Exercise and disability: ‘Now things hurt for the right reasons’

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confidence, Exercise, multiple sclerosis, Self-esteem, symptoms

Exercise and disability: ‘Now things hurt for the right reasons’

It’s hardly surprising that Shana Pezaro started comfort eating. After 20 years of unexplained and debilitating symptoms, she had just been diagnosed with multiple sclerosis. Having built up her own stage-school business, she was now losing the ability to walk and was forced to sell up. Then her marriage fell apart.

“My husband had found my illness and disability very difficult to deal with, but we always thought I was going to get better,” says Pezaro. “Then, when I was finally diagnosed with MS in 2007 and we realised I wouldn’t, he just couldn’t handle it. I used to be a dancer, but my body had changed and he told me he just couldn’t find me attractive anymore. Within a year of my diagnosis, we’d split up.”

It was a relief, she says, when he finally left, but the experience nevertheless dealt a blow to her self-esteem, not helped by the fact she had started to put on weight.

“I went from 12st to 15st in the space of three years. The fatigue was so bad that I didn’t have the strength to cook. I was living on microwave meals and snacks. The steroids and other medications made me incredibly hungry. And of course as my legs got worse I was getting less and less exercise – I could barely walk. I was miserable.”

Weight gain is a serious issue for the disabled community. In a study of 30,000 people published this summer by the University of Texas School of Public Health, 42% of adults with a disability were reported as obese, compared with 29% of those without a disability. Gaining weight not only affects a person’s emotional wellbeing, but can also make mobility even harder and symptoms feel worse. Yet fatigue and pain can make sport participation seem daunting. And although things are improving following the success of the Paralympics, access remains a major barrier. Just 18% of people with a disability or long-term limiting illness participate in sport each week, around half the level of the general population, according to a survey by Sport England.

“You don’t have to eat a lot to put on weight if you’re not moving and your body isn’t burning calories,” says Vanessa Daobri, a gym instructor who specialises in working with people with disabilities. “Disabled people often suffer because they don’t know how to exercise. If the disability is a result of an injury or it’s been a slow onset, they may find it hard to accept that they can’t do a sport in the way they used to, so they feel there’s no point.”

Organisations such as Aspire and the English Federation of Disability Sport run inclusive gyms across the country. But not everyone is lucky enough to be near one, and regular gyms are still lagging behind, says Daobri. “Often the staff get the approach wrong – sometimes it’s just laziness, sometimes it’s ignorance. Health and safety is used as a crutch, too.” Another issue, she says, is that disabled people can feel frightened to be seen going to the gym in case their benefits are cut.

Daobri has Ehlers-Danlos syndrome, a disorder affecting collagen. In 2007 she grew from a size 12 to a size 24 in less than a year. She felt “stuck”, until she joined a wheelchair racing group and the coach asked her if she used the gym.

“I just laughed,” she says. ‘I thought gyms were not for me – they were for other people.” She was shown how to use gym equipment in new ways and quickly became “addicted” to exercise. Now, she has made a career out of helping disabled people find ways to get fit.

“Once someone opened the door for me I realised there was a whole world out there,” she says. “Whatever your disability, there’s a version of a sport for you – you just have to be a bit creative.”

After six months of post-divorce counselling, Pezaro decided she wanted to lose weight. “I got a brilliant new carer who got me eating healthily,” she says. “Then I found out there was an MS treatment centre near me that runs lots of different exercise classes.”

She signed up to a class she has come to describe affectionately as “sadistic PE”. “The instructor is ex-military but also a counsellor and herself has MS. So she completely understands us, but she doesn’t let us get away with anything. We adapt everything to our own personal needs. It’s not your average fitness class – it’s not unusual for people to collapse and have a leg spasm in the middle of their situps, or to suddenly fall off their exercise ball, but we just laugh about it.”

At first Pezaro was unable to do most of the exercises, but she persevered and since starting the class three years ago has lost nearly 4st.

“It’s not been easy,” she says. “It took me 30 months to lose 45 pounds. But I didn’t get demoralised. I knew that over the years it would add up. And the more I’ve exercised the better my fatigue is. I still can’t walk, but I now have less weight to lift when I’m using my frame, or getting on and off the toilet, so everything is easier.”

Pezaro’s confidence has been transformed and now she is enjoying dating again. But perhaps most the important gain has been to her sense of control.

“I really worked myself at last night’s class, and today every muscle in my body hurts,” she says. “But I’m so used to living with pain, it’s kind of nice to know that for once, things are hurting for a good reason.”

• For information and support on multiple sclerosis visit mssociety.org.uk. Aspire’s Instructability programme offers free fitness industry training to disabled people. Visit aspire.org.uk

When the Bully Is a Sibling

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abuse, aggression, anxiety, Bullying, Children, Depression, family, Self-esteem, siblings, young people

When the Bully Is a Sibling

Siblings have been bickering and trading blows since the time of Cain and Abel. But the torment and fighting that is often shrugged off as normal sibling rivalry may not always be so benign.

New research suggests that even when there are no physical scars, aggression between siblings can inflict psychological wounds as damaging as the anguish caused by bullies at school or on the playground. The findings offer an unusual look at an area of family life that has rarely been studied, in part because infighting among brothers and sisters is widely considered a harmless rite of passage.

But ordinary skirmishes over the remote or joystick are one thing, experts say, and chronic physical and verbal abuse, particularly when it is directed at one sibling, is another. The new study, which involved thousands of children and adolescents around the country, found that those who were attacked, threatened or intimidated by a sibling had increased levels of depression, anger and anxiety.

Corinna Jenkins Tucker, the lead author of the study, which was published in the journal Pediatrics, said that behaviors among siblings that cross the line into abuse deserve more recognition.

“Historically, the general thinking has been that it’s not a big deal, and sometimes it’s even viewed as being a good thing,” said Dr. Tucker, an associate professor of family studies at the University of New Hampshire. “There appears to be different norms of acceptability. Peer aggression is unacceptable, but it’s not the same for siblings.”

Dr. Tucker said that the growing number of programs and public service announcements aimed at stopping bullying and violence in schools and other settings should include a focus on sibling relationships as well.

“The aggression among siblings should be taken just as seriously as that among peers,” she said.

While normal rivalries with siblings can encourage healthy competition, the line between healthy relations and abuse is crossed when one child is consistently the victim of another and the aggression is intended to cause harm and humiliation, said John V. Caffaro, a clinical psychologist and the author of “Sibling Abuse Trauma.” Parents who fail to intervene, play favorites or give their children labels that sow divisions — like “the smart one” and “the athlete” — can inadvertently encourage conflict.

Nationwide, sibling violence is by far the most common form of family violence, occurring four to five times as frequently as spousal or parental child abuse, Dr. Caffaro said. According to some studies, nearly half of all children have been punched, kicked or bitten by a sibling, and roughly 15 percent have been repeatedly attacked. But even the most severe incidents are underreported because families are loath to acknowledge them, dismissing slaps and punches as horseplay and bullying as boys just being boys, he said.

“Our society tends to minimize child-on-child violence in general,” he added. “We have these ideas that if you’re hurt by a child it’s less injurious than if you’re hurt by an adult, but the data don’t support that.”

In the new report, Dr. Tucker and her colleagues studied 3,600 children using data from the National Survey of Children’s Exposure to Violence, which collects information on children and teenagers under 17. Previous studies of sibling violence, which are few in number, have typically been small or narrowly focused on specific forms of aggression.

But the new research, conducted through interviews with children and their parents, measured the impact of a broad range of violence. It looked at physical assaults with and without weapons and the destruction or stealing of property, as well as threats, name-calling and other forms of psychological intimidation.

The researchers also measured the same types of behaviors perpetrated by peers outside the home and accounted for them in their findings in order to tease apart the specific toll of sibling violence.

Over all, a third of the children in the study reported being victimized by a brother or sister in the previous year, and their scores were higher on measures of anxiety, depression and anger.

Catherine Bradshaw, an expert on bullying and the deputy director of the Center for the Prevention of Youth Violence at Johns Hopkins University, said the study was impressive in its scope and scale, and noted that it showed that all types of sibling aggression, from mild to severe, were associated with worse mental health.

“Parents at times might be thinking that their kids can fight it out or that a little bit of victimization might not be so bad,” she said. “But these findings suggest that the threshold is pretty low. It’s not just the rough stuff you have to keep an eye out for.”

Dr. Caffaro said that the effects of sibling abuse often continue into adulthood. Over the years he has treated patients who struggled with emotional issues and sabotaged themselves in their careers because of repeated humiliation they experienced at the hands of a brother or sister.

“It can erode their sense of identity and their self-esteem,” he said.

What doesn’t kill us…

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adversity, autonomy, avoidance, cognitive processing, compassion, coping, distress, family, friends, gratitude, Grief, intrusion, measures, personal growth, positive changes, post-traumatic growth, post-traumatic stress, psychologists, psychology, PTSD, relationships, resilience, self-acceptance, Self-esteem, support, theory, trauma, vulnerability, well-being

What doesn’t kill us…

The field of psychological trauma is changing as researchers recognise that adversity does not always lead to a damaged and dysfunctional life. Post-traumatic growth refers to how adversity can be a springboard to higher levels of psychological well-being. This article provides an overview of theory, practice and research. To what extent is post-traumatic stress the engine of post-traumatic growth? How can clinicians measure change? What can help people to thrive following adversity?

Suffering is universal: you attempt to subvert it so that it does not have a destructive, negative effect. You turn it around so that it becomes a creative, positive force.
Terry Waite, who survived four years as a hostage in solitary confinement (quoted in Joseph, 2012, p.143)

Scientific interest in positive changes following adversity was sparked when a handful of studies appeared in the late 1980s and early 1990s, reporting positive changes in, for example, rape survivors, male cardiac patients, bereaved adults, survivors of shipping disaster, and combat veterans. Then, the topic of post-traumatic stress disorder (PTSD) was relatively new (following its introduction in 1980 by the American Psychiatric Association), and was attracting much research interest. The relatively few observations of positive change were overshadowed by research on the ways in which trauma could lead to the destruction and devastation of a person’s life.

But interest in how trauma can be a catalyst for positive changes began to take hold during the mid 1990s when the concept of post-traumatic growth (Tedeschi & Calhoun, 1996) was introduced. It proved to be popular and became the descriptor for a field of inquiry attracting international attention from researchers, scholars and practitioners (see, Calhoun & Tedeschi, 2006; Joseph & Linley, 2008a; Weiss & Berger, 2010). Over the past decade it has developed into one of the flagship topics for positive psychology (Seligman, 2011). This article aims to provide a state-of-the-art review of the psychology of post-traumatic growth.

What is post-traumatic growth?
After experiencing a traumatic event, people often report three ways in which their psychological functioning increases:
1.    Relationships are enhanced in some way. For example, people describe that they come to value their friends and family more, feel an increased sense of compassion for others and a longing for more intimate relationships.
2.    People change their views of themselves. For example, developing in wisdom, personal strength and gratitude, perhaps coupled with a greater acceptance of their vulnerabilities and limitations.
3.    People describe changes in their life philosophy. For example, finding a fresh appreciation for each new day and re-evaluating their understanding of what really matters in life, becoming less materialistic and more able to live in the present.

Several self-report psychometric tools were published during the 1990s to assess positive changes following trauma, the first such measure was the Changes in Outlook Questionnaire (Joseph et al., 1993), followed by the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996); the Stress Related Growth Scale (Park et al., 1996), the Perceived Benefit Scale (McMillen & Fisher, 1998), and the Thriving Scale (Abraido-Lanza et al., 1998). Each of these measures asks respondents to think about how they have changed since an event and to rate the extent of their change on a series of items.

Using such measures of perceived growth, and open-ended interviews, a large number of studies have shown that growth is common for survivors of various traumatic events, including transportation accidents (shipping disasters, plane crashes, car accidents), natural disasters (hurricanes, earthquakes), interpersonal experiences (combat, rape, sexual assault, child abuse), medical problems (cancer, heart attack, brain injury, spinal cord injury, HIV/AIDS, leukaemia, rheumatoid arthritis, multiple sclerosis) and other life experiences (relationship breakdown, parental divorce, bereavement, emigration). Typically 30–70 per cent of survivors will say that they have experienced positive changes of one form or another (Linley & Joseph, 2004).

Practitioners in health, clinical and counselling psychology will encounter patients daily whose lives have been affected by such events. Up to now practitioners may have drawn on theories of post-traumatic stress to help their patients. A pressing theoretical issue therefore is the relation between post-traumatic stress and post-traumatic growth. How can these new ideas improve how we work with patients?

Theory and practice of post-traumatic growth
Research is now untangling a seemingly intricate dance between post-traumatic stress processes and post-traumatic growth. The most successful attempt to date is organismic valuing theory, which explains how post-traumatic growth arises as a result of post-traumatic stress. This is a person-centred theory that draws together information processing and social cognitive theories of post-traumatic stress with research on self-determination theory. The theory shows trauma leads to a breakdown in self-structure, signalled by the experiences of post-traumatic stress indicating the need to cognitively process the new trauma-related information. People are intrinsically motivated towards processing the new trauma-related information in ways that maximise their psychological well-being (Joseph & Linley, 2005, 2006).

Organismic valuing refers to how intrinsic motivation is experienced by the person. One woman who was caught up in a fatal shooting in which her close friend was killed, and who had suffered from considerable post-traumatic stress for several years, said how she woke early one morning after a night of restless sleep and got up to look at a picture of her children:

In the silent wee hours of the morning, I sat staring at their picture and began to sob. Through my sobs, I heard the real voice of wisdom I believe we all possess. It was my voice, the voice that knows me best, but a voice that had become muted. Guess what. No one is coming to change the situation. No one will rescue you. No one can. It’s up to you. Find your strength. I realised that as long as I remained a victim, I too made my family a victim. My anxiety could only teach them to be anxious. I was robbing them of happiness and a positive outlook on the world. I had come to the intersection of intersections. I could choose to end my life or I could choose to live. I needed to live for my family – and later I understood most importantly, for myself. (quoted in Joseph, 2012, p.142)

Post-traumatic growth involves the rebuilding of the shattered assumptive world. This can be illustrated through the metaphor of the shattered vase. Imagine that one day you accidentally knock a treasured vase off its perch. It smashes into tiny pieces. What do you do? Do you try to put the vase back together as it was? Do you collect the pieces and drop them in the rubbish, as the vase is a total loss? Or do you pick up the beautiful coloured pieces and use them to make something new – such as a colourful mosaic? When adversity strikes, people often feel that at least some part of them – be it their views of the world, their sense of themselves, their relationships – has been smashed. Those who try to put their lives back together exactly as they were remain fractured and vulnerable. But those who accept the breakage and build themselves anew become more resilient and open to new ways of living.

These changes do not necessarily mean that the person will be entirely free of the memories of what has happened to them, the grief they experience or other forms of distress, but that they live their lives more meaningfully in the light of what happened.

The implication of organismic valuing theory is that post-traumatic stress is the catalyst for post-traumatic growth. Helgeson et al. (2006) conducted a meta-analytic review concluding that greater post-traumatic growth was related to more intrusive and avoidant post-traumatic stress experiences. As intrusion and avoidance are generally seen as symptoms of PTSD at first glance this result would seem to suggest that post-traumatic growth is indicative of poor mental health, but consistent with organismic valuing theory Helgeson et al. suggest is that these constructs reflect cognitive processing:
Experiencing intrusive thoughts about a stressor may be a signal that people are working through the implications of the stressor for their lives, and these implications could lead to growth. In fact, some might argue that a period of contemplation and consideration of the stressor is necessary for growth to occur. (p.810)

It is in this sense that post-traumatic stress can be conceptualised as the engine of post-traumatic growth. This is also the conclusion of a recent study by Dekel and colleagues (2012), who set out to shed light on the interplay between PTSD and post-traumatic growth. Using longitudinal self-report data from Israeli combat veterans who were studied over 17 years, with assessment at three time points, the researchers found that greater PTSD in 1991 predicted greater growth in 2003, and greater PTSD in 2003 predicted greater growth in 2008.
However, it also seems that the relationship between post-traumatic growth and post-traumatic stress is a function of the intensity of post-traumatic stress. Butler et al. (2005), for example, in their study following the attacks of September 2001, found that greater post-traumatic stress was associated with greater post-traumatic growth, but only up to a point, above which post-traumatic growth declines.

Could there be a curvilinear relationship between post-traumatic stress and post-traumatic growth? Low levels of post-traumatic stress reactions indicate that the person has been minimally affected, thus one would expect minimal post-traumatic growth. A moderate level of post-traumatic stress is indicative that the individual’s assumptive world has in some way been challenged triggering the intrusive and avoidant experiences, but the person remains able to cope, think clearly, and engage sufficiently in the necessary affective-cognitive processing needed to work through. A high level of post-traumatic stress, however, where a diagnosis of PTSD might be considered, is likely to mean that the person’s coping ability is undermined and their ability to affectively-cognitively process and work through their experience is impeded. The inverted U-shape relationship between post-traumatic stress and post-traumatic growth has been reported in several studies (e.g. Kunst, 2010).

Thus, through the above research and theory we are developing a new understanding of psychological trauma that integrates post-traumatic stress and post-traumatic growth within a single conceptual framework which can guide clinical practice. A new constructive narrative framework that can guide practitioners is the THRIVE model (Joseph, 2012). THRIVE consists of six signposts (see box). Starting with ‘taking stock’, the therapist works with the client to alleviate problems of post-traumatic stress sufficiently so as to enable them to engage in effortful cognitive processing. Then follows five further signposts in which the therapist can work alongside the client. Post-traumatic growth provides practitioners with a new set of tools in their armoury for working with traumatised patients. 

New directions
Each of the measures mentioned above provides a particular operational definition of the construct, and they tend to be only moderately inter-correlated. Unlike, for example, the construct of post-traumatic stress disorder, which has an agreed definition provided by DSM around which measurement tools can be developed, there is no gold standard definition of post-traumatic growth. One suggestion arising from organismic valuing theory is to reframe post-traumatic growth as an increase in psychological well-being (PWB) as opposed to subjective well-being (SWB) (Joseph & Linley, 2008b). Traditionally, the focus of clinical psychology has been on SWB, which can be broadly defined as emotional states. Clinical psychology has been largely concerned with the alleviation of negative emotional states. With positive psychology in the background, clinical psychologists are now also concerned with the facilitation of positive emotional states. But post-traumatic growth does not refer to a positive emotional state but to an increase in PWB, defined as high levels of autonomy, environmental mastery, positive relations with others, openness to personal growth, purpose in life and self-acceptance (see box).

The topic of post-traumatic growth has also attracted interest from quantitative researchers in personality and social psychology. People may say they have grown, but have they really? There is a limitation to the above-mentioned measures, which is that they rely on retrospective accounts of change – that is, asking people to report on what positive changes they perceive themselves to have experienced since an event. We might refer to this as perceptions of growth to distinguish from actual growth, as measured by calculating the difference between state measures of psychological well-being before and after trauma.

Research suggests that the strength of association between actual and perceived growth is moderated by the degree of distress: for those who are most distressed there is a weaker correlation, but for those who are less distressed there is a moderate association (Gunty et al., 2011). It may be that perceptions of growth are at times illusory and a way of coping with distress (Zoellner & Maercker, 2006). Therefore researchers do need to be wary of always taking reports of growth at face value, particularly in the immediate aftermath of a crisis when people are most distressed.

However, while we may question people’s perceptions of growth, there is no question that actual post-traumatic growth occurs, as this has been demonstrated in before-and-after studies (e.g. Peterson & Seligman, 2003). What is now needed are more prospective longitudinal studies able to document the development of growth over time, how both actual and perceived growth co-vary over time and how they relate to other variables – both as outcome variables in order to understand the development of growth, and as predictor variables in order to understand the consequences of growth. Research shows that greater post-traumatic growth is associated with: personality factors, such as emotional stability, extraversion, openness to experience, optimism and self-esteem; ways of coping, such as acceptance, positive reframing, seeking social support, turning to religion, problem solving; and social support factors (Prati & Pietrantoni, 2009). But now more sophisticated theoretically informed designs are also called for in which we can begin to understand the factors that mediate and moderate post-traumatic stress and thus lead to post-traumatic growth. As an example of the directions that social and personality researchers may pursue, in one recent study it was found that emotion-focused coping mediated the association between subjective ratings of distress and post-traumatic growth and that emotional intelligence moderated
the association between emotion-focused coping and post-traumatic growth (Linley et al., 2011). While there is much that can be learned from quantitative research, there is also a need for qualitative research to explore new contexts (e.g. Splevins et al., 2011) and interventions (e.g. Hefferon et al., 2008).

Conclusion

The idea of post-traumatic growth has become one of the most exciting topics in modern psychology because it changes how we think about psychological trauma. Psychologists are beginning to realise that post-traumatic stress following trauma is not always a sign of disorder. Instead, post-traumatic stress can signal that the person is going through a normal and natural emotional struggle to rebuild their lives and make sense of what has befallen them. Sadly it often takes a tragic event in our lives before we make such changes. Survivors have much to teach those of us who haven’t experienced such traumas about how to live.

Box

THRIVE
Taking stock (Making sure the client is safe and helping them learn to manage their post-traumatic stress to tolerable levels, e.g. through exposure-related exercises).
Harvesting hope (Learning to be hopeful about the future, e.g. looking for inspirational stories of people who have overcome similar obstacles).
Re-authoring (Storytelling, e.g. using expressive writing techniques to find new perspectives).
Identifying change (Noticing post-traumatic growth, e.g. using the  Psychological Well-Being Post-Traumatic Changes Questionnaire  to track change).
Valuing change (Developing awareness of new priorities, e.g. positive psychology gratitude exercise).
Expressing change in action (Actively seeking to put post-traumatic growth into the external world, e.g. making a plan of activity for following week that involves doing concrete things).

BOX: Assessing growth
Think of how you yourself have been influenced by events in your own life. The Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ) was developed to assess post-traumatic growth as defined by an increase in PWB. The PWB-PTCQ is an 18-item self-report tool in which people rate how much they have changed as a result of the trauma. A short six-item version is shown below.

Read each statement below and rate how you have changed as a result of the trauma.

5     = Much more so now
4     = A bit more so now
3     = I feel the same about this as before
2     = A bit less so now
1     = Much less so now

1.    I like myself
2.    I have confidence in my opinions
3.    I have a sense of purpose in life
4.    I have strong and close relationships in my life
5.    I feel I am in control of my life
6.    I am open to new experiences that challenge me

People may find it useful to use the PWB-PTCQ to gain insight into how they have changed. Often these dimensions of change go unnoticed in everyday life but deserve to be flagged up and nurtured. Clinicians will find the new tool useful as it allows them to bridge their traditional concerns of psychological suffering with the new positive psychology of growth following adversity (see Joseph et al., 2012).

Stephen Joseph is a Professor at the University of Nottingham and Honorary Consultant in Nottinghamshire NHS?Trust
stephen.joseph@nottingham.ac.uk

References

Abraido-Lanza, A.F. Guier, C. & Colon, R.M. (1998). Psychological thriving among Latinas with chronic illness. Journal of Social Issues, 54, 405–424. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd edn). Washington, DC: Author.

Butler, L.D., Blasey, C.M., Garlan, R.W. et al. (2005). Posttraumatic growth following the terrorist attacks of September 11th, 2001: Cognitive, coping and trauma symptom predictors in an internet convenience sample. Traumatology, 11, 247–267.

Calhoun, L.G. &Tedeschi, R.G. (Eds.) (2006). Handbook of posttraumatic growth: Research and practice. Mahwah, NJ: Lawrence Erlbaum.

Dekel, S., Ein-Dor, T. & Solomon, Z. (2012). Posttraumatic growth and posttraumatic distress: A longitudinal study. Psychological Trauma: Theory, Research, Practice and Policy, 4, 94–101.

Gunty, A.L., Frazier, P.A., Tennen, H. et al. (2011).Moderators of the relation between perceived and actual posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 61–66.

Hefferon, K., Grealy, M. & Mutrie, N. (2008). The perceived influence of an exercise class intervention on the process and outcomes of posttraumatic growth. Journal of Mental Health and Physical Activity, 1, 32–39.

Helgeson, V.S., Reynolds., K.A. & Tomich, P.L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74, 797–816.

Joseph, S. (2012). What doesn’t kill us: The new psychology of posttraumatic growth. London: Piatkus Little Brown.

Joseph, S. & Linley, P.A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of General Psychology, 262–280.

Joseph, S. & Linley, P.A. (2006). Growth following adversity: Theoretical perspectives and implications for clinical practice. Clinical Psychology Review, 26, 1041–1053.

Joseph, S. & Linley, P.A. (2008a). Psychological assessment of growth following adversity: A review. In S. Joseph & P.A. Linley (Eds.) Trauma, recovery, and growth: Positive psychological perspectives on posttraumatic stress. (pp.21–38). Hoboken, NJ: Wiley .

Joseph, S. & Linley, P.A (Eds.) (2008b). Trauma, recovery, and growth. Positive psychological perspectives on posttraumatic stress. Hoboken, NJ: Wiley.

Joseph, S., Maltby, J. Wood, A.M. et al. (2012). Psychological Well-Being – Post-Traumatic Changes Questionnaire (PWB–PTCQ): Reliability and validity. Psychological Trauma: Theory, Research, Practice and Policy, 4(4), 420–428

Joseph, S., Williams, R. & Yule, W. (1993). Changes in outlook following disaster: The preliminary development of a measure to assess positive and negative responses. Journal of Traumatic Stress, 6, 271–279.

Kunst, M.J.J. (2010). Peritraumatic distress, posttraumatic stress disorder symptoms, and posttraumatic growth in victims of violence. Journal of Traumatic Stress, 23, 514–518.

Linley, P.A., Felus, A., Gillett, R. & Joseph, S. (2011). Emotional expression and growth following adversity: Emotional expression mediates subjective distress and is moderated by emotional intelligence. Journal of Loss and Trauma, 16, 387–401.

Linley, P.A. & Joseph, S. (2004). Positive change processes following trauma and adversity: A review of the empirical literature. Journal of Traumatic Stress, 17, 11–22.

McMillen, J.C. & Fisher, R.H. (1998). The Perceived Benefits Scales: Measuring perceived positive life changes after negative events. Social Work Research, 22, 173–187.

Park, C.L., Cohen, L.H. & Murch, R.L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64, 71–105.

Peterson, C. & Seligman, M.E.P. (2003). Character strengths before and after September 11th. Psychological Science, 14, 381–384.

Prati, G. & Pietrantoni, L. (2009). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss and Trauma, 14, 364–388.

Seligman, M.E.P. (2011). Flourish. New York: Free Press.

Splevins, K.A., Cohen, K., Joseph, S. et al. (2011). Vicarious posttraumatic growth among interpreters. Qualitative Health Research 20, 1705–1716.

Tedeschi, R.G. & Calhoun, L.G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.

Weiss, T. & Berger, R. (Eds.) (2010). Posttraumatic growth and culturally competent practice: Lessons learned from around the globe. Hoboken, NJ: Wiley.

Zoellner, T. & Maercker, A. (2006). Posttraumatic growth in clinical psychology. Clinical Psychology Review, 26, 626–653.

How do we teach young people what sexual consent really means?

Tags

consent, peer pressure, rape, relationships, responsibility, Self-esteem, sexual assault

How do we teach young people what sexual consent really means?

“Young people will describe scenarios where, I think ‘this sounds abusive’,” says Rhiannon Holder, a youth worker for Brook, the sexual advisory service for young people and co-chair of Bread, a Bristol youth project.

“They’re not sure if they had sex or they wanted sex – and if they did have sex they’re not sure if they consented to it. As professionals, we’re having to reflect to young people [that some] of the situations they have experienced could be labelled as sexual bullying or assault, or rape.”

With politicians such as George Galloway and Tony Benn spouting shameful ideas of what consent means (having sex with someone who is asleep is “bad sexual etiquette”, not rape, according to Galloway), a worryingly high proportion of the adult public doesn’t seem to grasp it either. A survey for Amnesty found 37% of respondents thought a woman was responsible for being raped if she didn’t say “no” clearly enough. With attitudes like this, is it any surprise young people may be dangerously confused?

They certainly seem to be. Only 69% of young men would not try to have sex with someone who did not want to, and one in 20 said they would try to have sex with someone who was asleep, according to a shocking 2010 survey of young people aged between 18 and 25 by the Havens, the specialist London-based sexual assault referral centres. A significant proportion also seemed confused about what constitutes rape: only 77% of young men agreed that having sex with someone who has said no was rape. While in 2009, a study for the NSPCC found a third of girls aged between 13 and 17 who were in relationships had experienced unwanted sexual acts, and one in 16 had been raped.

So, what needs to change? “Too often [consent] is viewed as a simple yes or no, and it’s much more complex than that,” says Holder. “I don’t think many young people are offered the opportunity to explore all of the factors involved in giving consent: peer pressure, alcohol and drugs, self-esteem, coercion, gender issues.”

When Holder does workshops with young people, she asks them to consider different scenarios, “and generate discussion around what it means to be in a relationship; what it means to have safe and positive sex. For instance, we would look at situations where you have had sex with someone before, or if you’ve kissed somebody; does that mean you have to go on and have sex? Also it’s about taking responsibility for consent, so making it clear it’s not just the person who has the responsibility for saying ‘yes’. Young men should actively be seeking consent.”

It isn’t just about the words, she says. “We’ll explore what ‘yes’ does, and doesn’t, look like.”

“Often people don’t say ‘no’ but they’ll say ‘that hurts’, or ‘not yet’, or ‘I don’t like it’. Or it might be in their body language,” she adds.

Then there are the assumptions about timing, she says. “A lot of the young people I have met are shocked that you can revoke consent – you might have had sex with somebody before, or started a sexual act, but that doesn’t mean the sex can’t stop at any time.

“I’ve spoken to young people who have said they didn’t really want to do it, but they didn’t know how to say ‘no’ or ‘stop’.”

Whitney Iles, a community activist, agrees. She thinks many young people are confused by “so many different messages. On one side, you’re told about how you should have sex within a loving relationship, on the other side you can see how pop culture is highly sexualised. It’s a real confusion over identity and value of self, which then makes it harder to know what you want and where the line is. There is a blurred line of what is normal, or what has become normalised, and what is crossing a line.”

Earlier this year, the government launched an online and TV advertising campaign to educate teenagers about rape, and consent, but it seems a poor substitute for good sex education in schools. The problem, says Simon Blake, chief executive of Brook, is that sex education “is incredibly patchy, and what young people have been saying for a really long time is ‘too little, too late, too biological’.”

The Labour government failed to do enough to make personal, social, health and economics education (PSHE), of which sex and relationships education (SRE) is a part, a statutory requirement for schools. “Although secondary schools have to teach some SRE, virtually nothing is specified and there is no agreed curriculum for it, so schools can teach what they like,” says Jane Lees, chair of the Sex Education Forum.

The government’s review of PSHE, which ended last year, is still to report, but things could get even worse, Lees fears. “Our concern is that it is likely to slim it down much more, or reduce the expectation that schools will teach it,” she says. “When the coalition came in and started the review of PSHE, one of the issues that they raised was about consent, so it is on their minds but we still have no final outcomes from it. We’re in limbo at the moment.”

“A lot of young people are growing up without really knowing what consent means,” says Whitney Iles. “But then I think a lot of adults don’t really know either.”

Girls petition for Teen Vogue to put an end to airbrushed photos

Tags

airbrush, Depression, Eating Disorders, magazines, photoshop, Self-esteem, sexualisation

Girls petition for Teen Vogue to put an end to airbrushed photos

Teenagers Carina Cruz and Emma Stydahar delivered a 28,000 signature petition to Teen Vogue today to express their distaste for the common magazine practice of airbrushing images.

A group of approximately 10 girls staged a protest fashion show outside the Condé Nast building in Times Square to deliver the petition. Smiling for the cameras, the teenagers walked up and down a makeshift runway (which consisted of a 15-foot long red carpet produced by one of the activists and rolled out on Broadway) holding placards like “Let’s get real – all girls are beautiful” and “Teen Vogue #KeepItReal.”

“I don’t think girls should grow up in a world where beauty magazines dictate they should have a low self-esteem,” said Emma Stydahar, 17, a high school senior from Croton-on-Hudson, New York.

According to Stydahar, 75% of girls get depressed within three minutes of shuffling through a beauty magazine’s pages because the beauty patterns they convey as ideal are unattainable.

“Images that have been photoshopped have a bad effect and can really hurt young girls. We’re looking for more diversity of girls and body types [in these publications],” added Stydahar, whose younger sister, Hanah, 14, was also at the protest and said she wants to follow in her older sister’s footsteps.

The girls were part of a similar fashion shoot outside the offices of Seventeen magazine in May, when a 15,000-signature petition requesting the magazine to promise one un-photoshopped spread a month was delivered to the magazine’s editor-in-chief Ann Shoket.

Julia Bluhm, 14, along with Stydahar and Cruz, is a member of Sparksummit, an activist movement demanding the end to the sexualization of girls and women in the media. Bluhm’s petition quickly gained support after the Seventeen magazine action and ended with more than 84,000 signatures.

In Seventeen’s August issue, the editor promised to limit photo-editing to things like stray hair and zits, but not bodies. She also said the magazine would post before and after pictures on the magazine’s Tumblr.

“We’re focusing on Teen Vogue now, and then we’ll see what happens,” said Stydahar.

To organize the action, Stydahar started a petition on Change.org, an online social action platform, with activist friend Carina Cruz, 16.

“They are one of the lead mags on teen fashion, and if we can accomplish something with them then hopefully we can keep going,” said Cruz.

Teen Vogue has an audience of more than 3.5 million readers, 93% of whom are female. Outside their offices on Wednesday, the makeshift photoshoot was meant to show the magazine what kind of girls they would want to see on the cover of the popular fashion magazine.

In an official statement, Teen Vogue said: “Teen Vogue makes a conscious and continuous effort to promote a positive body image among our readers. We feature healthy models on the pages of our magazine and shoot dozens of non-models and readers every year and do not retouch them to alter their body size. Teen Vogue pledges to continue this practice.”

The magazine’s adult-targeted inspiration, Vogue, announced in May that it would only use models who are aged over 16 years and who, based on the editor’s judgment, do not have eating disorders.

Stydahar’s mom, Sheila Kelly, 54, attended the protests and told the Guardian: “I think it’s wonderful what they’re doing. They’re constantly bombarded with images that are overly sexualized and unattainable, and that clearly don’t contribute to their self-esteem.”

Kelly was a feminist activist in the late 70s in Chicago, where she went to DePaul university.

“I think young women are very active again, and with social media you can get your message out much quicker,” said Kelly.

Elderly struck by ‘epidemic’ of body image and eating disorders

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age, anxiety, Body Image, Depression, Eating Disorders, elderly, Self-esteem

Elderly struck by ‘epidemic’ of body image and eating disorders

A growing number of older British people – including those in their 70s and 80s – are suffering from low self-esteem and anxieties relating to body image.

Interviewed for the Observer Magazine this weekend, Professor Nichola Rumsey, co-director of the University of the West of England’s centre for appearance research, suggests that “as adults, 90% of British women feel body-image anxiety”.

She said: “It doesn’t wane – many women in their 80s are still anxious about the way their bodies look, which can even affect their treatment in hospital when their health choices are influenced by aesthetics.”

Popular opinion suggests that body image-related anxiety is a young person’s problem, with recent reports focusing on the age (five years old) at which we are now vulnerable to pressures to conform to an expected ideal. Constant media coverage of the debate on teenagers and their negative relationship with their bodies has served to reinforce the message that it is predominantly young people who suffer such anxieties.

However, Rumsey’s studies in Bristol counterbalance this with evidence that these anxieties do not dissipate as the years pass, but merely evolve into different types of concerns about appearance and how we are seen by others.

“We have conducted a study of about 1,200 people, which confirms that appearance-related anxieties persist well into later adulthood,” Rumsey said. “At an age where most healthcare professionals focus on controlling pain and body functionality, many patients feel the way they look is as much of a concern, but isn’t a legitimate topic of conversation.

“It can cause substantial distress to look in the mirror and see an ageing body, especially if they have very visible conditions such as rheumatoid arthritis or an obvious skin condition, for example, yet in the UK we can be very dismissive of what is often construed as vanity. GPs are not trained to deal with the psychological impact of these anxieties, which can have a significant influence on overall wellbeing.”

Even those who are relatively fit and healthy in later years struggled with the idea that they no longer conformed to a youthful ideal, said Rumsey, who recently co-wrote The Oxford Handbook of the Psychology of Appearance. “It is a myth that older people don’t care what they look like: the ‘normal’ signs of ageing can prove very depressing and many people find it hard to see themselves in a positive light when they see a wrinkled face and a sagging body looking back in the mirror. We are now at a point where there is a social stigma around the effects of the natural ageing process, and this can lead to very low self-esteem and the classic signs of body dysmorphic disorder.”

These observations are echoed by the increasing number of body image-related cases in older people being seen by Dr Alex Yellowlees, medical director and a consultant psychiatrist at the Glasgow Priory Clinic, who is witnessing “an epidemic of self-consciousness. We are suffering from a collective body dissatisfaction, which is a contagion in our society, and we must acknowledge that it affects all walks of society, young and old.

“It was once the case that we were happy to coast into retirement and relax in our old age, but now even in these later stages of life I am seeing people who are preoccupied with shape, weight and looks in a way that was once the domain of younger people who had yet to find their path or identity in life.”

Yellowlees reports an alarming rise in older patients with eating disorders, as all sectors of society strive to achieve what he calls “an unrealistic physical ideal”.

“Today everybody is acutely aware of how they look, and our appearance has become a currency we trade on,” he said. “That means we value old people less because they don’t fit the currency of ‘youth’. This in turn leads to a lack of self-esteem in older people, because they don’t feel valued by a culture that can’t get past superficial image. Appearance is a very fragile currency to trade in because a civilised culture interacts on more sophisticated values such as character, behaviour and language.”

In a culture where increasing value is placed on our appearance, Rumsey voices concerns that we must look beyond the superficial. “Older people are the wise ones we have always looked to for their experience and knowledge, and if they are preoccupied with appearance anxieties this becomes the norm for future generations.”

Uncomfortable in our skin: the body-image report

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airbrush, anxiety, appearance, Body Image, Bullying, cosmetic surgery, Depression, Eating Disorders, Exercise, Self-esteem, Teens

Uncomfortable in our skin: the body-image report

Outside, on a warm morning in March, students at the University of the West of England are shading their faces with textbooks, legs rippling in the sun. Inside, in a cramped, bright room lined with ring binders labelled “Intimacy”, the women who make up the world’s only Centre for Appearance Research (Car) are talking quietly about perfection. I arrived here after following a trail of newspaper reports – on the effect of airbrushing in the media, on men’s growing anxiety about their weight – reports used variously by politicians and educators to highlight the way our world is collapsing. It’s here, with their biscuits and gentle, resigned chatter, that a team led by Professor Nichola Rumsey and Dr Diana Harcourt is compiling the research required to understand how we deal with changing attitudes to appearance, and along the way helping answer the question: why do we hate the way we look?

Two years ago I started writing a column for this magazine, illustrated by a photo of my face. At times it made me feel odd (I have never liked photos), at other times sad, often anxious. It made me more aware that I don’t like the way I look, but more, I don’t like the fact that I don’t like it. But it’s not just me. All Car’s research suggests that Britain’s body image is in crisis.

Body image is a subjective experience of appearance. It’s an accumulation of a lifetime’s associations, neuroses and desires, projected on to our upper arms, our thighs. At five, children begin to understand other people’s judgement of them. At seven they’re beginning to show body dissatisfaction. As adults 90% of British women feel body-image anxiety. And it doesn’t wane – many women in their 80s are still anxious about the way their bodies look which, Professor Rumsey explains, can even affect their treatment in hospital, when their health choices are influenced by aesthetics. Many young women say they are too self-aware to exercise; many say they drink to feel comfortable with the way they look; 50% of girls smoke to suppress their appetite – is it too strong to suggest that these things, these anxieties, are slowly killing them?

Liberal Democrat MP Jo Swinson (who has succeeded in pulling a number of L’Oréal ad campaigns for being unrealistic) is one of a growing group of people whose campaigning indicates that it’s something worth worrying about. Last year I attended every session of her government inquiry into body image, the results of which were published in a report this month. She cited research showing how current “airbrushing” culture leads to huge self-esteem problems – half of all 16- to 21-year-old women would consider cosmetic surgery and in the past 15 years eating disorders have doubled. Young people, she said, don’t perform actively in class when they’re not feeling confident about their appearance.

It is research backed up by a new documentary by Jennifer Siebel Newsom,Miss Representation, about the under-representation of women in positions of power – women who are high “self objectifiers” have low political power. They’re less likely to run in politics, and less likely to vote: if value lies in their imperfect bodies, they feel disempowered. The long-term effects, the piling on of pressures one by one, like a dangerous Jenga tower, means women’s – and increasingly men’s, 69% of whom “often” wish they looked like someone else – lives are being damaged, not by the way they look but by the way they feel about the way they look. It’s complicated.

Even researching such a thing is tricky. The truth feels slippery. “Why,” I asked the psychotherapist Susie Orbach (who, since publishing Fat is a Feminist Issue in 1978, has become a loud and public voice in the conversation about body image), “when I know that beauty is subjective, that nothing terrible would happen if I put on weight, when my desk is covered in annotated research on bodies, do I still feel bad about the way I look?”

“Because none of us lives in a vacuum,” she said. Simply acknowledging the pressure doesn’t eliminate it. “We don’t even know we hate our bodies because we take that for granted.” She sighed. “When I wrote FiFi there was a pretty bad situation,” she said, “but the women of my generation have given birth to… this.” To my generation – 60% of whom feel ashamed of how they look. But before anybody begins to deal with this, this crippling western-worldwide anxiety, it’s important to try and work out why. How did we get here?

At the Centre for Appearance Research, they discuss with me how invested people have become in their appearance. And how central it now is to the value they place on themselves. We’ve always compared ourselves to other people, but what has changed is the way we use images. There’s a famous study which looked at teenage girls in Fiji after television was introduced to the island for the first time in 1995. After three years with TV, the girls who watched it the most were 50% more likely to describe themselves as “too fat”; 29% scored highly on a test of eating-disorder risk. One girl said of the western women she watched on Beverly Hills 90210: “In order to be like them, I have to work on myself, exercising, and my eating habits should change.”

Today the web ensures that we are drowning in visuals: we’re no longer comparing ourselves to “local images” – our friends – instead we’re comparing ourselves to social-networked strangers, celebrities, and to Photoshopped images, of which we see around 5,000 a week. I always bristle a little when “airbrushing” or Photoshop is blamed for the rise of body-image anxiety. It seems too simple. While I was impressed by Jo Swinson’s campaign to ban airbrushing in advertising, I did cheer, a little, when I read Tina Fey’s thoughts: “Photoshop itself is not evil,” she wrote. “Just like Italian salad dressing is not inherently evil, until you rub it all over a desperate young actress and stick her on the cover of Maxim, pretending to pull her panties down. Give it up. Retouching is here to stay. Technology doesn’t move backward. No society has ever deindustrialised.”

The problem is not the Photoshopping itself – the problem is that Photoshopped images threaten to replace all others, and that in slicing off the rounded hip of an actress it reveals our difficult relationship with the female body. The problem is that, in their ubiquity, Photoshopped images have changed our standards of comparison. So that’s one reason. Images. I started to make a list.

The “size zero” debate that began a few years ago led to an angry dissection of the fashion industry’s preference for skinny models. In response, a circular argument was repeated, laying blame on fashion magazines (for printing the pictures), then model agencies (for hiring the models), then designers (for making samples that only fit the very thinnest of them). In this month’s Vogue, editor Alexandra Shulman launched the Health Initiative, a six-point pact between the editors of the 19 international editions, aimed at encouraging a healthier approach to body image within the industry. They promise to encourage designers to “consider the consequences of unrealistically small sample sizes of their clothing, which… encourages the use of extremely thin models”. Is this the industry taking responsibility for our broken body image, for its power? Acknowledging that they help sell not only clothes, but ideas of which bodies are acceptable?

“We’re not taking responsibility for it,” Shulman says firmly. “We’re saying we realise we’re in a powerful position and we can do something about it.”

We’re sitting in her bright white office, beside shelves displaying internationalVogue covers. She points at them one by one. “There’s Kate Moss in Versace. That [sample-sized] dress is tiny. You can see it’s pretty tight on her. Then there’s Scarlett Johansson in vintage Prada – you see, ‘real people’, actors as opposed to models, don’t fit sample-size clothes.”

Caryn Franklin, Erin O’Connor and Debra Bourne, whose All Walks Beyond the Catwalk initiative encourages diversity in fashion, talk to designers and students about creating more “inclusive” designs. “The fashion industry has changed in the past decade,” Franklin explains slowly, trying to put her finger on why our body image is in crisis. “The catwalk used to be a factory space. But digital changed everything – it’s now become a luxury positioning experience, a consumer space.”

It’s helpful for fashion buyers (the audience at catwalk shows) to see clothes on a shape that is as close to a clothes hanger as possible – hence the tall, bony models whose breasts will not bother the line of a shirt. But since catwalk imagery has gone mainstream, these model shapes have drifted into the public subconscious. “We’re helping the industry understand this,” adds Franklin. “This inconvenient truth.”

Shulman has been pushing for larger sample sizes since 2009, when she wrote a letter to major international designers complaining that their tiny designs were forcing editors to shoot them on models with “no breasts or hips”. Has she seen any change? “Hmm. There is still a bit of a… blindness. I think fashion is a bit out of step with this. They don’t realise that people would really like to see something different.” She’s right – Ben Barry (a PhD student at Cambridge University) surveyed 3,000 women, the vast majority of whom “significantly increase purchase intentions when they see a model that reflects their age, size and race”.

Shulman was invited to give evidence at Jo Swinson’s inquiry but turned her down. “I’m very anti-legislation, anti-government initiatives. I don’t think they need to get involved. God knows they’ve got enough to be thinking about without worrying about sample sizes. And it isn’t just about ‘common sense’.”

I’m learning this. I ask her about other myths – are there any commonly held beliefs about Vogue, the industry and body image? Her eyes fall on the magazine shelf. “Ah! I know one!” she says, leaning in. “We shot Adele for our October cover, and everyone said: ‘How typical of Vogue – they shoot Adele and only show a head shot.'” It’s true – bloggers were disgusted that they hid her size-16 body.

“But Adele would not let us pull the camera back,” Shulman explains. “As soon as any of her body was shown on the camera’s digital screen she’d say no. It was her desire to have a head shot, which I found very frustrating. I was desperate for a full-length picture.” That issue was one of the worst-selling inVogue’s history.

I remember Orbach explaining that none of us lives in a vacuum. “Vogue,” Shulman continues, “is one of very few [women’s interest] magazines that never publishes diets, never points out when someone’s put on weight. We don’t come from that unhelpful culture where you forensically examine the way a woman looks. That’s appalling. We don’t have to put our hands up about that.”

Are today’s diets – the way we are encouraged to eat cognitively – to blame for our anxiety? An eating-disorder specialist at the inquiry confirmed that the “Atkins diet generates many cases for my work”, but the problem is not eating disorders but disordered eating. Disordered eating includes competitive dieting and eating in secret – it can lead to both eating disorders and obesity, but more commonly just adds to the eater’s anxiety.

Rates of depression in women and girls doubled between 2000 and 2010; the more women self-objectify, the more likely they are to be depressed. Could the mainstream media’s warm embrace of disordered eating have contributed to that rise? Grazia reports that Beyoncé lost 60lb of “baby weight” by eating only lettuce. Cosmopolitan wrote about Kate Middleton’s “Dukan diet”, which begins with seven days of pure protein, and later two “celebration meals” a week. If women don’t look like Beyoncé or Kate Middleton, their flat stomachs a testament to their stamina then, it seems, they are not working hard enough.

One celebrity whose body is frequently scrutinised (and scorned) by the tabloid media is The Only Way is Essex‘s reality star Lauren Goodger. “Never heard of Spanx, Lauren? Miss Goodger shows off muffin top in very unflattering dress,” read one Mail Online headline. There are 546. “Oops, maybe you should’ve tried the next size up. Lauren Goodger’s tiny dress feels the strain.” “Haven’t you learned your lesson? Lauren Goodger steps out in ANOTHER pair of unflattering leggings.” Rather than the corrosive dripping-tap effect of reading these once a day over the last two years, read together these 546 headlines feel like quiet waterboarding.

I meet Goodger at Max Clifford’s office. She is weeks into a “drastic diet plan”. Many women feel judged on their appearance in some way, but what does it feel like to have those verdicts read by 99 million people a month? “It is quite… draining,” she says. “I can’t look at comments. I can’t buy the mags any more. I used to love them, but I was happy then. Then my weight became a story, not just for the show but for the press. Yeah, I’m definitely aware of the online scrutiny. My body becomes my work.” She thinks for a bit. “But just because someone’s not a size 10 it doesn’t mean she’s a bad person.”

Last year Goodger had a nose job because, she said, she’d hated seeing her profile on TV. Most of her female Towie cast members have had cosmetic surgery – mainly breast implants, a bum lift, Botox, lip fillers. “Where does it come from, the idea that natural is not beautiful, that we all need the model look?” Goodger asks herself. In response to Jo Swinson’s inquiry, the British Association of Aesthetic Plastic Surgeons (Baaps) has called for a ban on adverts for cosmetic surgery, highlighting promotions that play on vulnerabilities, such as “divorce feelgood” packages of breast augmentation and liposuction, and surgical procedures sold via online discount sites such as Groupon.

“Do you think there should be psychological screening for those seeking surgery?” I ask Goodger tentatively. “It’s a subject that’s hard to talk about,” she says. “Especially because I’m… within it.”

We talk about the idea of “naughty” food, about the different expectations for men and women, about the celebrities who say they’re “big and happy” then suddenly lose weight. There’s a pause.

“My little sister was anorexic at 11,” she says suddenly. “It started with someone at school calling her Miss Piggy. I mean, I didn’t even know about dieting until I was 18. Things have changed so much. She gets the mags, she wants the bags, the Prada shoes. It’s crazy. She’s a baby! She wears lashes, make-up. But you do what everyone else is doing – you compare yourself. She’s fine now, a year and a half later. But she’ll message me going: ‘Have you lost weight? You look really good’ and I’ll think: God, don’t say that.”

Goodger and I were both born in the 80s. In our lifetime (one that has seen the internet enter our homes, along with hundreds more television channels), expectations of beauty have changed enormously. What must it be like growing up today, when cosmetic surgery is advertised on public transport, when “baby-weight loss” diets are rife?

I gather together a group of under-20-year-olds at Livity, Brixton’s “youth engagement agency”, to talk about body image. It’s not a concept that needs explaining to them. Apart from Stephen (who says: “The fact that I don’t have an opinion on body image probably says something itself. Boys have it easier, definitely”), they have much to say.

First, some fictions they are keen to shatter. The pressure, the girls agree, is not, in fact, to be skinny – instead it’s to look sexy. “Hot.” “Everyone wants to look like Kim Kardashian, even though we know she’s a boring person – we don’t want to have her personality, just her body,” says Claudia. “Not Kate Moss’s. Curves, not bones.”

This is the first time sex has been discussed – until now, everybody has talked about thinness and control, rather than changing your body to attract a boy. But as Bridget points out, you can starve yourself bony: “The sexy body is much more unattainable.” “I think our generation is really savvy about the media,” says Amber as they move quickly on to the subject of airbrushed ads. “So you know an image has been manipulated, but I suppose… you don’t know what that’s doing to you.”

I wonder about the fact that these young people are so literate in the issues of body image (as opposed to simply “bodies”) that their thoughts on the subject are so close to the surface. “We’re forced to think about it!” says Bridget. “It’s on every channel, every night. Programmes like Supersize vs Superskinny, orHow to Look Good Naked, or freaky ones like Half Ton Mum, or A Year to Save My Life.” Everyone shouts out names – programmes about overhauling your body with diets, clothes or surgery. “They have mixed messages,” says Amber. “On one hand they’re saying ‘love your body’, then on the other ‘fat’s bad, the worst thing you could do is be obese’. The message ‘be healthy and do exercise’ is a bit different from ‘be happy in your skin’, isn’t it?” The rhetoric of empowerment, here, actually disempowers.

Do we hate our bodies because of reality makeover TV? Susie Orbach describes how they often provide “dysmorphic and distressed women” the opportunity to “compete over their body distress and win the prize of radical restructuring”. The earliest technologies of body enhancement utilised techniques used on Second World War burn victims. “To hear [winning reality show contestants] tell it,” Orbach says, “they’ve been through their own individual wars, too… Their compulsion to change their bodies is a result of a different kind of assault on women, and increasingly men, which is sufficiently damaging to have persuaded them that the bodies they live in are urgently in need of transformation.”

Both the cosmetic surgery and the cosmeceutical industries (anti-ageing products) are growing, fast. It’s these industries, “along with the fashion houses, the diet companies, the food conglomerates [which own the diet companies], the exercise and fitness industry, and the pharmaceutical and cosmetic surgery industries”, that Orbach is now combating, because, she says, “they combine, perhaps inadvertently, to create a climate in which girls and women come to feel that their bodies are not OK”.

Orbach debated with representatives from the diet industry in parliament to applause from the public gallery – outside women protested with placards saying: “Riot, don’t diet.” Discussing Weight Watchers’ recent £15m TV ad, she suggested it was affordable to them only because their members are locked into lifelong “straitjackets” of unrealistic weight-loss expectations. When I speak to her later, she goes further. “I do think we should be prosecuting the diet industry for false advertising,” she says firmly. If dieting worked, she argues, you’d only have to do it once. There is evidence that diets may in fact contribute to fat storage and that, in giving a sense that food is “dangerous”, create conditions for rebellion, which eventually makes people fatter than they were to start with.

When I began my research, all roads led back to Orbach. She’s been crucial in hammering home the dangers of body-image anxiety, yet figures show that we are feeling worse about our bodies than ever. “You have to make the argument that this isn’t trivial, then you have to make the argument that this is a substantial issue, then you have to combat the industries. I’m exhausted by it,” she says, throwing her head back. “But what other options do we have?”

She’s working on a psychoanalytic research project on the transmission of body image from mothers to daughters, and she’s pushing for interventions by midwives, trained to show new mothers how their own body-image dissatisfaction will affect their babies. “New mums are caught up in problems with their own bodies when they’re bringing a new body into the world. We need a counterpoint to the nonsense that you should have a pre-pregnancy body six weeks after having a baby, or ever. What’s the erasure about? That’s where it should start.” She takes a breath. “And teachers – it’s all very well them taking classes about body image, but if they don’t raise their own awareness about their own distress, then they’re just passing it on.”

Back at the Centre for Appearance Research, we make our way down the narrow university corridors for lunch. In this surprise heat, the café is full of academics fanning themselves with menus, the odd bare-legged man. I am feeling a bit hopeless. All the statistics about sadness; all the people, like me, who aren’t able to enjoy their own health, privilege, relative youth, because of this niggle. This feeling that we don’t look right.

Jo Swinson’s report detailed various recommendations being put to government, regulators, voluntary organisations and the private sector. In light of Orbach’s evidence, they call for a review of the “inaccurate” body mass index as the standard way of determining whether somebody is overweight, and for better support for new mothers. They ask advertisers to reflect “consumer desire for authenticity and diversity”, and for tougher regulation of the cosmetic surgery industry. But all the people I interviewed balanced their delight at the inquiry with a healthy wodge of cynicism at how much change these recommendations would effect.

And I wonder what we can do – us lot, the people with the faces we don’t like, with the cankles, the muffin tops, the limp, lifeless hair. It’s in the personal, day-to-day things, I think. Like consuming media critically. The media is a construction – this is no secret. Magazines, film, TV, newspapers – they all rely on advertising. So reminding ourselves that the body types we see represented are the body types that generate purchases. Asking ourselves: “Am I being sold something here?” It’s not a terrible thing, being sold to, it’s just a… thing. Unpicking the media we consume, and talking about it, will help us feel better eventually. Cognitive dissonance programmes in schools have been effective – encouraging young people to speak out against the unrealistic ideals of beauty they see. In talking about it we reduce the internalisation of beauty ideals, and feel less awful about our implied failings.

I tell Car’s Dr Phillippa Diedrichs about something Amber mentioned – about femininity and dieting.

“Eating becomes a means of communication,” Diedrichs says after lunch. “In our food choices we’re demonstrating our femininity.” But it goes further than that. “We’re socialised to be negative about our bodies,” she says, and a slideshow of moments flashes through my head. Women standing in the ladies’ loos complaining about their boobs. Or comparing their limbs to their colleagues’ unfavourably. She introduces me to the idea of “fat talk”, everyday conversation that reinforces the “thin ideal” and contributes to our dissatisfaction. Like: “You look great – have you lost weight?” Or, on being offered a bun: “Ooh, I really shouldn’t.” “After three minutes of fat talk,” says Diedrichs, “there’s evidence that our body dissatisfaction increases significantly.” Naming this – fat talk – makes much sense to me.

After a day at Car, my body-image anxiety hasn’t disappeared, but I can at least see a way to control it. We hate how we look because of our new, complicated visual culture, because of a fashion industry that has not adapted, a media that forensically analyses women’s bodies and saturates our culture with body-change stories. Because of the rise of cognitive eating, the increasing abilities and accessibility of cosmetic surgery. Because to be feminine, today, means to hate your body.

I leave their building feeling quite different from when I arrived. I have the same legs, the same face, the same teeth, but something in my mind has changed.

Five-year-olds now worry about body image

Tags

body dysmorphic disorder, Bullying, cosmetic surgery, Eating Disorders, health problems, Self-esteem

Five-year-olds now worry about body image

More than half the British public suffers from a negative body image, an inquiry by MPs has heard.

The problem is so acute that girls as young as five now worry about their size and appearance, with children in danger of picking up their parents’ body-related anxieties, their report said.

Cosmetic surgery rates have increased by nearly 20% since 2008 and the rise was said to be fuelled by advertising and “irresponsible” marketing ploys, the cross-party group of MPs was told.

According to Reflections on Body Image, co-authored by the MPs and health and education charity Central YMCA, negative body image was seen as an underlying cause of health and relationship problems, a key contributor to low self-esteem and a major barrier to participation in school and progression at work.

Appearance is also the greatest cause of bullying in schools, evidence suggested.

The report, published by the All Party Parliamentary Group (APPG) on Body Image after a three-month public inquiry, identified a growing amount of evidence that body image dissatisfaction was on the increase, with the issue seen to be one affecting all of society regardless of age, ethnicity, gender, sexuality, disability, body size or shape.

Children and adolescents were seen to be more vulnerable to body image concerns however.

Around half of girls and up to one third of boys have dieted to lose weight and children and young people with body image dissatisfaction were less likely to engage in learning and participation in school, the report said.

Parents were identified as one of the main influences on children but by secondary school age, the peer group was seen to become a more important influence.

The inquiry heard that health issues attributed to excess body weight may be overstated meanwhile because body mass index, the measure commonly used, was seen to be an inaccurate way of classifying all individuals and their health risks.

And although being overweight or obese was associated with a range of health conditions, the inquiry received evidence challenging the notion that weight always entailed poor health.

The diet industry acknowledged the public had “unrealistic expectations” about weight loss, while critics argued there was no evidence diets work in the long term.

The inquiry, which took evidence from academics, the public, industry, charities and other experts, heard that:

:: Getting rid of dieting could wipe out 70% of eating disorders;

:: More than 95% of dieters regain the weight they lost;

:: 1.6 million people in the UK suffer eating disorders;

:: Up to one in five cosmetic surgery patients could suffer from body dysmorphic disorder;

:: One in three men would sacrifice a year of life to achieve their ideal body;

:: One in five people have been victimised because of their weight;

The report made a series of recommendations targeted at policy-makers, healthcare professionals, industry and the education sector designed to change public perceptions, attitudes and behavioural patterns.

These include compulsory body image and self-esteem lessons for primary and secondary schools, getting advertisers to commit to running campaigns that reflect consumer desire for “authenticity and diversity”, and reframing public health messages in “weight-neutral” language.

It also called for a review of broadcast and editorial codes on reporting body-related issues, a review of the evidence base to support the long term efficacy and safety of diets and a separate code of regulations governing cosmetic surgery advertising.

Patients should be screened before undergoing cosmetic surgery and a review should be carried out into whether the Equality Act ought to be amended to include appearance-related discrimination, the recommendations said.

Central YMCA will launch a campaign on the issues in the autumn after consulting the public beforehand.

APPG chairwoman Jo Swinson MP said: “Body image dissatisfaction in the UK has reached an all-time high and the pressure to conform to an unattainable body ideal is wreaking havoc on the self-esteem of many people.”

Central YMCA chief executive Rosi Prescott branded the report’s findings shocking.

“It’s clear that there’s something seriously wrong in society when children as a young as five are worrying about their appearance, based on the messages they are seeing all around them,” she said.

“Body image has become more important in our culture than health, and children are mimicking their parents’ concerns about appearance.

“We all have a responsibility to act now to bring about the attitudinal and behavioural change that’s necessary to prevent damage to future generations.”

The British Association of Aesthetic Plastic Surgeons agreed a separate code of regulations should be drawn up governing cosmetic surgery advertising and called for an outright ban on adverts of this type in public places like billboards and public transport.

BAAPS also announced it was funding long-term research into psychological assessment of patients.

:: The finding that more than half of people have a negative body image comes from a study by the Centre for Appearance Research at the University of the West of England, to be published in full later this year.

Bullying Linked To 65% Of Eating Disorders, Report Reveals

Tags

Bullying, Self-esteem

Bullying Linked To 65% Of Eating Disorders, Report Reveals

As many as 65% of people with eating disorders say bullying has contributed to their condition, according to a new report by UK eating disorder charity, Beat. This is a 41% increase on a similar survey carried out by the same organisation in 2009.

The survey also found that 49% were less than 10 years old when the bullying started and many stated that the effects had stayed with them into their 40s and 50s.

Worryingly, only 22% actually received any help from someone to overcome their bullying.

Cathy, a 46 year old from Derbyshire, who was bullied from the age of 12 by a teacher as well as her peers, told the charity: “The bullying made me lose my once bubbly personality and my confidence and my self-esteem was at an all-time low. I was too frightened to go out and felt incredibly isolated. It was a traumatic experience as the bullies were once my best friends – I will never forget the feelings of despair and loneliness.”

Beat Chief Executive, Susan Ringwood, told The Huffington Post: “All bullying lowers self-esteem, and low self-esteem is proven to raise the risk of eating disorders. Bullying about size, weight and shape – the innocuous sounding ‘fat teasing’ – is particularly toxic. Size, weight and shape is the last personal domain where stigmatising behaviour goes unchallenged and where pejorative comments go unremarked.

“We are calling for fat teasing to become as socially unacceptable as negative comments about race, ethnicity, sexuality or religion.

All schools should have anti-bullying polices. They should apply them and play their part in making a generation of young people both more resilient and respectful.”

Would you dare to wear Lycra outside? Half of women put off exercise in public

Tags

Exercise, Self-esteem

http://www.independent.co.uk/life-style/health-and-families/health-news/would-you-dare-to-wear-lycra-outside-half-of-women-put-off-exercise-in-public-7669143.html

It is good news for the celebrity fitness DVD industry, if no one else. More than half of the women in Britain are too embarrassed about their bodies to exercise in public, a survey suggests.

Nine out of 10 women over 30 have low self-esteem and poor body image, which forces many of them to exercise indoors or go running in the dark. The findings, by the mental health charity, Mind, are particularly unfortunate because outdoor exercise is known to be far more effective at improving mood and mental wellbeing than an indoor workout.

“We all know walking, cycling, even gardening are good for our mental health,” said Beth Murphy, the head of information at Mind. “However, for many of us, exercising outdoors can be incredibly daunting, especially if you are already feeling low and your self-confidence is at rock bottom.

“At these times you can feel like the only person in the world experiencing this, but our research highlights that far from being alone, 90 per cent of women are in exactly the same boat. It is time we start talking about how exercise makes us feel. We urge women to take the first step, invite a friend on a nature date and begin to support each other in taking care of our mental wellbeing.”

More than half of the 1,450 women surveyed said they exercised very early in the morning or late at night, solely to avoid being seen by others. Nearly two-thirds said they exercised in a location where they were unlikely to bump into anyone they knew, and a similar proportion said they wore baggy clothing to conceal their figures.

Gym classes are also a no-go area, it seems. Two-thirds of women said they did not think they would be able to keep up in an exercise group, that they would look silly, or that the women there would be “cliquey” and unwelcoming.

Sixty per cent were nervous about exhibiting themselves while sweaty, and were worried about their “wobbly bits”, passing wind or going red. Only 6 per cent thought they would be likely to make new friends.

Mind’s researchers found that women were acutely aware of the importance of keeping fit and active lifestyles, and therapists were increasingly prescribing outdoor exercise as a way to fight stress and depression.

But the charity said that, rather than exercising, women reported that they were more likely to spend time eating comfort food (71 per cent), listening to sad music (32 per cent), spending time social networking (57 per cent), going to bed (66 per cent) or finding a way to be alone (71 per cent).

Mind, which offers advice and support people with mental health problems, has launched a “Feel Better Outside, Feel Better Inside” campaign to encourage women to start talking about outdoor exercise, and to encourage friends to exercise outdoors together.

Case study: ‘I always felt so self-conscious and anxious’

Tracy Bell, 38, lives in Bedford and has suffered from occasional bouts of depression for 10 years

My GP prescribed me gym membership as therapy. I went to the sessions because I felt I had to, but I hated every minute and stopped as soon as I could.

I went time after time because it was my prescription, but I felt so self-conscious and anxious. The exercise environment is just so cliquey – I would never have made any friends.

Everyone there was completely different to me. They were thinner, fitter and better at exercise. To make things better, I would time my trips really carefully. I would make sure I went mid-morning, so I missed the morning rush and then the lunchtime rush, too – just to make sure I would be seen by as few people as possible.

I’ve been asked if I talked to my friends about how I felt, but there’s no way I could. They are so much thinner and more sporty than me.

A lot of my friends who live near me are a little bit younger and I just know they wouldn’t understand. I don’t know how to put it – I guess I feel like I must be the only one who feels like this.