# Motivation and emotion/Book/2015/Height and mental health

* Multimedia presentation (3 min)

## Overview

How tall are you? How tall are your friends and family? Are you happy with your height? Are you ever jealous of the fact that your siblings are taller than you? Have you ever wanted to be taller or shorter and whether your height affects your everyday life? This book chapter will discuss whether human height is related to mental health, and if so, what can be done about it. For example, what are the options for a person who is shorter than average and wants to be taller? And if height is related to mental health, what are some ways to help improve the mental health of someone who isn’t quite satisfied with their height?

## Height

Everyone is of varying heights. You might be of an average height whilst your friend may be a lot shorter. Research has shown that height is primarily determined by genetics and is also known as an indicator of the environment in which the individual grew up; i.e. it can be used to represent health and nutrition circumstances during a person’s childhood and teenage years (Quan, Jeong, & Kim, 2013; Magnusson, Gunnell, Tyelius, Smith, & Rasmussen, 2005). Although genetics is the main factor in the determination of height, there are many other factors that can influence someone’s height. Such factors include lifestyle (health, nutrition, and exercise), as well as stress (Quan et.al, 2013; Igic, Ruser,& Elfering, 2013).
Short stature is defined as being two standard deviations below the average of a particular age and sex (Rogol & Hayden, 2014) whereas tall stature is defined as being two standard deviations above the average (Kumar, 2013). Extremely tall or short statures are often caused by insufficient or excess levels of hormones (however, this may not always be the case) and are referred to as height or growth disorders (Nwosu & Lee, 2008).

### Height disorders
#### Familial tall stature and gigantism

Familial tall stature is the most common cause of tall stature in childhood and adolescents and is caused by genetics (Parmar, Makwana, Hapani, Kalathia, & Doshi, 2014). Gigantism is another cause for tall stature, however to a more extreme level. It results from excess secretions of growth hormone (GH) by a tumour within the pituitary gland, with onset beginning in childhood (Goldenberg et al., 2008; Glasker et al., 2011) and causes excessive growth. The condition is usually treated when the pituitary tumour is removed, however if GH continues to be secreted after the period of normal bone growth has ceased, the condition is then known as acromegaly (Wisse, 2013).

#### Psychosocial (PSS) and hyperphagic short stature (HSS)

Psychosocial short stature (PSS) is a disorder of short stature that is associated with emotional deprivation, a pathological psychosocial environment, or both; meaning PSS is caused by emotional distress (such as child neglect) between the child and the caregiver. PSS has three types and is categorised in terms of age of onset, behavioural characteristics, and levels of GH. Onset in type I PSS is during infancy but research has found no evidence of caregiver neglect. The age of onset of type II PSS around the age of three years or older and there is evidence of caregiver neglect. Those with type II PSS often express depressive symptoms and behaviours whilst type III, age of onset is in infancy or older (Sirotnak, 2015). Little research has been conducted on PSS but it is known that psychological and environmental stressors are the main causes. Thankfully, PSS is an extremely rare condition (Kumaran & Kershaw, 2014; Sirotnak, 2015).
Hyperphagic psychosocial short stature (HSS) is another syndrome of growth failure, however is primarily associated with excessive eating (hyperphagia) and emotional distress. Literature has found some risk factors for psychosocial deprivation include a lower socioeconomic class, single parenthood, drug and alcohol abuse, and illegitimacy. Behavioural characteristics associated with HSS include excessively eating with no feelings of satiety and typically hoard food. In extreme cases, children may go out of their way to find a source of food. For example, they may sneak out of home during the night and may even search in bins for food (Kumaran & Kershaw, 2014).
Both PSS and HSS can occur throughout childhood and adolescence. They are associated with psychosocial deprivation, which in turn impacts on the growth and development of the child. Both conditions are caused by hormonal imbalance – an insufficient level of GH along with low concentrations of Insulin-like growth factor-1 (IGF-1), which plays a vital role in childhood growth. However, short stature caused by PSS and HSS is generally reversible when the stressor is removed. For example, when the child is placed in an alternative, more nurturing psychological and emotional environment (Kumaran & Kershaw, 2014).

#### Dwarfism

An individual is considered to have dwarfism when they are 4’10” or below due to a medical condition that limits growth (Hanson, 2010). There are several causes of dwarfism. Such causes include achondroplasia and other genetic disorders, hormonal imbalances, and psychological and emotional distress, with achondroplasia being the most common (Hanson, 2010; Munoz-Hoyos et al., 2011).
From the research conducted thus far in the area of height and well-being, it is generally agreed upon that certain situations can negatively impact on the child’s overall development, which includes physical and psychological. In terms of the biological perspective, studies have suggested that negative psychological and emotional situations may impair the regulation of hormones within the hypothalamic-pituitary-adrenocortical (HPA) axis, and can result in an increased risk of vulnerability to stressors throughout the lifecycle (Munoz-Hoyos et al., 2011). This increased vulnerability to stress could then potentially impact negatively on the individual’s psychological and emotional well-being.

### Factors impacting on height
#### Stress

Growing research in this area has shown that stressful psychosocial circumstances can have adverse effects on overall health. Various studies examined the impact that work stress has on height and reported that in addition to the physical stresses such as lifting and sitting at desks for extended periods, psychological stress may also impact on back disorders (e.g. lower back pain) and spinal shrinkage. There is also increasing evidence that intense mental activity is associated with the development of lower back pain (Igic et al., 2013). To explain this association, researchers have proposed that psychological stress results in higher muscle activation, and in turn increases the pressure exerted onto the vertebrae. This pressure will push the vertebrae closer together, resulting in a decreased height (Igic et al., 2013).

#### Lifestyle and genetics

It is a common misconception that genetics has the biggest role in determining height. In fact, studies have suggested that genetics only contributes around 20% to height[factual?]. Height is an indicator of an individual’s lifestyle whilst they were growing up. Poor health throughout childhood will impact into adulthood, which can impact on adult height (Beeri et al., 2005; Case & Paxon, 2008). The nutritional status of an individual throughout childhood is considered to be one the most important factors in overall health (Case & Paxon, 2008; Quan et al., 2013). Thus, a well-balanced diet and healthy lifestyle including at least half an hour of daily activity will have the greatest benefit in optimal growth and development in children (National Health and Medical Research Council (NHMRC), 2013).

## Mental health and psychosocial outcomes

Mental health not only refers to our emotions and thoughts, but also our cognitive function.

### Society's perceptions of height, attractiveness and body image

Body image can result in dissatisfaction with one’s body and thus, height. With the media’s growing obsession with Hollywood (where a majority of celebrities appear ‘lean and tall’), younger generations may feel the need to look a specific way because if they don’t, they won’t appear ‘attractive’ according to society’s standards.
A study conducted on males in university reported their responses in regards to society’s perceptions of what constitutes as a physically ‘attractive’ body[factual?]. The study found that men reported muscularity, leanness and a taller height as the main factors that are emphasised by modern society as attractive. Furthermore, the same study found that in general, participants perceived that men preferred not to be short[Provide more detail] (Rideway & Tylka, 2005). Another study focusing on sociocultural attitudes amongst adolescents in Hong Kong reported that more females than males had a higher level of negative body image. The findings suggest that the more adolescents and younger generations are exposed to messages from the media and society regarding 'ideal' body image, the more likely they would be unsatisfied with their appearance (Lai et al., 2013).
Research conducted on physical preferences found that height has a significant role in choosing a partner. In general, studies observed that both males and females prefer to be in a partnership where the male is taller than the female (male-taller preference). Whilst women prefer taller men (slightly above average), men prefer a partner who is closer to average height, however preferences vary across individuals as partner height also depends on the individual’s own height (Stulp, Buunk, & Pollet, 2013). It was also reported that women were happier when their partner was at least 21cm taller than themselves and that height is an important factor in being satisfied with their appearance for men more so than women. Adding to this, those who are slightly above average in height were found to be the most satisfied with their height (Stulp, Buunk, & Pollet, 2013). Figure 3 shows an example of the height difference between a couple.

#### Workplace success

Psychological research literature has found that some aspects of life are easier for those who are taller as height is a socially desirable characteristic. Taller individuals are perceived as more persuasive, powerful, have a higher self-esteem, and are more competent in being able to fill a leadership position than their shorter counterparts (Judge & Cable, 2004). This could explain why shorter individuals may not move ‘up the ranks’ in the workplace as fast as those who are taller and why they are associated with a lower socioeconomic class (Magnusson et al., 2005). Judge and Cable (2004) examined many aspects in regards to workplace success including gender, body image, intelligence, and earnings and reported a positive association between the height of an individual and their earnings; taller individuals were paid more than their shorter co-workers, however this may relate back to the fact that taller individuals holding higher positions in the workplace.

### How does height affect mental health?

Quan et al., (2013) examined the relationship between height and cognitive function in an elderly population aged 65 and older. They found that in both males and females, those who were taller had better cognitive functioning than shorter individuals. Although more research is needed, when examining the relationship between early-childhood development reflected by height, current research proposes that height is related to cognitive function and dementia[factual?]. That is, the shorter an individual is, the higher risk they have of developing mental impairment[factual?]. Thus, taller individuals have a lower risk of developing cognitive impairment (Beeri et al., 2005). Similar to height, lifestyle factors such as nutrition and exercise have been proven to be beneficial in reducing the risk of cognitive impairment and aid in maintaining optimal function.

#### Children and Adolescents

Substantial evidence supports the proposal that stature affects mental health. Various studies have reported that short stature impacts more in adolescence than in childhood, however behavioural and psychological effects are seen in both life stages. A study conducted by Theunissen et al. (2002) found that with the exception of social functioning, no other emotional or psychological differences were found in children treated for short stature when compared to the normal population[Provide more detail]. Those who were treated for short stature during childhood reported a significant increase in height. Potential psychological benefits of this include an improved self-esteem and overall happiness with their height (Zlotkin & Varma, 2006).

#### Adults

Research focusing on a large cohort of Swedish men found that short men had double the risk of suicide than tall men[factual?]. The study suggests several possibilities for shorter men and this increased risk of suicide. [what?]Literature has found that psychological distress throughout growth periods such as childhood and adolescence can impair growth, which can in turn lead to an increased risk of developing a mental illness. This is one of the explanations utilised to explain[awkward expression?] the findings in the study conducted by Magnusson et al., (2005). It also proposes that shorter individuals are usually associated with a lower socioeconomic class, regardless of level of education and are also less likely to marry in comparison to taller individuals. This association of shorter individuals being of a lower socioeconomic class may stem from the relationship between height and workplace success discussed earlier, and how taller individuals are seen as more powerful and successful.
One cohort study concentrating on taller Australian women (above 173cm) examined the long-term psychosocial outcomes of women assessed or treated during adolescence for tall stature. Findings reported that although there was no link between tall stature and major depression, it was proposed that taller women did have poorer mental health (Bruinsma et al., 2006).
* Did you know?
* Actor Peter DInklage (Figure 4), was born with achondroplasia, the most common form of dwarfism. He has stated in several interviews that as the only person in his family to have this condition, he was often angry about his height whilst growing up. However, he also notes that he grew up in a very supportive and understanding family and had a happy childhood. In 2003, whilst talking about his height, he said:
* "When I was younger, definitely, I let it get to me. As an adolescent, I was bitter and angry, and I definitely put up these walls. But the older you get, you realise you just have to have a sense of humour. You just know that it’s not your problem. It’s theirs.” - New York Times Magazine, 2012

## What can be done about short or tall stature?

Children with diagnosed short stature may undergo growth hormone therapy. It is painful as it involves many injections throughout several years, however research suggests that the psychological and emotional outcomes that come with increased height discussed previously may be beneficial to children in the long run (Zlotkin & Varma, 2006).
While being tall does have its advantages, there has also been concern regarding the psychosocial outcomes of females who are of taller statures. To address this, hormone treatment can be used and is available in many Western countries such as Australia and the USA. The treatment utilises high doses of oestrogen during puberty, with the aim to reduce adult height by speeding up the bone fusion process (Bruinsma et al., 2006). In males hormonal treatment is also used, however testosterone is used in place of oestrogen (Murray & Butler, 2013). Another option may be to undergo surgery, altering the length of the long bones within the leg. Although shown to be effective, the safety of this method of treatment is of concern and those choosing to utilise surgical treatment should only do so after careful consideration (Murray & Butler, 2013).

## Conclusion

Height is often seen as a desirable characteristic, however it is not always something that can be controlled (for example, medical and genetic growth disorders). Circumstantial growth disorders such as HSS and PSS are reversible when the child is placed into an alternative environment. Many other factors have been found to influence height and these include psychological and emotional distress, lifestyle, and genetics (though not as much as we are lead to believe!).
Previous and current evidence suggests that there is in fact an association between height and mental health. Various studies conducted in this field have consistently reported that being of a taller height appears to be the most beneficial in many aspects of life, including relationships, the workplace, and in the general society. Taller individuals are also less likely to develop cognitive impairment and mental disorders such as dementia than shorter individuals, however lifestyle changes can also help those who are shorter decrease this risk. Substantial research has suggested that psychological and emotional distress throughout childhood and adolescence is the primary factor in explaining the association between height and mental health. Both tall and short stature can be significantly altered via hormonal treatments and studies suggest treatments beginning in childhood for short stature have more positive psychosocial outcomes over time.