1. DEFINITION—"Mental picture of body's appearance; an interrelated phenomenon which includes the surface, depth, internal and postural picture of the body, as well as the attitudes, emotions, and personality reactions of the individual in relation to his body as an object in space, apart from all others."^*
2. OPERATIONAL DEFINITION ^†
1. Body image is created by social interaction.
1. Approval given for "normal" and "proper" appearance, gestures, posture, etc.
2. Behavioral and physical deviations from normality not given approval.
3. Body image formed by the person's response to the approval and disapproval of others.
4. Person's values, attitudes, and feelings about self continually evolving and unconsciously integrated.
2. Self-image, identity, personality, sense of self, and body image are interdependent.
3. Behavior is determined by body image.
3. CONCEPTS RELATED TO PERSONS WITH PROBLEMS OF BODY IMAGE
1. Image of self changes with changing posture (walking, sitting, gestures).
2. Mental picture of self may not correspond with the actual body; subject to continual but slow revision.
3. The degree to which people like themselves (good self-concept) is directly related to how well defined they perceive their body image to be.
1. Vague, indefinite, or distorted body image correlates with the following personality traits:
1. Sad, empty, hollow feelings.
2. Mistrustful of others; poor peer relations.
3. Low motivation.
4. Shame, doubt, sense of inferiority, poor self-concept.
5. Inability to tolerate stress.
2. Integrated body image tends to correlate positively with the following personality traits:
1. Happy, good self-concept.
2. Good peer relations.
3. Sense of initiative, industry, autonomy, identity.
4. Able to complete tasks.
5. Assertive.
6. Academically competent; high achievement.
7. Able to cope with stress.
4. Child's concept of body image can indicate degree of ego strength and personality integration; vague, distorted self-concept may indicate schizophrenic processes.
5. Successful completion of various developmental phases determines body concept and degree of body boundary definiteness.
6. Physical changes of height, weight, and body build lead to changes in perception of body appearance and of how body is used.
7. Success in using one's body (motor ability) influences the value one places on self (self-evaluation).
8. Secondary sex characteristics are significant aspects of body image (too much, too little, too early, too late, in the wrong place, may lead to disturbed body image). Sexual differences in body image are in part related to differences in anatomical structure and body function, as well as to contrasts in lifestyles and cultural roles.
9. Different cultures and families value bodily traits and bodily deviations differently.
10. Different body parts (e.g., hair, nose, face, stature, shoulders) have varying personal significance; therefore, there is variability in degree of threat, personality integrity, and coping behavior.
11. Attitudes concerning the self will influence and be influenced by person's physical appearance and ability. Society has developed stereotyped ideas regarding outer body structure (body physique) and inner personalities (temperament). Current stereotypes are:
1. Endomorph—talkative, sympathetic, good natured, trusting, dependent, lazy, fat.
2. Mesomorph—adventuresome, self-reliant, strong, tall.
3. Ectomorph—thin, tense and nervous, suspicious, stubborn, pessimistic, quiet.
12. Person with a firm ego boundary or body image is more likely to be independent, striving, goal oriented, influential. Under stress, may develop skin and muscle disease.
13. Person with poorly integrated body image and weak ego boundary is more likely to be passive, less goal oriented, less influential, more prone to external pressures. Under stress, may develop heart and GI diseases.
14. Any situation, illness, or injury that causes a change in body image is a crisis, and the person will go through the phases of crisis in an attempt to reintegrate the body image Table 10-5. Four Phases of Body Image Crisis .
4. ASSESSMENT: Table 10-6. Body Image Development and Disturbance Throughout the Life Cycle: Assessment .
5. ANALYSIS/NURSING DIAGNOSIS—body image development disturbance may be related to:
1. Obvious loss of a major body part—amputation of an extremity; hair, teeth, eye, breast.
2. Surgical procedures in which the relationship of body parts is visibly disturbed—colostomy, ileostomy, gastrostomy, ureteroenterostomy.
3. Surgical procedures in which the loss of body parts is not visible to others—hysterectomy, lung, gallbladder, stomach.
4. Repair procedures (plastic surgery) that do not reconstruct body image as assumed—rhinoplasty, plastic surgery to correct large ears, breasts.
5. Changes in body size and proportion—obesity, emaciation, acromegaly, gigantism, pregnancy, pubertal changes (too early, too late, too big, too small, too tall, too short).
6. Other changes in external body surface—hirsutism in women, mammary glands in men.
7. Skin color changes—chronic dermatitis, Addison's disease.
8. Skin texture changes—scars, thyroid disease, excoriative dermatitis, acne.
9. Crippling changes in bones, joints, muscles—arthritis, multiple sclerosis, Parkinson's disease.
10. Failure of a body part to function—quadriplegia, paraplegia, stroke (brain attack).
11. Distorted ideas of structure, function, and significance stemming from symbolism of disease seen in terms of life and death when heart or lungs are afflicted—heart attacks, asthmatic attacks, pneumonia.
12. Side effects of drug therapy—moon facies, hirsutism, striated skin, changes in body contours.
13. Violent attacks against the body—incest, rape, shooting, knifing, battering.
14. Mental, emotional disorders—schizophrenia with depersonalization, somatic delusions, and hallucinations about the body; anorexia nervosa, hypochondriasis; hysteria, malingering.
15. Diseases requiring isolation may convey attitude that body is undesirable, unacceptable—tuberculosis, AIDS, malodorous conditions (e.g., gangrene, cancer).
16. Women's movement and sexual revolution—use of body for pleasure, not just procreation, sexual freedom, wide range of normality in sex practices, legalized abortion.
17. Medical technology—organ transplants, lifesaving but scar-producing burn treatment, alive but hopeless, alive but debilitated with chronic illnesses.
6. GENERAL NURSING CARE PLAN/IMPLEMENTATION:
1. Protect from psychological threat related to impaired self-attitudes.
1. Emphasize person's normal aspects.
2. Encourage self-performance.
2. Maintain warm, communicating relationship.
1. Encourage awareness of positive responses from others.
2. Encourage expression of feelings.
3. Increase reality perception.
1. Provide reliable information about health status.
2. Provide kinesthetic feedback to paralyzed part (e.g., "I am raising your leg.").
3. Provide perceptual feedback (e.g., touch, describe, look at scar).
4. Support a realistic assessment of the situation.
5. Explore with the client his or her strengths and resources.
4. Help achieve positive feelings about self, about adequacy.
1. Support strengths despite presence of handicaps.
2. Assist client to look at self in totality rather than focus on limitations.
5. Health teaching:
1. Teach client and family about expected changes in functioning.
2. Explain importance of maintaining a positive self-attitude.
3. Advise that negative responses from others be regarded with minimum significance.
7. EVALUATION/OUTCOME CRITERIA:
1. Able to resume function in activities of daily living rather than prolonging illness.
2. Able to accept limits imposed by physical or mental conditions and not attempt unrealistic tasks.
3. Can shift focus from reminiscence about the healthy past to present and future.
4. Less verbalized discontent with present body; diminished display of self-displeasure, despair, weeping, and irritability.

^* Adapted from Kolb, L: Disturbances in body image. In Arieti, S (ed): American Handbook of Psychiatry. Basic Books, New York.

^† Adapted from Norris, C: Body image. In Carlson, C, & Blackwell, B (eds): Behavioral Concepts and Nursing Intervention, ed 2. JB Lippincott, Philadelphia.