Body image and long-term health conditions
Body image is an important issue for many people affected by long-term health conditions, be they related to mental or physical health. The body image of individuals with long-term conditions or disabilities is informed by factors discussed in previous sections as well as the often significant changes to appearance and functioning that can accompany illness and disability and affect the way we think about and experience our bodies.
Body image and physical health conditions
Experiences of chronic illness, particularly those where the effects are physically visible, have been associated with greater body image concerns (85). There is a substantial body of research on the ways that experiences of cancer specifically can affect body image (86,87). Cancer is associated with a range of bodily changes as a result of both the illness itself and its treatment. This can include hair loss, scarring, swelling, sensory changes (e.g. pain or numbness) and functional impairment, all of which can affect the ways people with cancer relate to and experience their bodies (86). Cancer symptoms and treatment (e.g. chemotherapy and surgery such as a mastectomy) may contribute to feelings of shame or body dissatisfaction due to the way they can affect people’s self-perceived identity, fertility and attractiveness, as well as their impact on functionality and the ability to perform daily tasks (87-89). This, in turn, can negatively affect mental health and quality of life (86,87,89).
While the research reviewed here focuses on experiences of cancer, experience of bodily changes and changes to functionality, and the relationship this has to body image, will also apply to many other chronic conditions and disabilities. Furthermore, many long-term health conditions are associated with experiences of chronic pain. One review of the research suggests that chronic pain may affect the way we experience and perceive our bodies, particularly the areas of the body where the pain is localised (90). Therefore, the ability to change and manipulate bodily perception may provide a route to the management of some forms of chronic pain – for example, the use of visual feedback for the management of phantom limb pain (90).
In our survey, a higher proportion of adults who had a health problem or disability that substantially limited their daily activities reported feeling shame (31%) or feeling down or low in the last year (47%) because of their body image compared to individuals without a limiting condition (18% and 32% respectively). Similarly, 50% of adults with a health problem or disability said their body image negatively affected their self-esteem, compared to 36% of adults without a limiting condition.
Body image, mental health problems and learning disabilities
There is relatively little research looking specifically at the body image of individuals with learning disabilities. However, individuals with learning disabilities are often at a greater risk of obesity than their peers (91), which is something that has been linked to increased feelings of body dissatisfaction and poor body image among both adults and young people in the wider research (31,67). There is also some evidence to suggest that children with learning disabilities may have less awareness of their bodies and limited opportunities for social engagement, and that they are more likely to be bullied than their peers, which can lead to feelings of isolation and low self-esteem (91,92). Some small studies have looked at dance and movement therapy for individuals with learning disabilities, which may have positive effects on body awareness and wellbeing, though the research in this area is still developing (93,94).
Autism spectrum disorder
There is some research to suggest that individuals with autism spectrum disorder can experience their bodies differently than neurotypical peers, and that this may affect how they think and feel about their bodies, though research in this area is still developing (95,96). One study, which spoke with young people with autism about their feelings about their bodies found that some young people expressed difficulties in feeling fully aware of, in control of, and connected to their bodies, especially in the context of challenges with coordination and motor skills (97). Young people who reported having functional strategies for challenges in their daily lives related to their motor difficulties reported feeling more positively towards their bodies, and proud of their abilities, suggesting that this may be a potential avenue to support body awareness and body image (97).
Medication for severe mental health problems
Medications used to treat some severe mental health problems commonly have side effects that involve weight gain. This weight gain can have negative effects on body image and quality of life. One review of the literature found that individuals taking psychotropic medication reported weight gain as one of the most distressing adverse effects of the medication, and expressed feelings of embarrassment, shame and hopelessness, which negatively affected their self-esteem and quality of life (98). Additionally, concern about weight gain, and the distressing emotions that can accompany it, can contribute to choices to interrupt, adjust or otherwise stop taking medication and can serve as a barrier to participation in physical activity (98,99). Therefore, it is important to consider the impact of medication on quality of life, body image and self-esteem alongside its effectiveness for the treatment and management of mental health problems. There is some support for approaches such as Cognitive-Behavioural Therapy and counselling in aiding in offsetting some of these negative effects (100). Following good practice guidelines for maintaining positive cardiometabolic health – for example, through the use of tools such as NHS England’s Lester Tool – may not only guide the effective monitoring of physical health, but potentially also help to address body image concerns linked to weight gain (101).