Skin disease and body image

To understand the social and psychological experience of living with a skin disease, it is essential for health professionals to understand patients' cognitions and the ways in which they represent their illness and their sense of self (Weinman et al., 2000).

Body image can be hypothesised as the 'inside view' that pertains to our own highly personalised experiences of our looks. For many people in society, body experiences are fraught with discontent, unhappiness and self-conscious preoccupation, and body image problems are difficulties in their own right, contributing as they do to a large range of psychological disturbances (Papadopoulos & Walker, 2003).

Early in the 20th century, body image concepts and studies had a tendency to focus on neurologically impaired patients. Although this brought the area of body image into the domain of scientific study, little attention was paid to the psychological aspects of body experience. More recently this has changed and in the past 20 years, much of the research on body image has emanated from a burgeoning interest in clinical eating disorders. Indeed much has been gained from this marriage of body image and eating disorders research but there have also been detrimental consequences (Cash & Brown, 1987). Body image has tended to become synonymous with either distorted body width estimates or a general emphasis on weight. As such, other aspects of body image such as skin disease have tended to be sidelined.

Cash and Pruzinsky (1990) delineated several integrative themes from the body image literature and concluded that body images were multifaceted and referred to perceptions, feelings and thoughts about the body. Body image feelings are intertwined with feelings about the self and body images have a strong social component. That is, interpersonal meaning and cultural socialisation define the social meaning of physical aesthetics and the personal meanings of an individual's physical characteristics. Furthermore, Cash and Pruzinsky showed that body images were not static but could operate on both trait and state levels, and so could be free to interact with the episodic nature of a range of factors including external, social events and the presence of a disfiguring condition such as skin disease. This is particularly relevant to skin disease patients since their conceptualisation of their body image may vary with the episodic nature and visibility of their disease (Thompson et al., 2002).

It has been reported that there are moderate associations between body dissatisfaction and poor psychological adjustment for men and women across the lifespan (Cash, 1985) and research has revealed that evaluative body image accounts for around a quarter to a third of variance in global self-esteem (Cash & Pruzinsky, 1990). As such, body satisfaction can have a considerable influence on psychosocial health. The literature has also shown a relationship between body satisfaction and depression (Noles et al., 1985), social confidence and social evaluation anxiety (Cash, 1993).

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