Blossoming for Whom? Social Approval and Body Image

Body image is a multidimensional construct that reflects the way we perceive and feel about our physical appearance. This inside view of our body heavily influences our self-esteem, mental health, and overall well-being. Under the influence of mass media, peers and family, individuals, especially women, may feel pressured to conform to the societal standards of beauty, engage in upward social comparison, and consequently experience negative body image. While our sociocultural surroundings plays a role in the internalization process, other intrapersonal factors, such as appearance-based rejection sensitivity and lack of self-concept clarity, may heighten the risk for some individuals. Body image disturbances can be manifested in forms of avoidance behaviors, monitoring, eating restraints, and body modification. In order to promote body acceptance, we ought to gain insights into the formation of our body image and challenge the commonly held belief on who defines beauty.


Introduction
Our relationship with our body has always been complicated. Although our body is an integral part of our life experience, many of us do not grow to like or appreciate our body as the way it is. Through the process of socialization, we develop ideas of what is preferred in our society and how we should look at our body. This belief system shapes our perception of and attitudes towards our body. While the size and shape of our body are an objective measure, our body image is not always as stable or realistic. It is not uncommon for one to hold a distorted view of his or her body, which could lead to body dissatisfaction and compromise one's psychological well-being.
Psychologists have devoted an entire body of research on this particular topic and investigated how our perception of our body influences thoughts, beliefs, feelings, and behaviors. Some researchers looked into the origins of body image, others studied the influence of negative body image on our mental health. They raised many interesting questions that inspire us to reflect upon. For example, what role do our families and friends play in the shaping of our body image? What makes some individuals more vulnerable to social comparison than others? In this chapter, we will delve into some of these questions and reveal how our societal standards explicitly and implicitly influence our body image.
Before we get started, it is worth mentioning that body image is not a subject that only pertains to girls or women. As many of our male readers may attest, men can be equally troubled by their body images as well. Moreover, body image is not only about size. It would be unfair to assume that one is only concerned with his or her weight or size, given the rich diversity of human experiences. Literature has examined a great variety of body-related topics, such as physical diseases and injuries. For the purpose of this chapter, we will mainly look at the section of literature that relates to shapes and sizes. But it is not to say that other aspects of body image are not as equally important.

Body image and beauty
Body image is commonly understood as how one looks in the mirror. By staring at your body in the mirror, you will notice some physical characteristics including shape, size, height, skin tone, and so forth. However, do you think these characteristics truly reflect your body? Does your body seem bigger or smaller than you expect? I think you would agree with me that what we see is often not how we feel. There is a great amount of discrepancy between what our body actually looks like and what we perceive our body to be. Furthermore, how do you like the way you look? Do you have an opinion about your body every time you check yourself out in the mirror?
Psychologists coined the term body image to refer to one's perceptions and attitudes towards his/her physical characteristics [1]. Body image is a multidimensional concept that subsumes cognitive, affective, behavioral, and perceptual facets [2,3]. For instance, perceiving your body to be a certain way can give rise to various emotions, lead you to have positive or negative thoughts, and result in behaviors in an attempt to modify your body.
More specifically, psychologists have been interested in studying the development of body image and its influence on other aspects of people's life. Plato once said, "The body, in which we are imprisoned like an oyster in its shell" [4]. One can easily imagine that our feelings towards and opinions of our bodies can fundamentally influence our day-to-day life experiences. Therefore, in order to understand one's idea of beauty, we must inevitably take a close look at his/her body image.
The first question that researchers began to investigate was how accurate people's body perception was. Researchers asked individuals to estimate their body sizes and compared the estimations against their actual measurements. The results show that some people have inaccurate estimations as they perceived their bodies to be either bigger or smaller than their actual sizes [5,6]. Furthermore, people who tend to overestimate their sizes are more likely to develop eating disorders [7]. Among anorexic patients, researchers examined whether their body distortions stem from inaccurate visual inputs or distorted views of their bodies. They employed assessments such as digital photography techniques and figure drawing scales. It turns out that there is not much difference in the patients' visual sensitivity (i.e. heightened ability in processing visual information) but disturbances in how they interpret the images of their bodies [8,9]. Hence, their biased attitudes towards weight and size caused them to have a distorted body image.
This discovery naturally led to the next question about the attitudinal component of body image. In other words, what attitudes do people have in relation to their physical appearance? Researchers examined this question by first asking people if they were satisfied with their body image. The results show that around 61 to 93% of people were not satisfied with either their overall appearance or specific body areas [10,11]. More specifically, around 50% of preadolescent girls and 30% of preadolescent boys reported dissatisfaction with their body [12][13][14]. In adults, approximately 60% of women and 40% of men see their body negatively, and these Blossoming for Whom? Social Approval and Body Image DOI: http://dx.doi.org /10.5772/intechopen.94503 rates remain stable across the lifespan [15,16]. In addition to being dissatisfied, people also reported experiencing emotional distress (including shame, anxiety, or discomfort) with regards to their body [1]. They could experience such distress at specific moments or as part of their general life experience.
Body image distortion and dissatisfaction can have serious consequences. People with negative body image are at risk of having low self-esteem, depression, social anxiety, impaired sexual functioning, and reduced quality of life [1,17,18]. They may engage in risky health behaviors including unhealthy eating, physical inactivity, unsafe sex, smoking, and so forth [19][20][21][22]. Negative body image can also contribute to the development and maintenance of body dysmorphic disorder and eating disorders [23,24].
Eating disorders are serious and sometimes life-threatening illnesses. They often involve serious medical complications that can cause permanent damage or death. People with eating disorders also have an increased risk of dying by suicide. According to the National Institute of Mental Health, the accumulated lifetime prevalence of eating disorders (including anorexia nervosa, bulimia nervosa, and binge eating disorder) was around 4% among adults and 2.7% among adolescents aged 13 to 18 years [25]. Overall, approximately 30 million Americans have struggled with an eating disorder over their lifetime. Moreover, probably twice the number of people or more are also struggling with eating disturbances even if their conditions do not yet meet the criterion of a clinical diagnosis [26]. This is why body image distortion and dissatisfaction are implicated in a range of public health concerns such as eating disorders [27].
For people with negative body image, their passage to beauty and selfappreciation is blocked, because having a healthy and positive body image sits at the core of beauty. Merriam-Webster defines beauty as "a quality or aggregate of qualities in a person or thing that gives pleasure to the senses or pleasurably exalts the mind or spirit" [28]. It is one thing to please the senses of others, but it is another to please oneself. To appreciate the beauty within him/herself, a person must be able to view his/her body positively in the first place. However, it would difficult if a person views him/herself unfavorably and struggles with unpleasant emotions and feelings towards his/her own body. Therefore, in order to reinstate the sense of beauty and self-appreciation within individuals, we must first understand the concept of body image.

Societal standards of body image
At this point, you might wonder what causes people to have distorted and disapproving views of their body. Thomas F. Cash, a leading expert in the field of body image, proposed that there are two views of human appearance [29]. One is the "outside view" as how our physical appearance influences our interpersonal experiences. For example, physical attractiveness plays a role in an array of contexts such as friendship, romantic relationships, and job opportunities. The other is the "inside view" which is a person's subjective experiences of his/her appearance. The inside view was later defined as "body image" [29]. When we talk about body image, we are referring to a person's own perceptions, attitudes, emotions, and beliefs regarding his/her appearance. However, the inside view is built upon and largely influenced by the outside view.
Societal standards regarding body image have a prominent influence on an individual's self-image. As a society, we hold standards for a large variety of qualities. Among these dimensions of self, one's physical body is the most prominent [30]. The values and beliefs about physical attractiveness are referred to as societal standards of beauty. The concept of beauty is ever-changing, as it has constantly evolved over time and varied across cultures. The standards of different societies stem from two main sources of influence: biology and culture [31]. In developed countries, as the issue of survival becomes less of a concern, people's preferences for ideal body shape have shifted from a sultry and voluptuous ideal to a thin and slender ideal. Nowadays, the modern ideal body shape has increasingly become both thin and very fit [32]. These ideals then circulate to other parts of the world due to globalization and have been infused into the standards of other countries and cultures. A crossnational comparison study found that the pressure to conform to Western ideals significantly predicts ideal body stereotype internalization for female participants from America, Poland, and the Czech Republic [32].
How are people influenced by these societal standards? Psychologists proposed a persuasive model -the Tripartite Influence Model [33]. It describes how social influence from media, family, and peers can predict body image and eating disturbances. The model also suggests that individual factors, such as internalization of the ideal body shape (regardless of how the ideal body shape is defined in a given society) and a chronic tendency towards social comparison, could mediate these social influences.
Societal standards are pervasively communicated through media messages. Traditional forms of media, such as TV commercials and magazines, have been advocating and promoting the desirability of an unrealistically thin ideal [34,35]. For example, a study about print media found that adolescent girls would endorse their ideal as the models in fashion magazines specifically targeting teenage girls [36]. New social media, such as Instagram, Pinterest, or Tumblr, are image based. Seeing the images of thin and athletic peers provides a convenient target of upward social comparison for female viewers and motivates them to achieve a similar body shape. Many researchers in the field of eating disorders have criticized the media's role in the formation of eating and body image disturbances (e.g., [34][35][36]).
The media equate an ideal body shape not only with attractiveness but also with success. American culture emphasizes that physical attractiveness helps to achieve success in every area of life [32]. It is believed that thinness is crucial for success and happiness and people with the ideal body shape are likely to have a high social status. On the contrary, overweight or obese people are under pervasive appearancebased social discrimination and are often associated with negative qualities such as unattractive, lazy, immoral and dishonest [37].
Through this socialization process, women are disproportionately influenced by the social standards of beauty. Studies have unanimously observed greater body dissatisfaction among women than men [8,9,15]. Psychologists propose that the gender differences in body image originate from a sexual dimorphism through the general developmental process and the subsequent divergent psychosocial experiences of both genders [8,31]. From an evolutionary perspective, beauty and attractiveness are not merely a cultural concept, but rather an important factor in determining one's odds of survival and reproductive success. Through the process of defining prominent features of attractiveness for both genders, different standards have emerged. Traditional gender roles associate femininity with beauty and the desire for an attractive appearance, while masculinity is associated with force and control [8]. This focus on esthetic qualities of the body creates a low level of body esteem and dissatisfaction among women [31]. Moreover, mass media portray beauty as a woman's primary objective. They also normalize the pressure that women experience with body image as if it is normal and acceptable for a woman to be ashamed and anxious about her body and appearance [38]. However, this is by no means to say that men are not affected by societal standards of beauty. In fact, a growing trend of body dissatisfaction has been observed among men [39]. While some of them are affected by the thin ideal, others are actively pursuing a masculine body ideal with high muscle mass. This tendency could posit men at similar risk of developing body image disturbance and eating disorders.

Internalization of societal standards
Not all women are equally influenced by societal standards of beauty. Some individuals may not be affected by media messages at all, while others are greatly affected and tend to modify their behaviors in a dysfunctional way to model media-promoted images. Researchers speculated that some interpersonal and intrapersonal factors play a role in influencing an individual's response to societal standards.
One specific individual difference variable, internalization of societal pressures regarding standards of attractiveness, appears to moderate or even mediate the media's effects on women's body dissatisfaction and eating dysfunction. Internalization is a process in which individuals assimilate the idea that possessing the ideal body shape is associated with being happy and successful and begin to hold themselves up against the societal standards [40]. Researchers identified two trends of internalization. One is thin-internalization, in which an individual wants to be thin or skinny; the other is athlete-internalization referring to the desire to possess a lean but muscular body [33]. While these two trends differ in the societal standards that one subscribes to, individuals who experience greater pressure to conform to either societal standard are more likely to internalize the ideal body stereotype [39]. Living in a culture that puts such a strong emphasis on the media and uses it to convey beauty standards increases the perceived pressure to conform for some individuals. This may increase their propensity to internalization and create a strong desire for them to achieve ideal beauty standards. Thus, they are at a greater risk of experiencing body image disturbances.
Empirical studies substantiate extensive evidence of internalization. For example, middle-school-aged girls who perceive higher peer influence and more television influence on the importance of attractiveness reported greater dissatisfaction with their body image and having pathological beliefs about eating [14]. College women who saw photographs of thin models from fashion magazines reported significantly higher levels of private body self-consciousness and anxiety than women in the control group [41]. Women with eating disorders demonstrated significant increases in overestimating their body size following exposure to photographs of models from popular fashion magazines. However, no such effect was found among women without eating disorders [41]. People with bulimic symptoms, regardless of the severity of their symptoms, experienced lower levels of self-esteem and weight satisfaction after seeing photographs of thinner models compared to after seeing photographs of larger models [42].
Why are some individuals more likely to internalize societal standards than others? Psychologists suggest that "People differ considerably in how they want to be seen, but they share in common an active pursuit of those desired self-images." [30]. Femininity and attractiveness, among many other qualities, are important to women's self-image. One study found that, in order to present themselves as feminine, female participants consumed less food when getting acquainted with a desirable male companion than with others [43]. Compared to the other qualities, societal standards of attractiveness is a highly accessible external source that can be used to define the self. Therefore, for women who lack a clear definition of their identity, internalizing the thin ideal and comparing their appearance to other women may serve as a means to gain self-knowledge [44].
Unfortunately, defining their self-concept in these ways can have negative implications for women's body image. A sociocultural model stressed that the current societal standards for thinness, as well as other standards of beauty for women are impossible to achieve for the average woman [31,34]. It is not difficult to notice discrepancies between the actual self and the ideal self through upward social comparison. For example, when flipping through fashion magazines, one may make comparisons between her body shape and the models' and inevitably notice the differences in their sizes. Strauman and colleagues found that actualideal discrepancies among female undergraduates were correlated with dissatisfaction with weight and appearance-related beliefs about self [45].
Another source of self-knowledge comes from one's interaction with others. Interpersonal contexts provide opportunities for one to gain insights into his/her self-knowledge [30]. In particular, they allow people to choose comparison targets and interaction partners in ways that maximize benefits to the self. People tend to choose interaction partners who see them as they see themselves due to the desire for self-verification [46]. They create environments that confirm their self-views, primarily by choosing appropriate interaction partners, and they interpret and remember their interactions as confirming their self-views. People choose and are highly committed to interaction partners who confirm their self-views, even if those self-views are negative [46]. Therefore, their negative self-views can be verified, maintained, or even reinforced through their interactions.

Social approval and fear of appearance-related rejection
Messages about societal standards of attractiveness do not emanate just from media sources. Unfortunately, family, peers, coaches, teachers, and others help reinforce this socialization of women [37,47,48]. Their perception plays a critical role in influencing our self-image. Many interpersonal influences have been identified to contribute to the development and maintenance of shape-and weightrelated disorders [49]. The factors include, but are not limited to, teasing or critical comments about one's appearance from parents, peers, or other significant others. For example, one study found that body-related comments received in childhood predicted body esteem in adulthood [49].
The fear of interpersonal rejection leads to a high amount of stress for women. People's sensitivity to rejection based on their appearance within interpersonal contexts are named appearance-rejection sensitivity (RS). Highly sensitive people are self-conscious about how they look. They anxiously anticipate that other people would reject them for their appearance. Moreover, when they are rejected, they attribute their appearance as the reason of rejection. Appearance-RS strongly predicted disruptive and excessive body image concerns [50]. The more sensitive participants were to being rejected based on their appearance, the more likely they were to report thoughts and behaviors characterizing body dysmorphic symptoms, to view cosmetic surgery as acceptable for both social and intrapersonal reasons, and to consider having cosmetic surgery in the future [50]. Appearance-RS also predicted social reasons for having cosmetic surgery [50]. This finding is consistent with research linking higher sensitivity with sociocultural influences, such as peer acceptance and feeling pressured to please others [37,51,52].
Women view their body image as an area that they can improve in order to gain social acceptance. In an experiment examining the implicit relations between rejection and appearance, female participants attempted to modify their body image in order to achieve self-enhancement [53]. Self-enhancement is one of two general sets of motives. When people are under threat (e.g., rejection, negative DOI: http://dx.doi.org /10.5772/intechopen.94503 feedback, low self-esteem, depression, illness), their affective system and desires for self-enhancement are invoked [54]. Kunda proposed that the motivation to self-enhancement leads people to believe that they possess the desired traits, which in this case is smaller body size [55]. In another study, women who received self-esteem threats reported greater satisfaction with their appearance and less preoccupied with it than women who received positive feedback [56]. While the results indicate that participants held self-defensive perspectives immediately after receiving negative feedback, they might experience a paradoxical increase in investment in body image later on [57,58]. As counterintuitive as this may seem, evidence shows that, after rejection and disapproval, people are motivated to protect their self-image by regulating their body image in order to maintain a balanced selfconcept and diffuse the unbearable emotional distress. Compared to other aspects of the self, such as intelligence, one's body seems to be salient yet more malleable.

The crazy efforts in controlling body image
As a result of the interplay between sociocultural influences and the internalization process, women experience dissatisfaction towards their appearance. On the perceptual level, they are likely to overestimate their weight and size and see themselves as bigger than their actual size. Such irrational and inaccurate perception could lead to greater distress and a stronger motive to change. Consequently, individuals may develop distorted beliefs and automatic thoughts about their appearance and its significance [59].
As a result of the negative self-schema, individuals may resort to two common approaches to help regulate their body image. One is the avoidance approach, as some individuals are prone to avoid situations that might generate body image distress. For example, they might wear baggy clothes, avoid tight-fitting or revealing clothes, avoid mirror, and voluntarily isolate from social situations [60]. Other individuals may be prone to actively pursue the ideal body image and try to minimize the actual-ideal discrepancies [61]. They might monitor the condition of their body through repeated weighing and mirror checking. They are also preoccupied with their appearance and spend time-consuming efforts to groom and manage specific body areas. The more dangerous forms of effort include extreme restraints of eating behaviors and cosmetic surgeries. Regardless of the differences in approach, these actions are inherently self-reinforcing. They might relieve the individuals of immediate distress, but perpetuate the problems in the long term.

Conclusion
Struggles with body image have accompanied men and women throughout history and across cultures. With the development of research, we are fortunate to uncover the underlying mechanisms and pathways that link sociocultural influences and individual risk factors. However, many aspects of this problem still remain unresolved. Despite the active effort of studying and intervention, many individuals are still dissatisfied with their appearance and resort to alter their body in dysfunctional manners.
As we are embracing increasing diversity within our culture, it is imperative to reevaluate the dichotomous nature of our societal standards. When we put a category of qualities on the pedestal, we are essentially labeling people who do not possess such qualities as inadequate. Subsequently, individuals are subject to social scrutiny and risk disapproval from their significant and/or desirable others.

Author details
Wenting Mu 1 * and Fan Wu 2 1 Center for the Treatment and Study of Anxiety, Philadelphia, US 2 Parent Planet Parenting Support Center, Nanjing, China *Address all correspondence to: wenting.mu@pennmedicine.upenn.edu The stakes are raised obviously too high to the degree that it may erode individuals' self-esteem and overall well-being. In order for individuals to regain control over their body image, the real effort that we should spend is to challenge media messages and commonly held beliefs about beauty and help individuals develop a secure and stable self-concept that captures their true essence.
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