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Body Image
Improving Body Image Among People With a Visible Difference
New research shows that asking "What can my body do?" may be helpful.
Posted May 30, 2024 Reviewed by Gary Drevitch
Key points
- People with a visible difference may experience appearance concerns.
- Expand Your Horizon (EYH) can help individuals focus on what their body can do and why that is important.
- Among people with a visible difference EYH led to higher functionality appreciation in a 3-month follow-up.
- No group differences were found for overall body appreciation, anxiety, and depression.
Visible differences refer to any appearance-altering condition that a person is born with (e.g., cleft lip and/or palate) or acquires later in life (e.g., due to burns, injuries, or medical treatments).
Although many people adjust well to their visible difference, for others, visible differences can contribute to aspects of ill-being such as appearance dissatisfaction, social anxiety, and depression. A large reason for this is the depiction of visible differences in the media—where such individuals are often depicted as villains or victims—and experiences of stigma and discrimination in daily life, such as staring, unwanted questions, and teasing.
While system-wide changes are needed to address these issues, individual-level techniques that can boost and protect individuals’ well-being are also important. To this end, in a recent study led by my colleague at the Centre for Appearance Research, Ella Guest, we investigated an online programme to improve positive body image as one aspect of well-being.
The programme is Expand Your Horizon, which was developed by me and my colleagues back in 2015. Expand Your Horizon is made up of three writing exercises that help individuals to focus on the functionality of their body. Body functionality refers to everything that the body can do, including functions related to physical capacities (e.g., walking), internal processes (e.g., digesting food), creative endeavours (e.g., painting), bodily senses (e.g., hearing), communication with others (e.g., via body language), and self-care activities (e.g., bathing). In the writing exercises, users are asked to reflect on the various functions of their body and why those functions are important to them.
The idea behind Expand Your Horizon is that it helps to shift the focus from an overemphasis on physical appearance (which has been shown to contribute to negative body image and ill-being) to an appreciative and holistic focus on all of the valuable things the body can do, which are often taken for granted in daily life. To date, Expand Your Horizon has been tested among different populations, but Guest’s study is the first in which it was tested among people with a visible difference.
In the study, 68 adults with a visible difference were randomized to either Expand Your Horizon or a waitlist group. Participants in the Expand Your Horizon group completed questionnaires at pretest, then completed the Expand Your Horizon programme over the course of one week. They completed the same questionnaires again immediately after finishing Expand Your Horizon, and three months later. Participants in the waitlist group completed the questionnaires at the same time points, and received Expand Your Horizon after finishing the follow-up measurement.
We used the questionnaire data to test whether there were any changes in positive body image, anxiety, and depression across time. We expected that, compared to the waitlist group, participants in the Expand Your Horizon group would report higher positive body image, and lower anxiety and depression, across time.
The Results
The data showed that, as expected, participants in the Expand Your Horizon group reported higher functionality appreciation at posttest and at the three-month follow-up compared to the waitlist group. Functionality appreciation is a core component of positive body image and refers to appreciating and respecting the body for what it is able to do. Based on content analyses of participants’ writing exercises, we also found that participants were able to describe their body functionality holistically, and appreciated how their body is positively connected to the Self and helps them to lead their daily lives. For example, one participant described, “My body and brain allow me to work and be good at my job.”
Unexpectedly, we did not find any group differences for overall body appreciation, anxiety, or depression. Nevertheless, based on intervention feedback questions, the participants in Expand Your Horizon evaluated the programme positively. For example, they scored the programme as being enjoyable and impactful, and thought that the number and length of the writing exercises was acceptable.
The Take-Home Message
On the one hand, the findings are promising because they suggest that Expand Your Horizon led to higher functionality appreciation among people with a visible difference, with these improvements even persisting three months later. Functionality appreciation is a core aspect of positive body image, and extensive research has shown that it is positively related to many other aspects of well-being. Further, Expand Your Horizon is an individual-level technique that is easily accessible given its online format, and it is self-led, so it can easily be distributed to larger numbers of people. It is also promising to see that Expand Your Horizon, which has substantial support among other participant populations, can lead to positive changes for people with a visible difference too. The participants themselves also gave Expand Your Horizon positive scores in their intervention feedback. Therefore, overall, Expand Your Horizon could be a useful tool for adults with a visible difference who are looking for ways to improve their body image.
On the other hand, it is important to underscore that we did not find any group differences for the other outcome measures: overall body appreciation, anxiety, and depression. As described above, a major contributor to ill-being for many people with a visible difference is poor treatment by other people, and unfair depictions of visible differences in mass media. Luckily, there are other individual-level techniques that may address these experiences, such as those that focus on coping strategies. Therefore, as described by Guest in the research article, “having a toolbox of different interventions may provide the best approach for supporting this population.” We also underscore that system-wide changes are crucial to tackle how visible differences are portrayed in media and how people with a visible difference are treated by others.
To access a PDF version of the Expand Your Horizon exercises for adults with a visible difference, click here.
