1. Psychological impacts of appearance dissatisfaction

3. Overview Why people may be self-conscious – reminder Impact Emotional - feelings Cognitive - thoughts Behaviours

4. Many reasons people may be self- conscious of appearance... For example, acne scarring

5. Many reasons people may be self- conscious of appearance... For example, “Port wine stain” skin difference

6. Many reasons people may be self- conscious of appearance... For example, Weight/ size (real or imagined)

7. Psychological impact

8. The three dimensions to consider

9. 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.”

10. 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

11. Emotional impacts – what is felt Shame Internalised and/or externalised shame

12. 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”

13. Emotional impacts – what is felt Externalised Shame “awareness that once is a member of a stigmatised group”

14. Emotional impacts – what is felt Isolation – physical and emotional distance Felt sense of isolation, and a real distance – Strangers – Colleagues – Friends – Family

15. Emotional impacts – what is felt Sense of belonging is a key human need.

16. Emotional impacts – what is felt Feeling “Abnormal”/ “Other” Not belonging On the outside, looking in

17. Emotional impacts – what is felt Physical Aggression Verbal Aggression Anger Hostility Sometimes observed as reaction to having different appearance

18. Emotional impacts – what is felt Aggression Often masks underlying fear and anxiety Anxiety may not be conscious

19. Cognitive impacts – what it thought Fear of negative evaluation I expect you to think badly of who I am or what I look like

20. Cognitive impacts – what is thought Increased salience – preoccupation with own/others’ appearance (esp. sensitive “features”) The way I look is often in my thoughts

21. 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)

22. 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)

23. 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

24. Understanding staring Staring, “double takes”, furtive glances Poor adjustment – assumes malicious reasons (e.g., disliking appearance, disgust, etc.)

25. Understanding staring Staring, “double takes”, furtive glances Positive adjustment – assumes benign reasons (e.g., curiosity, natural attention to noticing difference etc.)

26. Awareness of own self Trigger: an audience, mirror, camera Negative feeling (anxiety, depression) Self-focus Awareness of feeling Intensity of feeling

27. Behavioural impacts – what is/n’t done Social avoidance – Restaurants, bars – Shops – Public transport – Work/interviews

28. Behavioural impacts – what is/n’t done Social avoidance A short term strategy Linked to poor outcomes

29. Behavioural impacts – what is/n’t done Reduced social contact Loss of social skills

30. Behavioural impacts – what is/n’t done Fear and anxiety Expectations of negative outcomes Social avoidance

31. 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

32. Social functioning Findings: Positive body image was associated with greater perceived intimacy & social confidence in social interactions Interaction quality is related to body confidence

33. 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

34. 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?

35. 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?

36. Please consider now... Can having a “different” and stigmatised appearance every have any positive implications for the individual concerned? What might these be?

37. Please consider now... Can having a “different” and stigmatised appearance every have any positive implications for the individual concerned? Example: for some, unusual appearances have prompted consideration of core life values. “Now I recognise what is really important in life, I know who my good friends are, and what really matters to me”

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

39. Tips for trainers Be aware that appearance dissatisfaction may show through behaviour, thinking differences, or emotional responses Note the vicious cycles associated with negative impacts of appearance – help clients identify and break these Note potential virtuous cycles – help clients establish these (e.g., though enhanced social skills)