# Motivation and emotion/Book/2023/Burn injury and body image

* Multimedia presentation (3 min)

## Overview

* Case Study:
* Jenny is a 24-year-old burn victim who suffered severe burns to 60% of her body. Her self-esteem has noticeably decreased. She often wears clothing to cover her burns, refuses to be in pictures with friends, and does not like to leave her house much as she fears others will judge how she looks. She often becomes anxious about social or intimate settings where her scars may be noticed. Jenny thinks her burn scars are “ugly” and worries that others will reject her because of them. Jenny’s mum has noticed that she is sadder than usual and says Jenny often mentions how she misses her old body and wishes she looked like all her friends.
* Do you think Jenny’s burn injuries have impacted her body image?
* What can be done to improve the way Jenny thinks about her body and burn injuries?
Body image involves the thoughts and emotions a person has about their body. A person's experiences with their body image can range from negative to positive, and they may experience both at various periods. Body image is influenced by both internal (personality) and external (social environment) aspects and refers to a person's level of contentment, comfort, and confidence with their appearance (National Eating Disorders Collaboration, 2023).
Burn injuries, both minor and severe, can result in body image issues which can alter how the body functions and appears. When burn survivors are first admitted to the hospital, many experience severe distress due to changes in how their bodies look, feel, and function. A third of burn survivors, both children and adults, report experiencing substantial discomfort because of physical changes that occurred during initial hospitalisation. Fortunately, most kids and adults grow into good adjusters over time; nonetheless, practically everyone goes through some ups and downs as they heal from burns and get used to their new appearance (Model Systems Knowledge Translation Centre (MSKTC), 2017).
The following focus questions will be discussed in this chapter.
* Focus questions:
* What is body image?
* What determines body image distress?
* How do burn injuries impact a person's body image?
* What helps to improve body image issues after burn injuries?

## What is body image?

The American Psychological Association (APA) defines body image as:
   “The mental picture one forms of one's body as a whole, including its physical characteristics and one's attitudes toward these characteristics.”
Body image is the perception, ideas, emotions, and attitudes a person has about their own physical appearance. It includes how people perceive themselves when they look in the mirror, how they feel about their overall physical appearance, and how they view their own physical features. A wide range of factors, such as societal and cultural ideals of beauty, media representations of idealised bodies, personal experiences, and unique personality traits, can have an impact on one's body image (Brazier, 2020).
Body image can be positive or negative. In order to have a positive body image, one must feel confident and at ease in their own skin, regardless of societal expectations or outside pressures. It frequently entails appreciating and accepting one's body as it is. On the other hand, someone with a negative body image might feel dissatisfied, ashamed, or critical of their appearance. People who have a poor perception of their bodies might practise extreme exercise or dieting in an effort to alter their bodies to conform to an ideal. It's crucial to remember that body image is highly subjective and affected by psychological and social factors in addition to being based on objective physical characteristics (Tylka & Wood-Barcalow, 2015). Promoting a positive body image is crucial for overall wellbeing because having a poor body image can lead to mental health problems like depression, anxiety, and eating disorders. Self-acceptance, self-compassion, and battling unrealistic beauty standards and social pressures are frequently key components of developing a positive body image (Brazier, 2020).
Table 1. Four aspects of body image :
| Type of body image | Definition | Example |
| Perceptual body image: | How a person perceives and visually evaluates their own body size, shape, and physical characteristics. | A person with anorexia nervosa may have a distorted perceptual body image, perceiving themselves as overweight when they are underweight. |
| Affective body image: | The emotional and affective responses, such as self-esteem, satisfaction, or dissatisfaction, related to one's body. | A teenager may feel happy and confident about their body after receiving compliments from friends or positive feedback on their appearance. |
| Cognitive body image: | Thoughts, beliefs, and cognitions about one's body, including judgments about attractiveness and comparisons to others. | Someone who has lost a significant amount of weight might think, "I look so much better now," indicating a positive cognitive body image. |
| Behavioural body image: | Actions and behaviours influenced by one's body image, such as dieting, exercise, and avoidance of social situations. | A person who experiences dissatisfaction with their body may start a new exercise routine or diet as a behavioural response to improve their body image. |
Keep in mind that these factors are interconnected, that they can influence one another, and that a person's body image can change over time and in various contexts. In order to foster a positive and balanced relationship with one's body, it is important to address and nurture each of these elements.

## What determines body image distress?

Distress over one's body image, also referred to as negative body image or dissatisfaction with one's body, can be influenced by a number of internal and external factors. Major burn injuries can alter how the body appears and functions and can cause distress with one's body image. The location of the burn and the degree of the burn do not always determine how unhappy burn survivors are with their altered appearance. A person with a small burn might cause them a lot of pain, whereas a person with very large burns might not even cause them any pain. Body image distress is significantly influenced by a person's personality, history of depression, social support, coping skills, and thoughts about their appearance before the injury (Lawrence et al., 2016). Some burn victims might feel that their scars make them look "ugly" and worry that others will reject them as a result. Body image issues might include:
* sadness or grief over physical and/or visual changes (Lawrence et al., 2016).
* fear of being seen in public or in private situations where one's scars might be visible (Lawrence et al., 2016).
* concerned about how people might react to the scars when exposed (Lawrence et al., 2016).

### Factors influencing body image distress

Here are some important factors that affect body image distress:

#### Societal/culture influences

Body image distress is significantly shaped by societal and cultural ideals of beauty and burn injuries can severely impact this. Because of the burns, a person may feel inadequate or dissatisfied with their own body if it doesn't meet idealised and unrealistic body standards that are frequently promoted by the media, advertising, and popular culture. (Frew, 2021).

#### Peer and social pressures

Individuals may feel pressure from their friends, peers, and social circles to conform to particular body ideals. Peer pressure, bullying, and critical comments can exacerbate problems with body image (Frew, 2021).

#### Family values and attitudes

Body image can be influenced by upbringing and family values. Childhood and adolescent experiences with messages about appearance, weight, and self-worth can affect how people view their bodies later in life. A family that strongly values thinness, for instance, might contribute to body dissatisfaction (Frew, 2021).

### =Media exposure

Body image issues can arise from exposure to unrealistic or digitally altered images of models and celebrities on television, in magazines, and on social media. Constantly comparing oneself to these pictures can cause one to feel self-conscious about how they look (Frew, 2021).

#### Personal experiences

Personal experiences like past trauma, bullying, or unfavourable comments can have a big impact on how you feel about yourself. Distress over one's body image can be worsened by traumatic incidents or experiences related to appearance (Frew, 2021).

#### Personality traits

Some people may be more prone to body image distress due to specific personality traits and tendencies like perfectionism or low self-esteem. In particular, perfectionism can result in an impossible quest for the perfect body (Frew, 2021).

#### Physical changes and health conditions

Body changes brought on by ageing, illness, or injury (such as burn injury) can also have an impact on how someone feels about their bodies. When people believe their bodies no longer live up to their standards or expectations, they may experience distress (Frew, 2021).

#### Peer comparisons

Body image distress can result from frequently contrasting one's physical appearance with that of peers, friends, or even total strangers. Feelings of inadequacy or a sense of not measuring up may result from these comparisons (Frew, 2021).

### Quiz

The way you THINK about your body is...
Perceptual
Cognitive
Affective :

## How do burn injuries impact a person's body image?

Burn injuries can have a significant impact on an individual's body image, affecting how they perceive and feel about their own body. Living with a burn can be challenging because it can make the victim feel and look different from other people. The burn may appear extremely "raw," "gory," or "crusty" in the first few days and weeks, and it may be covered in thick bandages. Some people's injuries also cause them to lose some of their body parts.
Living with scars in a culture that places a lot of value on beauty can be difficult for burn victims. Health care providers should be aware of this shifting notion of normality, especially in the current society where there are signs that rising demands for beauty are becoming normalised. This changing notion of normality may increase the need for cosmetic and plastic surgery interventions while simultaneously decreasing the acceptance of visible differences (Van Loey, 2020). A growing number of people are engaging in beauty practises that are supported by the new idea of normality as a result of changing body image and perceptions of bodies[factual?]. In general, however, the objective severity of scarring is a poor predictor of psychological adjustment[factual?]. Both small and large defects can elicit body image concerns and diminish satisfaction with the appearance of one's body (Van Loey, 2020).

### Social Comparison Theory

Social Comparison Theory, developed by psychologist Leon Festinger in 1954, posits that individuals evaluate themselves and their abilities by comparing themselves to others. In the context of body image issues, this theory helps explain how people form perceptions about their own bodies by comparing them to the bodies of others (Festinger, 1954). Social Comparison Theory can also be applied to understanding body image issues in individuals who have experienced burn injuries. In this context, the theory helps elucidate how people with burn injuries may assess their own bodies in comparison to others, which can impact their body image and psychological well-being (Festinger, 1954).
Burn victims may engage in upward social comparison by contrasting themselves to people who don't have any obvious scars or burns. If they believe they fall short of societal expectations for beauty, this can cause feelings of self-consciousness and body dissatisfaction. When they contrast their appearance with that of those without burn injuries, they might feel inferior (Festinger, 1954). In contrast, those who have suffered burns may engage in negative social comparison by contrasting themselves with those who have sustained more severe or extensive burns. Due to their perception that they are in better shape than those who have sustained more severe injuries, this can momentarily increase their sense of self-worth and body satisfaction. The relief or gratitude that their injuries are not as severe as others' may result from such comparisons (Festinger, 1954).

#### From survival to socialisation: Longitudinal outcomes for body image in survivors of severe burn injury

Body image esteem or satisfaction is a multifaceted concept that has to do with how one feels about their physical appearance and how satisfied they are with it. In a sociocultural context where physical attractiveness is highly valued and perceived physical attractiveness is linked to many significant personal traits and social advantages, concerns about physical appearance are very important. People's perceptions of themselves and their emotions are closely related. Therefore, it is not easy to determine how scars relate to psychological issues following burns.
An important component of self-esteem is how someone feels about their appearance. There is proof that people value their appearance greatly when recovering from burns and the significance of appearance in predicting the distress of living with burn disfigurement (Thombs et al., 2008). A study conducted by Thombs and colleagues looked to longitudinally investigate the impact of body image on overall psychosocial functioning and to test a proposed framework for understanding the trajectory of body image dissatisfaction among burn survivors. By tracking the trajectory of body image dissatisfaction longitudinally among a sample of survivors of serious burn injury from the time of discharge from the index hospitalisation (survival) to 1 year post-discharge (socialisation), this study aimed to test whether body image worsens over the first year of burn recovery, as suggested by both Thompson et al. and Partridge.
A sample of 79 severe burn injury survivors[where?] completed the SF-36, the Importance of Appearance sub-scale of the Multidimensional Body-Self Relations Questionnaire, and the Satisfaction with Appearance Scale (SWAP) while they were still in the hospital as well as 6 and 12 months after discharge. A path analysis model was used to examine the role of body image dissatisfaction in mediating the relationship between pre-burn and post-burn psychosocial functioning. A repeated-measures analysis of covariance model was used to assess the course of body image dissatisfaction over time (Thombs et al., 2008).
Results showed that body image dissatisfaction was predicted by female sex, total body surface area burned, and importance of appearance. Body image dissatisfaction increased for women and those with larger burns compared to men and those with smaller burns from hospitalisation to 12 months after discharge, respectively. The most important predictor of psychosocial function at 12 months in the path analysis was body image dissatisfaction, which also served as a mediator between pre-burn and 12-month psychosocial function (Thombs et al., 2008). The results of this study point to the significance of routine psychological testing for distress related to body image both during hospitalisation and after discharge. This study supports the notion that burn injury can have severe impacts on how the victim psychologically and physical perceives their body.

## What helps to improve body image issues after burn injuries?

As part of the overall recovery process, addressing body image issues brought on by burn injuries can be difficult but crucial. Self-acceptance, interpersonal support, and therapeutic interventions must all be combined.

### Cognitive Behavioural Therapy

For those dealing with body image issues following burn injuries, cognitive-behavioural therapy (CBT) can be a highly effective therapeutic approach[factual?]. CBT is especially helpful for addressing body image issues because it places a strong emphasis on recognising and altering unfavourable thought patterns and behaviours[factual?]. CBT helps individuals recognise and challenge distorted thoughts and beliefs related to their body image.
After burn injuries, people may develop negative self-perceptions, such as feeling disfigured or unattractive. CBT allows them to identify and reevaluate these thoughts (Tylka & Wood-Barcalow, 2015). Following the identification of distorted thoughts, CBT encourages clients to swap them out for more sensible and well-rounded beliefs. By highlighting the distinctiveness and resiliency of their scars, therapists help patients develop healthier, scientifically supported perspectives on their bodies (Tylka & Wood-Barcalow, 2015). Exposure-based exercises and behavioural studies are frequently used in CBT. This could entail gradually exposing oneself to situations that cause discomfort or anxiety about one's appearance in the context of body image issues following burn injuries. This can help people become less sensitive to their fears and boost their self-confidence over time (Tylka & Wood-Barcalow, 2015). In CBT, clients are encouraged to keep diaries or other records of their thoughts and feelings regarding their bodies. Through self-monitoring, people can better understand their thought processes and the situations that make body image issues worse (Tylka & Wood-Barcalow, 2015).
CBT also gives people useful coping mechanisms to deal with upsetting emotions and issues with their bodies. These techniques might consist of breathing exercises, mindfulness practises, and practical stress-reduction techniques (Tylka & Wood-Barcalow, 2015). Clients can set realistic goals for improving their body image and self-acceptance with the aid of CBT therapists. Larger goals can be broken down into smaller, more manageable steps to help the process seem less daunting and more doable. In CBT, homework assignments are frequently given to encourage patients to use the techniques and skills they have learned in therapy in their daily lives. This supports the therapeutic procedure and promotes continued development. The goal of CBT is to give people the tools they need to keep making progress and avoid relapsing. Clients can keep working on improving their body image on their own by learning how to recognise and handle potential setbacks (Tylka & Wood-Barcalow, 2015).

### Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a therapeutic strategy that has been shown to be particularly successful in treating burn survivors' body image problems. The foundation of ACT is the idea of accepting challenging thoughts and emotions while committing to actions that are consistent with one's values and objectives. When used to address body image issues resulting from burn injuries, ACT can assist people in establishing a more accepting and kind relationship with their bodies and participating in worthwhile activities that enhance wellbeing (Pearson et al., 2010).
The ACT method encourages people to become mindfully conscious of their thoughts and feelings regarding their appearance. People are instructed to acknowledge their thoughts without passing judgement on them rather than trying to suppress or avoid them. By separating themselves from their unfavourable thoughts about themselves, people can observe these thoughts as passing events rather than unchanging truths (Pearson et al., 2010). ACT includes methods for disengaging or separating from upsetting thoughts. Burn victims can learn to see their negative views of themselves as "just thoughts" rather than accurate descriptions of their reality. By doing so, they may be able to lessen the emotional impact of these thoughts and make room for better ideas (Pearson et al., 2010).
People who participate in ACT learn to recognise their core values and what matters most to them in life. This process of values clarification can assist burn survivors in refocusing their attention away from outward appearance and towards values like resilience, self-acceptance, relationships, and personal development (Pearson et al., 2010). Accepting challenging feelings and experiences is a key aspect of ACT. The journey of a burn survivor should include accepting their scars and their emotional responses to them. While pursuing a meaningful life, this acceptance does not imply resignation but rather a readiness to make room for these experiences (Pearson et al., 2010). ACT includes mindfulness practises that can assist people in becoming more present and less self-conscious. Additionally, body image-related anxiety and depression can be lessened with mindfulness (Pearson et al., 2010).

## Conclusion

Burn injuries can have a significant and complicated effect on a person's perception of their body. Burns can leave behind visible scars, disfigurements, and physical changes that can cause a variety of emotional and psychological problems. Burn survivors frequently experience negative body image, problems with self-esteem, and feelings of self-consciousness. It's important to understand that the effect of burn injuries on body image can differ greatly from person to person and is influenced by things like the severity of the injury, the level of social support, and individual resiliency. Addressing body image issues in burn survivors requires a multifaceted approach that combines psychological strategies, social support, and self-acceptance. Through approaches such as Cognitive-Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) individuals can work towards a more positive and accepting relationship with their bodies. By fostering self-compassion, resilience, and a supportive environment, burn survivors can navigate the challenges of body image concerns and move toward greater self-acceptance and well-being.