interviews 2013-1-NOl-LEOOS-06154

24. Behavioural impacts – what is/n’t done Social avoidance A short term strategy Linked to poor outcomes 2013-1-NOl-LEOOS-06154

25. Behavioural impacts – what is/n’t done Reduced social contact Loss of social skills 2013-1-NOl-LEOOS-06154

26. Behavioural impacts – what is/n’t done Fear and anxiety Expectations of negative outcomes Social avoidance 2013-1-NOl-LEOOS-06154

27. Social functioning Study example: participants rated (1)all their interactions lasting > 10 mins, over 3 week period, & (2)their own body image Interaction quality is related to body confidence 2013-1-NOl-LEOOS-06154

28. Social functioning Findings: Positive body image was associated with greater perceived intimacy & social confidence in social interactions Interaction quality is related to body confidence 2013-1-NOl-LEOOS-06154

29. Who is most self conscious of their appearance? 2013-1-NOl-LEOOS-06154 WE CAN’T POSSIBLY KNOW FROM THESE PHOTOGRAPHS

30. 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. ( Moss, 2005) 2013-1-NOl-LEOOS-06154

31. 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 2013-1-NOl-LEOOS-06154

32. Severity analysis Self assessed severity ratings of appearance differences – does predict well being 2013-1-NOl-LEOOS-06154

33. Severity analysis Surgeon assessed severity ratings of appearance differences – did not predict well being 2013-1-NOl-LEOOS-06154

34. Severity analysis How different someone THINKS they look predicts well being How different someone ACTUALLY looks does NOT predict well being 2013-1-NOl-LEOOS-06154

35. Social skills improve body image Enhance social functioning by practicing – Conversational opening/maintenance/closing – Skills to develop social intimacy – Appearance specific skills How to handle direct questions about appearance How to handle stares, “second looks”, etc. Enhanced social functioning improves body image Enhanced body image improves social functioning 2013-1-NOl-LEOOS-06154

36. Please consider now... How might appearance self-consciousness manifest at different points in the lifespan? How might the concerns and behaviours of adolescents compare to older adults? 2013-1-NOl-LEOOS-06154

37. Please consider now... How might appearance self-consciousness manifest in different contexts? Consider the home, in close relationships, in public settings, in work/training/education? 2013-1-NOl-LEOOS-06154

38. Summary: Different appearance increased risk for... Anxiety, depression, shame Isolation, avoidance of others Unhelpful thinking Impact will vary across situations, time 2013-1-NOl-LEOOS-06154

40. This project (project n° 2013-1-NO1-LEO05-06154) has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein. LEONARDO DA VINCI TRANSFER OF INNOVATION PROJECT November 2013 -October 2015 2013-1-NOl-LEOOS-06154