American society places a tremendous emphasis on physical appearance. Many adolescent girls go to great lengths to achieve these unrealistic standards of thinness. Eating disorders have become a prevalent disease in Western society. Dissatisfaction with one’s physical appearance is viewed as a core feature of eating disorders. A negative body image is also a common feature associated with depression. There appears to be a link, although unclear, between depression and a poor body image.
Adolescence is a tumultuous period in one’s life. Bodies of adolescents are dramatically changing, and these physical changes are associated with changes in body image. Body image pertains to how individuals view and assign meaning to their own bodies. It is a reflection of body structure and function, early and continuing body related experience, life long social response to body appearance, and sociocultural values and ideals regarding the body (Reirdan, 1997).
Adolescence: A Period of Dramatic Change
A normative developmental task for both girls and boys is to assimilate pubertal change into a positively valued body image. This task is more difficult for girls than for boys; girls are more concerned about attractiveness than boys, and they are less satisfied with their appearance (Rierdan, 1989). In a list of body areas, girls were more concerned that their thighs, buttocks and hips were too large. Even normal to thin girls were highly likely to desire smaller thighs, buttocks or hips. It is interesting to note that younger girls, aged 10-12 years, were less likely to select areas of sexual attractiveness, but tended to be dissatisfied with areas such as teeth, face, and feet (Moore, 1993). It is clear that the onset of adolescence produces changes in body image.
Depressed Adolescent Girls
During adolescence, depression rates increase, and gender differences in depression are observed. Current data indicates that the depressed girl experiences her body as less satisfactory, and she also views it as deficient along a number of other dimensions. The depressed girl experiences her body as less pretty, less interesting, sicker, weaker, clumsier, less useful, less familiar and more out of control (Rierdan, 1987). Depressed girls are particularly dissatisfied with their face, a primary basis of social judgments about attractiveness of females, and with weight, a major determinant of adolescent girls’ overall body image (Rierdan, 1987). It is possible that girls experiencing early onset depression have a body experience that is radically different from other adolescents. This could be attributable to biochemical dysfunction. This dysfunction could be reflected in symptoms such as fatigue, sleep disturbance, eating disturbance, and other bodily complaints. When body attractiveness becomes important in adolescence, the foundation may already be laid for these at risk adolescents to be less satisfied with their bodies and vulnerable to the lowered self-esteem associated with eating disorders (Reirdan, 1988). Very simply, adolescence is a critical time in emotional development. As their body changes, adolescents are faced with the complicated task of reorganizing their body image. For some teenagers, especially those with depression, this proves to be a difficult task.
Some adolescent girls develop depression in response to their changing bodies. The heightened attention and critical appraisal of the body, coupled with the greater vulnerability to emotional distress, suggests that body dissatisfaction in young adolescent girls might be an important correlate of depression (Rierdan, 1987). Menstruation causes biological and physical changes in a girl’s body. Studies in menarche support the findings that body image can contribute to depression. A normal part of a girl’s development involves a significant increase in fat and weight. Girls at relatively lower stage of ego development are concerned with bodily feelings and it is understandable that the onset of menstruation could disrupt a girl’s sense of well being. These girls are less able to adapt to the bodily changes that accompany early menarche and depressive symptoms are likely to develop (Rierdan, 1989). Adolescent girls experience a number of bodily changes. They are forced to reorganize their body image. In a society that places a tremendous value on thinness, it is often difficult to assimilate these changes into a positive body image.
Negative Body Image: A Core Feature of Depression
Many people suffering from depression also possess a negative body image. Research beginning with Dion, Berscheid and Walster (1972) has demonstrated that the objective appraisal of adult attractiveness correlates with judgments of success, competency and happiness. Other research (Dion, 1973; Langlois, 1986; Langlois & Stephan, 1977; Vaughn & Langlois, 1983) shows that these tendencies also exist for preschool and elementary school children. Archer and Cash (1985) reported that adult clinical inpatients who rated themselves as less physically attractive tended to show higher levels of depression on the MMPI. Similarly, depressed college students manifest higher levels of body image dissatisfaction than non-depressed students, regardless of ethnicity or gender. Research has suggested that satisfaction with body’s appearance is more salient in the self concept of college females than satisfaction with the body’s effectiveness, with reverse findings occurring for males. Noles, Cash and Winstead (1985) indicated that self-evaluations of attractiveness has even stronger implications for depressive symptomology than actual attractiveness. The strongest predictor of CDI scores in regression analyses was dissatisfaction with body’s attractiveness. While depressed adults perceived themselves as less physically attractive and reported less satisfaction with their bodies, objective evaluations of attractiveness did not differentiate the groups. The present findings indicate that depressed individuals do not have a global distortion of body image. It appears that dysphoric children also negatively distort their own attractiveness, while maintaining reality based perceptions of other’s attractiveness. Dysphoria is maintained by a unilateral bias in social comparison; the underevaluation of one’s self, not a distorted evaluation of others. This is consistent with Beck’s model, which implicates a negative view of the self as a critical cognitive aspect of depression (McCabe, 1993). In essence, dissatisfaction with physical appearance emerges as a hallmark feature of depression. It is not a global distortion but simply pertains to one’s own body.
Beck’s (1973, 1976) cognitive theory of depression includes a distorted body image as a cognitive symptom of depression. Beck (1973) classified 975 individual as non-depressed or as mildly, moderately, or severely depressed based on their Beck Depression Inventory scores. He reported that in each group, 12%, 33%, 50%, and 66%, respectively, suffered from a distortion of body image. Marsella, Shizuru, Brennan, and Kameoka (1981) investigated body image and depression. They categorized college students on their Zung Self-Report Depression Scale scores and found depressed students were more dissatisfied with 17 body areas. It is apparent that individuals with an average body image did not differ in depression from those with a positive body image. For the sample, persons with a poor body image were significantly more likely to report depressive symptomology than were subjects in the other two groups (Noles, 1985).
External Influences on Body Image
Mori and Morey (1991) conducted an experiment using students from Vanderbilt University. The experiment was designed to investigate the impact of external weight related feedback on the body image of females with different level of depression. Participants were asked to estimate their body weight. The Zung Self-Rating Depression Scale was used to assess depression levels. Body image estimation was taken by using the Image Marking Technique. In the first session, subjects were weighed in pounds on a digital scale. In the second session, participants were weighed on a scale that was set in kilograms. Participants were randomly given one of two bogus weights, either 3% lighter or 3% heavier. The body estimations of the participants with low feelings of depression were not affected by the weight related feedback. In contrast, findings indicate that females with feelings of depression were affected by the weight related feedback. These findings indicate that females with feelings of depression are more vulnerable to external feedback which may have implications about the treatment and prevention of body image disturbances. It is conceivable that societal messages in the form of diet and beauty advertisements creates a situation where the target female compares herself to an ideal image. Depressives tend not to question the validity of negative inferences about themselves and often incorporate distorted information into their body image (Mori, 1991). Simply put, women are constantly bombarded with images of the ideal woman. This is a precarious situation for depressed individuals, because they are more likely to incorporate these messages into their body image, putting themselves at risk for developing an eating disorder.
An Ambiguous Link
A negative body image is a central feature of eating disorders. Since depression is known to cause a negative body image, it is important to study its relation to eating disorders. The link between eating disorders and depression is inconclusive. Many common depressive features such as depressed mood, irritability, low energy, and low concentration have been reported in studies of the physical and psychological effects of semi-starvation . Some psychologists argue that eating disorders represent a variant or masked form of depression. Over short periods of time, underweight patients with anorexia nervosa tend to show improvements in their depressive symptoms with weight gain and nutritional stabilization. However, a small number of long term follow up study suggest that a disproportionate number of patients show signs of depression at follow up. Patients who present for treatment may represent a sicker or more depressed subgroup (Devlin, 1989). Although these studies are indecisive, they suggest new options in treating depression and eating disorders. Some psychologists have suggested that treating depression may involve addressing body image issues, whereas eating disorders may respond to treatment with anti-depressants.
Biological markers have also been investigated in order to gain insight into the relationship between depression and eating disorders. The dexamethasone suppression test (DST), widely studied as a potential biological marker for depression, has been found by several groups to show high rates of nonsuppression or early escape in underweight patients with anorexia nervosa. However, because starvation can bring about similar changes in the hypothalamic pituitary adrenal (HPA) axis, an abnormal DST does not necessarily link anorexia nervosa with depression (Devlin, 1989). The cause and effect relationship between depression and eating disorders remains ambiguous.
Socio-cultural pressures on females cannot fully account for the presence of eating disorders. Other factors must be present for the development of severe problems. Does depression cause a distorted body image or does a poor body image lead to depression? There does not appear to be a well defined answer. However, it is clear that a strong link between depression and body image exists.
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