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Body Dysmorphic Disorder Techniques for Treating Obesessions with Body Perfection
Body Dysmorphic Disorder: Diagnosis & Treatment - 10 CEUs

Section 17
The Influence of Self-Objectification on BDD in Women

CEU Question 17 | CE Test | Table of Contents | Body Dysmorphia
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The objectification of women within Western culture teaches women that the mature female body is a thing that belongs to and is evaluated by others. Women also encounter messages and images in which a thin female body is associated with success and power (Tolman & Debold, 1994), communicating to women that their body is an important commodity and can influence life experiences. Indeed, research suggests that in addition to appearance-based criticism, overweight women experience various forms of discrimination (Crandall, 1994; Rothblum, 1992). Girls' understanding of the importance of appearance for women in a patriarchal culture may contribute to feelings of fear, shame, and disgust that some experience during the transition from girlhood to womanhood because they sense that they are becoming more visible to society as sexual objects (Lee, 1994). Nolen-Hoeksema and Girgus (1994) proposed that the belief that one's body belongs to others is a diathesis for mental health risks of depression and eating disorders because young women believe that conforming to the expectations of "attractiveness as thinness" is a way to gain respect and become successful. Women are at a disproportional risk for a variety of mental health problems (American Psychiatric Association, 1994), which may, in part, be related to women's struggle and inability to achieve a narrow beauty ideal (Crawford & Unger, 2000).

In addition to perpetuating a thin-ideal standard for women, the sexual objectification of women occurs in a variety of contexts and forms such as sexual gazing, commentary, and evaluation; sexual harassment; and sexual violence. These forms of sexual objectification can also contribute to women's experiences of mental health problems (Crawford & Unger, 2000; Harned, 2000). Fredrickson and Roberts (1997) have proposed a theory of objectification that provides a framework for understanding the psychological experiences of women that can potentially result from pervasive objectification. According to Fredrickson and Roberts (1997), objectification occurs when a woman's body is separated from her person and is regarded as representing her. Objectification of women is prominent in our society, occurring in a variety of contexts, thus it is assumed that most women encounter objectification and are affected by it to some degree. The theory proposes that societal objectification of women teaches women to adopt and internalize an outsider view, treating themselves "as an object to be looked at and evaluated" (p. 177). This can lead to continual self-monitoring which raises self-consciousness and contributes to feelings of shame and anxiety, diminished awareness of internal states, and detracts from "peak motivational states" (p. 194; see Fredrickson & Roberts, 1997 for a comprehensive explanation).

Tentative evidence exists to support some of the postulates of objectification theory. Research has demonstrated that self-objectification contributes to low body esteem (McKinley, 1998) and to body shame (Fredrickson, Roberts, Noll, Quinn, & Twenge, 1998). In an experimental study, Fredrickson et al. (1998) experimentally induced self-objectification, surveyed participants' degree of body shame, and measured the amount of food the participants left following an eating task. Participants who scored high on measures of self-objectification reported the greatest amount of body shame and this predicted restrained eating. The induced state of self-objectification did not independently predict restrained eating in this study, suggesting that shame may mediate the relationship between self-objectification and restrained eating in this sample. In a related study, Noll and Fredrickson (1998) found evidence that shame does mediate the relationship between self-objectification and disordered eating. Lastly, Tiggemann and Slater (2001) tested a path model examining the relationship between self-objectification and disordered eating among dancers and nondancers. These authors found significant correlations between two separate measures of self-objectification, shame, and disordered eating. This recent research begins to provide a foundation of support for the objectification theory's postulate that self-objectification induces body shame and influences disordered eating practices.

Although a link has been established between self-objectification and disordered eating symptoms, the effect of other mediating variables still needs to be explored. One consequence of self-objectification postulated by Fredrickson and Roberts (1997) was a reduction of internal awareness. Individuals are often able to express and identify emotions as well as recognize physiological states associated with such experiences. If self-objectification contributes to an inability to recognize such internal states, an individual may have a greater vulnerability for developing mental health problems (Lesser, 1985). In a recent study, Tiggemann and Slater (2001) used the Body Consciousness Questionnaire (BCQ; Miller, Murphy, & Buss, 1981) as a measure of internal awareness and tested its mediational relationship between self-objectification and disordered eating. The mediational relationship was not significant, nor were the correlations between the measure of internal awareness, disordered eating, and self-objectification. Although these results do not support objectification theory's postulate, it is too early to disregard the idea that self-objectification contributes to a lack of internal awareness. In addition, the BCQ used in the previous study is not the best measure of internal awareness currently available. Measures of alexithymia, an inability to identify or express emotions, more closely assess internal awareness and are more widely used.

Individuals with eating disorders often suffer from alexithymia (Cochrane, Brewerton, Wilson, & Hodges, 1993; Smith, Amner, Johnsson, & Franck, 1997) and alexithymia has been found to be an independent factor contributing to the development of various mental health disorders, including disordered eating (Vingerhoets, Van Heck, Grim, & Bermond, 1995). Since it is important to continue to test the potential mediating effects of internal awareness as a variable within objectification theory, this study improved upon past research by utilizing measures of alexithymia as its definition of internal awareness. Thus, alexithymia was tested as a potential mediator in the relationship between self-objectification and disordered eating.

Depression and Self-Objectification
Depression is over-represented among women, often at a rate of two to three times that for men (APA, 1994). Fredrickson and Roberts (1997) propose that this disparity may result, in part, from the experiences women have as a result of self-objectification. Women who self-objectify are likely to be confronted with their perceived physical inadequacies, which could lead to feelings of hopelessness or shame, thereby increasing the risk for depressive disorders. Kalodner (1997) found that viewing pictures of models in popular press magazines significantly lowered body-esteem and increased depressive symptoms in their sample of women, replicating earlier studies (see Stice & Shaw, 1994). Research has found that body dissatisfaction is related to depressive symptoms in both clinical and nonclinical samples of women (Denniston, Roth, & Gilroy, 1992; Koenig & Wasserman, 1995; Stice, Hayward, Cameron, Killen, & Taylor, 2000). Other researchers have found that depressed moods accentuate concerns with body shape and weight among women who value physical appearance (Cohen-Tovee, 1993) and depression may contribute to long-term body dissatisfaction (Keel, Mitchell, Davis, & Crow, 2001). The literature suggests that depression, evaluation of physical appearance, and body satisfaction/dissatisfaction are interrelated although the causal direction between these variables is unclear and likely reciprocal. However, the consistent relationships found among these variables support the idea that women who self-objectify and experience a discrepancy between their actual and ideal body image are prone to develop negative evaluations of themselves (McKinley, 1998). These negative evaluations of the self may contribute to negative affective experiences, making women more vulnerable for developing depressive disorders. Although indirect evidence exists to support the postulate that self-objectification contributes to depressive symptoms for women, this has yet to be tested. Therefore, the relationship between self-objectification and depressive symptoms was assessed in this study. Research has also found that depressed individuals have difficulties identifying feelings and bodily sensations, despite a hypervigilant focus often placed upon themselves (Parker, Bagby, & Taylor, 1991). It is possible that this focus highlights the perceived negative features of the self rather than one's physiological and affective states. Bagby, Taylor, and Ryan (1986) found a moderate positive correlation between alexithymia and depressive symptoms in a nonclinical college sample. These findings are consistent with the prediction of self-objectification theory, which suggests that a lack of internal awareness may mediate the relationship between self-objectification and depressive symptoms.

Because this notion has not been tested, we included this mediational factor in our model. In addition to research supporting the link between self-objectification and depression is the extensive overlap between eating disorders and depressive disorders. The high rates of co-morbidity found between eating disorders and depression may, in part, be caused by the common features of negative self-evaluation and general dissatisfaction with one's physical appearance (Koenig & Wasserman, 1995). Due to the relationship between eating disorders and depression, researchers often include depressive symptoms as a risk factor within their models. Studies have consistently found that depression is a significant risk factor in the development of disordered eating (Pook, Conti, & Lester, 1996; Stice, 2001; Stice, Killen, Hayward, & Taylor, 1998).
- Muehlenkamp, J.J., Saris–Baglama, R.N.; Self–Objectification and its Psychological Outcomes for College Women. By; Psychology of Women Quarterly, 03616843, Winter2002, Vol. 26, Issue 4

Personal Reflection Exercise #3
The preceding section contained information regarding the influence of self-objectification on BDD in womenr.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Lin, K. L., & Raval, V. V. (2020). Understanding body image and appearance management behaviors among adult women in South Korea within a sociocultural context: A review. International Perspectives in Psychology: Research, Practice, Consultation, 9(2), 96–122.

Newman, S. (2020). Review of Clinical evolutions on the superego, body, and gender in psychoanalysis [Review of the book Clinical evolutions on the superego, body, and gender in psychoanalysis, by J. S. Lieberman]. Psychoanalytic Psychology, 37(1), 86–87.

Rosenmann, A., Kaplan, D., Gaunt, R., Pinho, M., & Guy, M. (2018). Consumer masculinity ideology: Conceptualization and initial findings on men’s emerging body concerns. Psychology of Men & Masculinity, 19(2), 257–272.

Online Continuing Education QUESTION 17
According to Muehlenkamp, why may women be more prone to depression and BDD than men? Record the letter of the correct answer the CE Test.

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