Whole Woman: Body Image

How would you describe your appearance? Beautiful, sexy, gorgeous, feminine, good-looking — maybe cute? If you’re like most women, probably not.

In 2004, as part of its global Real Truth About Beauty study, Dove asked 3,200 women between the ages of eighteen and sixty-four that question. The two most common answers, natural” and “average,” accounted for 56 percent of the total responses. Only 2 percent of women surveyed described themselves as “beautiful,” and as for gorgeous?

Not surprising, zero percent touched that one.

Does Dove’s survey mean that in a crowd of 3,000-plus women, you’re unlikely to find even seventy-five who are beautiful? No, what it does is reiterate the unfortunate reality that many women struggle with negative body image — the way they believe others see them and how they see themselves. What makes the study so noteworthy is that Dove seemed genuinely disturbed by the findings. In the years since, the company’s ad campaigns have continued to focus on “real women” and to provide a broader picture of beauty. Its ads show women of diverse ethnicities, body shapes and appearances. The company also launched a program aimed at young girls called the Dove Self-Esteem Project.

The goal of enabling more women to become comfortable in their own skin seems, at times, like an uphill battle. In July, ModiFace, a maker of virtual makeover technology, launched a new app for iPhones and iPods called Beauty Mirror that shows users how their face could look with a bit of surgical assistance. The app produces three-dimensional, photo realistic images depicting how you’d look after a brow lift, facelift, lip injections, weight loss, with clearer skin or less acne. In all, the app offers fourteen ways to change your face. Users can save and share their altered-self images as photos or videos on social media. The company has similar apps in its cache — including MakeUp, FaceLift and Photo Editor — that use facial visualization technology to produce younger, dolled-up or otherwise modified (read: improved) images of its users.

According to the ModiFace website, the company has also designed apps for Sephora, the Android platform and seventeen.com — the website complement to the popular teen magazine. On seventeen.com, visitors can play with the “Seventeen Salon” feature, which allows them to adjust complexion, makeup and hairstyles. The technology itself is cool (and it’s easy to get sucked into an hour-long game of virtual makeover), but what effect does this type of technology have on adolescent girls and women?

The common perception of what is ideal has long been influenced by the media, celebrities and the fashion industry. The “ideal” body type with which women are inundated is possessed naturally by only 5 percent of American women. Not only do many of the women in advertisements have bodies that are simply unattainable by the majority of the population — and unhealthy to boot — their uncommon body images become even more unrealistic during the production process (thank you, Photoshop, but thigh gap is not a regularly occurring law of physics). Regardless of how far-fetched these images are, they influence a women’s perception of what is normal or desirable. The natural instinct is to compare one’s own image to what one sees on the pages of glossies lining bookstore shelves and supermarket checkout aisles. The result of that comparison is not good: In separate studies, Stanford University and the University of Massachusetts found that 70 percent of college women report feeling worse about their body image after reading women’s magazines.

Body dysmorphic disorder, or BDD, is defined as a preoccupation with perceived physical flaws. Dr. Katharine Phillips, director of the Body Dysmorphic Disorder (BDD) Program at Rhode Hospital and a professor of psychology and human behavior at the Warren Alpert School of Medicine at Brown University, has studied BDD for twenty-plus years. Although not everyone who has appearance concerns has BDD, Phillips says it’s a fairly common and under-recognized disorder. It’s estimated that one person in fifty suffers from BDD, which has varying degrees of severity ranging from mild to life-threatening.

Brown University’s Health Services Department cites a study indicating that nearly 75 percent of normal-weight women think about their weight or appearance “all the time” or “frequently.” With it so common for women to feel negatively about their bodies, how can you determine whether your insecurities are “normal” or whether you may have BDD? Phillips says there are guidelines that professionals look for beginning with how much time each day you spend thinking about parts of your body that you don’t like.

“If you add up all the time you spend in one day thinking, ‘I hate my skin, my skin looks horrible,’ it could be any part of the body, if it’s at least an hour a day, that is an indicator of BDD,” says Phillips, who stresses that the hour measure is a guideline and not an absolute. Patients who meet the criteria for BDD also suffer clinically significant distress, such as anxiety or depression, as a result of the way they believe that they look.

For instance, she says, “It’s affecting your job, making you late because you’re stuck in the mirror or making it hard to concentrate because you’re having these negative thoughts.” Some individuals are unable to work at all or stay in school because they don’t want people to see them. Another key indicator of BDD is that the flaw perceived by the individual may be unnoticeable by others.

Phillips says recent studies indicate that individuals who suffer from BDD have abnormal visual processing. In other words, they actually see things around them — not just themselves — differently than other people. Phillips says patients with BDD have a tendency to hyper-focus on minutia in all aspects of their lives, and that it is more difficult for them to see the big picture. “It’s a brain-based disorder. It’s not vanity,” she says.

Neurological disorders and the media aren’t the only things that influence the way women see themselves. “I think we all have things about ourselves that, when we look in the mirror, we’d like to change,” says Dara Chadwick, a local journalist and author who writes about body and women’s issues. Chadwick chronicles some of her own body image issues in You’d Be So Pretty If…, a book that explores how mothers influence their daughters’ body images. Published in 2009, Chadwick was inspired to write the book while working on a yearlong personal weight-loss column for Shape magazine. During her twelve-month odyssey, Chadwick came to realize that her mother had played a role in the development of her physical insecurities. She also began questioning how she might be impacting her eleven-year-old daughter’s body image.

The book includes Chadwick’s own reflections, advice from experts and snippets of interviews she conducted with mothers and daughters.


Last year, Vogue caught a lot of flak for publishing an essay by a mother who, some readers felt, went to extreme measures after a doctor diagnosed her seven year-old daughter as clinically obese. Some of the mother’s tactics, which included putting the girl on Weight Watchers and once depriving her of dinner, were criticized as borderline cruelty.

“My mom wasn’t very critical of me, she was very critical of herself,” Chadwick says. “She had this self-deprecating humor: If I say it first, then nobody else can say anything bad.” But Chadwick implies that regardless of how the negativity is manifested — whether it’s directed toward others or reflected inwardly — children pick up on it.

How many times has your daughter overheard you lament to your friends about having gained a few pounds or witnessed you fly through multiple outfits in an effort to find something that doesn’t make you “look fat.” When you politely refused that piece of birthday cake at the last children’s party you brought her to, explaining to the hostess that you wanted “to be good,” she very well may have been listening and absorbing that message.

If you don’t think that body image is an issue for pre-pubescent girls, think again. According to the National Eating Disorders Association, 70 percent of girls aged six through twelve — those are girls in kindergarten through grade seven — want to be thinner. Although the older girls in this spectrum are becoming more aware of their bodies thanks to puberty, peers and more external exposure to print and digital media, the younger ones have a smaller sphere of influence and guess what, Mom: You are at the center of it. In You’d Be So Pretty If…, Chadwick writes, “Showing our girls that we accept them at any weight starts with showing them that we accept ourselves — no matter what the scale tells us.”

On the surface, it seems as though body image is merely an aesthetic issue, but it’s deeper than that. Women often equate their value with their appearance: The trimmer and prettier they are, the more valuable they are to society. One of the subjects Chadwick interviewed said that when she felt fat, she wouldn’t raise her hand in class. “How we feel about the way we look has an impact beyond what we see in the mirror,” Chadwick says. “It is not this trite thing — it really can have an impact on what we think is possible for ourselves, and that’s what people need to understand.”

A negative body image can hold you back from relationships, from career opportunities and from realizing your potential. “When your body image is affecting your happiness and what you think is possible for yourself, that’s when it’s time to see someone and talk to someone about what you want for yourself,” says Chadwick. Phillips agrees, saying that opening up about how you feel is the first step toward improving your outlook. Cognitive behavioral therapy has been shown to significantly help patients who suffer from BDD, as have certain prescription anti-depressants.

And, even in terms of the media, all hope isn’t lost. “One of the positive things I’ve observed lately is there is a lot of conversation around media and Photoshopping. It’s positive not just for young girls, but for women as well,” says Chadwick. In addition to videos produced by Dove that depict how doctored advertising images often are, there are entire websites out there dedicated to calling out heavy handed Photoshop editors. A simple Google search will elicit oodles of gaffes showing everything from Victoria’s Secret Angels who appear to be lacking ribs to clothing models whose appendages have mysteriously gone missing.

In addition, other brands geared toward women and girls seem to be following Dove’s lead. Most notably, the spring 2014 ad campaign for Aerie, American Eagle’s underwear line that targets the fifteen to twenty-year-old demographic, features young women who don’t fit the typical Barbie-lingerie model shape. And, what’s better, the ads make it clear that the images haven’t been digitally retouched. The message: “The real you is sexy.”

Whether or not you suffer from BDD, a negative body image can be a daily drain on your self-esteem. Ultimately, having a positive body image comes down to being able to accept yourself for what you are, not comparing yourself to other people’s ideals. “It’s about being the best version of yourself,” says Chadwick. “Let go of that idea that you have to be perfect.”

Only Skin Deep

How cosmetic surgery fits into the image equation.

Although negative body image is common, it’s not common in Dr. Patrick K. Sullivan’s Providence office. “That doesn’t tend to be my clientele at all,” he says.

Sullivan is a double-board certified plastic surgeon and faculty member at the Warren Alpert School of Medicine at Brown University, and he’ll be the first to tell you that plastic surgery isn’t a cure for negative body image. “I can’t make people happy internally,” says Sullivan. “I can change their faces, but that doesn’t mean they’ll be happy.” If, during a patient consultation, he feels that an individual’s expectations are unrealistic, he won’t operate. “If I get the feeling that someone isn’t doing well psychologically, there are a lot of people I’ll try to get to see a therapist.”

Sullivan says the majority of his patients have a positive body image but, for various reason, find there is a disconnect between how they feel and how they look. “People are telling them they look tired, when they’re not, or angry,” he says. “They feel very good on the inside, but on the outside, there’s this mismatch.”

Sometimes, age is the culprit. Facial drooping that occurs in the jowls and neck can cause people to look upset or unapproachable, says Sullivan. While the mismatch can be distressing in social situations, it can be more serious in a professional context. “There are companies out there that discriminate based on what they want for a company image, and an old person doesn’t fit that image,” he says.

And professional concerns aren’t limited to older people. Sullivan recalls one patient who was only twenty years old, but who had trouble getting hired because of discoloration and bags under her eyes. “She got out of college and everyone thought that she had been up late the night before, that she had been partying — that she was a party girl — and people don’t want to hire somebody like that.” Her family had trouble understanding her decision because of her age, but she did get a job shortly after Sullivan performed her eye surgery.

Sullivan, whose patients hail from all over the country, says the attitude toward cosmetic surgery in New England is different than it is elsewhere. “We have this conservative kind of feel that people shouldn’t get cosmetic surgery. Accept yourself the way you are, this is what God did, it’s a sin to get cosmetic surgery, all these things. I think it’s preposterous, even an Irish Catholic boy like me thinks it’s preposterous.”

While he’s not warm to the trendy, light-hearted “mommy makeover” approach you’ve probably seen in advertisements elsewhere, he does operate on mothers. “Your body image before pregnancy and after pregnancy might be pretty different. I have a number of people who will not let their husbands see them in the nude anymore — they’re mothers.

I think that’s tragic. So, I really get a lot of gratification from helping people like that. I like women to feel good about themselves so they can feel very good with their partner.”