Looking through a broken mirror: Understanding distorted body image in children and teens

Most of us can relate to the feeling of not liking something about our appearance: wishing you were taller, had a smaller nose, or a flawless complexion. Some of these imperfections may bother us, but we accept them as part of being human, and don’t let them interfere too much with our daily lives.

Children and teens with a distorted body image, however—as seen in eating disorders—spend hours focusing on their real or perceived flaws. “When negative thoughts about body image get so overwhelming and distressing that they interfere with a child’s or teen’s daily functioning, that should be a red flag that something more is going on,” says Dr. Holly Agostino [1], a specialist in Adolescent Medicine at the Montreal Children’s Hospital.

What is body image distortion?

Body image distortion is characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance. “These individuals see their body in a way that is different from how others see them, and they don’t have the ability to believe people who tell them they look fine,” explains Dr. Agostino.

In reality, a perceived defect may be very slight or nonexistent, but for someone with distorted body image the flaw is significant and prominent, often causing severe emotional distress and difficulties with daily functioning. Children or teens may miss work or school, avoid social situations and isolate themselves, even from family and friends.

“This distorted body image is what can fuel dangerous habits and attempts to control or change the perceived flaws, sometimes through drastic measures like controlling food intake or doing excessive exercise to ‘fix’ the problem,” says Dr. Agostino.

How does distorted body image differ from normal teenage preoccupation with appearance?

Children and teens who struggle with body dysmorphia can find it difficult to focus on anything other than their perceived flaws and defects.

A teen struggling with body dysmorphia might:

Focus disproportionately on one or a handful of flaws when talking about his or her body;
Refuse to believe that they look fine, even after repeated reassurance from family and friends;
Express deep fears about gaining weight (if weight is the primary focus), not being able to cover up the flaw, etc.
Retreat from family and friends, preferring to be isolated;
Miss school or work because they fear others will notice their flaws;

What can parents do to help?

“It’s very important for parents to talk to their children if they notice changes in their child’s behaviour, particularly in how they talk about themselves and their bodies,” says Dr. Agostino.

“Parents have a great deal of influence in their children’s lives and it’s important to remember that kids will model the behaviour they see around them.”

If as a parent you are concerned about your child’s continued behaviour, it may be a good idea to speak to a medical professional about the changes you’ve observed. “The earlier a child or teen receives treatment, the better are the chances that they will make a full recovery,” says Dr. Agostino.

For more information about eating disorders and body dysmorphia, visit the following websites:

Anorexia and Bulimia [2]Quebec
National Eating Disorder Information Centre [3]