Body Image and Social Self-Esteem: 

Rethinking how you look; improving how you feel

What is Body Image?

Most of us feel dissatisfied with our looks from time to time: maybe we‘ve gained a few pounds, a pimple pops up out of nowhere, or we are having a bad hair day.  For those living with burn injuries however, body image concerns can be debilitating, affecting both their mood and their willingness to engage socially. Even a hidden or small burn can make someone feel self-conscious.  One friend of ours wore his pressure garments long after it was necessary because he didn’t want people to see the scars on his hands; another friend is afraid to wear a strapless dress because of scars on her shoulders. Body Image

The question is: why are we so concerned with our appearance? Most of our bodies are never even seen by most people. It does not represent all the intangible qualities about us, and people we want to know are more interested in our personality than our looks.  So why does it matter so much to us?   The answer is that we as a society seem remarkably preoccupied with how people look.  We use our eyes the way a dog uses his sense of smell: to identify, appraise and approach or avoid.  In the abstract this is just fine – it’s the way people protect themselves in ambiguous circumstances -- but in a particular social situation, as when someone is staring at us in a restaurant, it can feel painful. 

Our minds are wired to identify threats and dangers, so when someone is staring, we assume the worst: that they are disturbed or disgusted by our appearance.  But in this situation, the mind might be on the wrong track.  Unless they tell us, we can never really know what someone else is thinking, so our minds fill in the gaps.  We make assumptions then look for evidence to confirm our pre-existing assumptions.  If our minds were in a laboratory and not our heads; they’d be kicked out for bad science. Our thoughts are the grand marshals of an emotional parade that may or may not be going in the right direction.  It’s like Hamlet tells Rosencrantz and Guildenstern, “there is nothing either good or bad, but thinking makes it so.”   What we tell ourselves about what others think of us, good or bad, determines how we act around a person and how they ultimately respond to us.   So it’s the thinking about body image that gets us into trouble and it’s thinking that can get us out.  Our sense of what we look like has been carefully studied by psychologists and there are useful and convenient solutions when it becomes a problem.

Types of “Body Images”

First let’s look at the terms. “Body image” can refer to many things:

· Body perception: This is how we see our bodies in our minds.  Is it accurate?  Do we tend to distort certain regions and ignore others?  People with eating disorders may have distorted body perception.

· Body Esteem: This is how we see our body when comparing it to others.  Do we think that we are attractive?  Sexy?  Does body esteem affect our diet, activity level or social life?

· Body Awareness: This describes how often we think about or knowingly bring attention to our bodies. Athletes and performing artists are able to bring focused attention to their bodies when they are performing.  For the rest of us, this may be more difficult.  The other side of this is negative body awareness, always assuming that our bodies will not perform as we expect.

· Body Satisfaction: This can be defined as the difference between how you see yourself and how you would like to look, regardless of how you are seen by others. Do you always say “Man, I wish I looked like that!”?

Psychologists see all of these as part of “body image,” however you might notice that they are all also forms of thinking.  Two problems arise when thinking about our bodies:  first, we have a tendency to believe what we are thinking or perceiving when more often than not there is evidence available to prove otherwise; second, these beliefs directly affect our behavior and emotions.  The person with a high degree of body dissatisfaction might be afraid to ask someone out on a date because of the chance of getting turned down. In studies when people are told that they look tired, they begin to feel less energetic.  A person who thinks he/she is out of shape may feel afraid or embarrassed to go to the doctor or even the gym. In these examples, you can see that one’s quality of life changes when thinking becomes distorted.

As a society, we tend to try to smother our body image issues. Because everybody has some body dissatisfaction which they are trying to contain, they may not be so helpful when listening to yours. Some people assume that body image issues need some kind of involvement by professionals such as doctors, psychologists or social workers.   This may be true for people whose body dissatisfaction is affecting their mood or behavior. But for the rest of us, dealing with minor anxiety and negative thoughts can be a lot easier than you think.

Changing negative thinking in three and a half steps:

Cognitive Restructuring
The first step
: notice what you are thinking.

Ask yourself, “what is going through my mind right now?” It can help to write it down. If your thoughts are coming too fast, imagine them in slow motion.  It’s not necessary to do this perfectly, because the thoughts that are most distressing tend to occur again and again.

Step two: notice how these thoughts make you feel.

Again, it may be helpful to write this down.  Does the thought make you feel sad? Angry?  Embarrassed? Sometimes feelings make themselves known by sensations: are you feeling tired or bored? Are you sweating? Have you suddenly developed a headache? All of this is important as well as the intensity of your feelings. You may want to rate a feeling’s power from 1-10.            

Step three: Respond to your thoughts and notice when you feel better.

That’s right - talk back to it! Imagine your thought is a small child; what would you say to the child if someone was telling him the things you are thinking.  It’s important here to reason with yourself, don’t just dismiss your thought as “crazy.”  It’s your thought and is a part of you, but you decide how powerful it gets to be.  Offer alternatives:

“Maybe he is staring because he doesn’t know what to say?”  

“That child is curious, not afraid.”

“I want people to value me for my inner qualities not based on what I look like.”

“What’s the worst thing that could happen if I ask her out?  I can survive if she says no.”

Step 3.5: Notice when you feel better. And congratulate yourself on developing a new skill that you can use in a variety of uncomfortable social situations.  Like any skill it takes practice.

An Example:

Jim is a 31 year old man who works as paralegal.  When he was a teenager he had an accident with gasoline igniting a lawn mower.  He sustained 3rd degree burns to his face and chest.  Reconstructive surgery has helped to repair some of the damage to the skin on his face but he still notices the scarring and texture differences from the grafts.  On the train to work each morning, Jim tries to hide himself by sitting at the end of the car, behind a newspaper.  One day he has forgotten his newspaper, and the boxes are all out.  The train arrives and it’s more crowded than usual; Jim is forced to stand in the center of the car.  

A little boy is staring at him, then the boy’s mother notices and tells him to stop. She looks in Jim’s direction, but looks right through him as if pretending he’s not there. Jim immediately thinks that the boy is afraid and the mother is disgusted by him. Because Jim is new at working with his thoughts in this way he writes them down.

This is what his notes looked like:

First Thoughts

Immediate Feelings
Rational Responses
Feelings Now
That child is afraid of me!
The child was just curious; he only became afraid when his mother reprimanded him.
Not sad. I can smile at the child and show him that it’s okay to look.
That woman is afraid and disgusted, so she ignores me.
angry and embarrassed
The woman doesn’t know how to react; she looks away because she doesn’t want to offend me.
I feel sorry for her.  Maybe she wants to be kind but doesn’t know how.
Everyone is looking at me.
self-conscious; ashamed
They are just staring because they wonder how I’ll react.  Everyone can be insensitive from time to time.
 Great, I can really do this!  I can keep thoughts and feelings and put them in perspective.
What Jim is doing is called detaching from feelings, giving himself a little space to breathe and reflect.  Rather than assuming that his initial feeling is based on rational assumptions he takes a more scientific approach by looking carefully at the connections between his thoughts and feelings.  Unquestioned belief of our first thoughts and feelings is one of the things that can get us into trouble in social situations. It’s also human.  Many people feel anxious in social situations; so you are not alone even when you feel like you are.   Come to think of it that might be something to write down in the first column!

Try it yourself!! Body Image and Social Self-Esteem

Now you try it with something that bothered you today.  Here are the steps:

1. Think of the situation; try to remember what you were thinking at the time.

2.  Now try to remember how the situation felt. These are your immediate feelings.

3.  Next try to talk back to the thoughts, not the feelings. Don’t edit yourself. Let yourself think of any response to the negative thoughts or assumptions.  Choose the one or two responses that make the most sense to you.

4. Notice any changes in how you feel. 

That’s all there is too it.  Now we all know that it isn’t always easy to talk ourselves out of a negative mood, but the more consistently you attempt to recognize and respond to uncomfortable social situations the easier it becomes. 

Disfiguring injuries can heighten sensitivities in social situations.  But that doesn’t have to keep you from being as socially engaged as you want to be.  The 3 and a half-step thinking tools explained here take practice, but they work better and better as you get more skillful.  If they don’t work and you still feel anxious or inhibited socially then it is time to consult your doctor and ask for a therapist or support group that can help you through your social anxiety.  No one deserves to suffer in silence. A good heart and warm personality can melt even the coldest stare.

Hot Issue


Paul A. Jargowsky, Ph.D. 

We were privileged to have Professor Paul A. Jargowsky, of the Rutgers University Center for Urban Research and Urban Education, as our guest speaker at our 39th Annual Gala on October 19, 2012.  

At the age of 15, Paul sustained burns over 70% of his body.  At that time, the chances of recovery from such extensive burns were remote, but Paul was fortunate to receive care at the newly opened Crozer-Chester Burn Center.  He made an amazing recovery and went on to graduate from Princeton and Harvard (masters and doctoral).  

Paul showed tremendous courage through his recovery and has devoted much of his life to serving others.   His bravery and inspiration of others are shining examples of the qualities that we are fortunate to see in many of our burn survivors.


The Burn Foundation Fall, 2012 newsletter has been published!

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