Eating disorders and body image concerns are increasingly becoming common in psychiatric practice, affecting both men and women across the world. Asian countries have been presumed to be less vulnerable to body image concerns. However, there is growing evidence that disorders of body image are gradually reaching levels to those seen in Western countries. With the growing exposure to Western media and a rise in socioeconomic status, the younger generations in low- and middle-income Asian countries are gradually becoming susceptible to body image disturbances and its subsequent consequences such as disordered eating.
In India, there are reports that this disorder is growing among young women. One of the factors associated with the development and maintenance of eating disorder pathology is disordered body image. Body dissatisfaction refers to negative subjective evaluations of one's physical body, and it usually involves a perceived discrepancy between a person's evaluation of his/her body and his/her ideal body image. Studies done in India for the presence of this problem reveal that body image concerns are present in about 10%–30% of the adolescent girls and college women.
Sociocultural theory of body image concerns reiterates the importance of perceived pressure by family and peers to aspire to the thin ideal propagated, especially by the media. However, since most women remain unaffected by these pressures, researchers have explored the mediating role of self-esteem and personality factors in the development of eating disorder pathology and body dissatisfaction. They postulate that internalization of culturally unattainable ideals is mediated by self-esteem. Women with low self-esteem are more vulnerable to internalization of perceived pressure by media and peers that lead to the development of harmful diet control measures. Certain personality traits such as neuroticism, impulsiveness, and avoidance have been found to increase the susceptibility to body dissatisfaction while agreeableness and extraversion have been negatively associated with body image concerns.
Since body image is socially constructed, it is prudent to examine it in our cultural context. To the best of our knowledge, there are no Indian studies conducted to explore the relationship between personality factors and body image concerns. This study aims to throw light on this particular aspect in young Indian women.
Aims of the study
The aim was to study the prevalence of body image dissatisfaction among young Indian women and to analyze its relationship with self-esteem and personality traits.
MATERIALS AND METHODS
This was a cross-sectional study done among graduate and postgraduate students in colleges of private universities at Sikkim and Kanpur (North India). Data was collected using a self-report questionnaire administered to consenting participants in the age group of 18–30 years over a period of 3 months. Even though all the students were conversant in English, the investigator was present during the time of filling the questionnaire to clarify any doubts. Ethical clearance was obtained from the Institutional Ethics Committee.
The following questionnaires were used to collect the data
- Sociodemographic pro forma that included details of age, weight, and height
- Body Shape Questionnaire-8C – The full version BSQ is a self-report questionnaire, originally comprising 34 questions measuring the extent of concerns about body shape. The questions refer to the participant's state over the past 4 weeks and are answered on a 6-point Likert scale, from “never” to “always.” Higher values on the BSQ indicate more body dissatisfaction. The BSQ has been shown to have good concurrent and discriminative validity. The BSQ-8C is the short version of the BSQ and consists of eight items extracted from the full version. For the purpose of the study, we categorized body dissatisfaction severity based on the cutoff values into no concern/mild/moderate and severe concern
- Rosenberg's Self-Esteem Scale– A widely used 10-item scale that measures global self-worth by measuring feelings about the self. The items on this scale are answered using a 4-point Likert scale that ranges from strongly agree to strongly disagree. The scale demonstrates a Guttman scale coefficient of reproducibility of 0.92, indicating excellent internal consistency. Test–retest reliability over a period of 2 weeks reveals correlations of 0.85 and 0.88, indicating excellent stability
- Mini-International Personality Item Pool (IPIP)– It is a useful short measure of the Big Five factors of personality such as extraversion, agreeableness, conscientiousness, neuroticism, and imagination. It is a 20-item short form of 50-item International Item Pool five-factor model measures and was developed and validated across five studies. The responses follow a 5-point Likert type scale ranging from 1 (strongly agree) to 5 (strongly disagree) to questions that describe a behavior. The scale had coefficient alphas ranging from 0.65 to 0.77. The Mini-IPIP offers an adequate trade-off between conciseness, reliability, and both construct and criterion validities.
Statistical analysis was done using Minitab 17 statistical software (State College, PA: Minitab Inc., USA). Mean, standard deviation (SD), and percentage were used for descriptive statistics, and Spearman's rho was used to find the significance of correlation between variables.
Data were collected from 570 participants, of whom 15 could not be included in the analysis due to incomplete/missing data. In the final analysis, 555 participants' data was used. The mean age of the participants in the study was 22.24 years with SD ± 2.75. Majority of them were in their high school (n = 198, 35.68%) or pursuing graduation (n = 285, 51.35%) and 72 (12.97%) were pursuing their postgraduate studies. The mean body mass index (BMI) of the women in the study was 21.01 with SD ± 3.60. About 24.14% of the participants were underweight (n = 134), 58.38% had normal BMI (n = 324), 15.32% were overweight (n = 85), while 2.16% were obese (n = 12). The mean score of the study sample on Rosenberg's Self-Esteem Scale was 18.00 (±4.18). The mean BSQ (-8C) score was 20.95 (±8.69). Twenty-seven percent of the participants had moderate-to-severe body concern [Table 1]. Table 2 shows the distribution of the Big 5 personality traits in the sample.
We found a negative correlation between age and BSQ scores. There were a significant positive correlation between BMI and BSQ (-8C) scores and a significant negative correlation with self-esteem scores [Table 3].
Multiple linear regression analysis showed that the Big Five personality traits explained 2.56% variance in body dissatisfaction (F = 2.88, P = 0.014). Among the personality traits, only neuroticism (P = 0.01) and conscientiousness (P = 0.031) significantly predicted body shape dissatisfaction [Table 4].
More than one-fourth of young women (28%) reported moderate-to-severe body dissatisfaction. This finding represents a similar trend reported across the Indian subcontinent. Rashmi et al. reported 19% of participants in their study being unsatisfied or very unsatisfied with their body image, while Goswami et al. and Priya et al. reported prevalence rates for body dissatisfaction at 13.5% and 33.3%, respectively. Similarly, a study done in Nepal among high school adolescents reported that 29% of girls scored high for eating disorders.
The rise in body image concerns in this part of the world can be explained in terms of changing sociocultural milieu. Socioeconomic development along with widespread media exposure to Western ideals has ushered in an era of unrealistic expectations regarding norms and standards of beauty in this region. Thus, the gap between Western and Asian or South Asian prevalence in eating disorders and body image concerns is gradually reducing. In a review of comparative studies from Asia, Pike and Dunne showed that the prevalence of eating disorders and body dissatisfaction was similar to or worse than those reported by Western countries.
In our study, we did not find any significant correlation between body image dissatisfaction and age. Our study was focused on young adults, and the study sample formed a more or less homogeneous group with a mean age of around 22 years. Hence, the difference in body dissatisfaction scores according to age may not have been obvious.
There was a significant positive correlation between BMI and body dissatisfaction. This result is in line with the current evidence that women tend to pursue a thin body image ideal as opposed to men who strive to achieve a heavier and muscular body image ideal.
Consistent with previous studies, we found a significant negative correlation between self-esteem and body image dissatisfaction. Researchers postulate that cultural idealistic standards for the feminine body are virtually impossible to realize fully, and women who fully internalize them, connecting achievement of those standards with their identity, may feel ashamed when they do not measure up. This attitude subsequently lowers their self-esteem. Other researchers hypothesize a bidirectional relationship between body dissatisfaction and self-esteem. In women with low self-esteem, not achieving a culturally ideal body shape and image may contribute to increasing negative self-evaluation, which over a period of time, gradually magnifies their vulnerability to environmental pressures to achieve the cultural body ideal. In fact, low self-esteem predicts health-related behaviors such as dieting and exercise in such individuals increasing their proneness to develop disordered eating and depressive symptoms.
On measures of Big Five personality traits, we found that neuroticism and extraversion positively correlated with body dissatisfaction while agreeableness, imagination, and conscientiousness had a negative correlation. However, only neuroticism and conscientiousness demonstrated a significant correlation. This finding is in line with the previous studies that have shown a positive association between neuroticism and negative body image and a negative relation of conscientiousness to disordered eating.
The relationship between neuroticism and body image concerns has been explained by proposing that women who score high on neuroticism may be more sensitive to appearance evaluation and rejection and are more likely to experience negative emotional states. This makes them more easily dissatisfied if they are unable to fulfill the need to attain the ideal image of beauty. On the other hand, individuals who score high on extraversion may be more accepting of their bodies leading to positive body appreciation. Personality has furthermore been shown to act as a risk factor, a moderator of symptom expression, for selection of intervention and as a predictor of treatment outcome for eating disorders.
Conscientiousness is a personality trait that is characterized by organization and goal-oriented behavior. Conscientious individuals generally are less prone to affective instability and display higher levels of confidence. This makes them less receptive to exposure to idealized physical appearance. Conscientious individuals also have optimal eating habits and are healthier in general which might translate into a more positive appreciation of their bodies. Taken together, there is a reason to consider that conscientiousness might be negatively correlated with body dissatisfaction.
Strengths and limitations
One of the strengths of our study is that it is the first to explore the relationship between personality traits and self-esteem with body image dissatisfaction among young Indian women. We selected the college population for research since this problem has been found to be greater among adolescent and young adult females compared to older women. Nevertheless, our study has certain limitations.
Body image is a multidimensional and complex concept. The BSQ may not have adequately captured the entire range of body image concerns. Second, due to the cross-sectional nature of the study, it is difficult to determine the cause-and-effect relationship between body dissatisfaction, self-esteem, and personality factors as this relationship can be bidirectional. We explored only the Big Five personality traits though other personality factors such as perfectionism and impulsiveness, approach, and avoidance motivation have also been implicated in body image concerns. Another limitation is selection and self-report bias. Since this study is done on college students, extrapolating them to all young women must be done with caution. However, we feel that this population is at the greatest risk for body image and subsequent eating disorders as evidenced by clinical and research data.
This study adds further evidence to the limited but growing literature on the pervasiveness of body dissatisfaction and body image concerns in the Southeast Asian context. A significant percentage of young women in this study had a negative body image associated with low self-esteem and high levels of neuroticism. These findings shed light on the probable areas of intervention that could focus to reduce levels of neuroticism and improve self-esteem and assertiveness. Educational programs in college campuses could help college students become aware about body image concerns and address any misconceptions they have regarding this growing epidemic.
Financial support and sponsorship
This is a self-funded study.
Conflicts of interest
There are no conflicts of interest.
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