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“Body Image and Self-Esteem in Adolescence” Program Transcript

NARRATOR: In this program, Dr. John Sommers-Flanagan discusses the challenges teens face as they navigate the many physical changes associated with adolescence. He is joined by Brian Taggart, who describes the Trapper Creek Job Corps program, and a group of Trapper Creek teens, who have a candid discussion about poor body image in adolescence.

JOHN SOMMERS-FLANAGAN: I would like to begin by saying that I love to work with adolescents. And the reason I love to work with adolescents is because they're so engaged, they're so present, they're so genuine, and there are so many things happening to them and with them in their lives. And some of the things that are happening include all the social media now and the huge peer pressure in peer relationships, sometimes conflicts between the adolescents and their parents. If any of you have ever been a parent of an adolescent, you know that sometimes those conflicts can just occur. And it can be a big challenge.

They are also, I think--and this is one of the things that really bugs me about American culture is I think oftentimes we dismiss or discount adolescents. And we say, oh, it's just a teenager. And sometimes I think that message gets conveyed to adolescents, and as a consequence, they actually feel worse about themselves. And so if it's OK, I'd like to begin with the story. And this is a story of when one of the things that adolescents go through so much has to do with physical change and physical development, puberty and other kinds of physical and emotional changes that happen so rapidly.

I was doing a lecture at a local high school. I was asked to talk about the physical developmental changes that occur during adolescence. I was with a group. And I strayed away from my notes, and I was sharing with them some of the physical changes that happen that both male and female adolescents may not be all that happy about. So I talked about skin issues and acne and that those kinds of things can be really hard and difficult to young people and their body image and their self esteem. And I talked about breast development. And I talked about pubic hair development. And of course, they're getting more and more reactive as I talk about the real physical changes that happen. And I remember at one point talking about the physical changes that happen in young men in particular when one student in the class, he jumped up. I remember very vividly, he jumped up and he said, shut up, just shut up, which I took to mean he didn't really want to talk about these things. And in fact, I did shut up at that point for a little while and said, what's going on? And I think what the story tells me is that there's so much going on physically and emotionally for teenagers or adolescents that sometimes it's really hard for them to talk about it. And because the story has to do with body image, I thought I also should talk some about body image and how much of a struggle that is for teenagers and adolescents.

BRIAN TAGGART: Trapper Creek Job Corps is a training program for disadvantaged youth ages 16 to 24. It's a place where students can get their education and get a trade skill in nine different trade areas. I want to say it's a safe and secure, drug and alcohol-free free center for redirecting their lives and making positive impacts in their lives.

Currently at Trapper Creek Job Corps we have 216 students enrolled, and our capacity is 224. And the ratio of males to females is three to one.

What makes Trapper Creek Job Corps a great place to work is the impact that you make on these young adults' lives, mentoring and teaching them skills, helping them with their education. You're like their friend to them, a positive influence in their lives where you can change their lives. The reward is when they give you a call back and say, Mr. Taggart, I really appreciate what you've done for me, and this is what I'm doing now. My life is going well. And that's what it comes down to is that callback that you've made an impact. And if it's just one student, that makes it worthwhile.

FEMALE SPEAKER: There are many physical changes that take place during the teen years. What physical changes do you think are most difficult for teenagers to deal with?

MALE SPEAKER: Like facial hair. That was pretty bad.

FEMALE SPEAKER: Facial hair is one.

MALE SPEAKER: Yeah and hormones and change in attitude and how you think about things and how you have an outlook on life. You actually need to get stuff done now. You're not just a little kid anymore.

MALE SPEAKER: Acne. I hate acne. It's horrible. It's horrible.

FEMALE SPEAKER: Definitely.

MALE SPEAKER: It's the worst thing.

JOHN SOMMERS-FLANAGAN: The media and peers and sometimes parents have begun to influence very strongly how young people think about their bodies and in particular thinness and muscular development has become really crucial for young women and young men. I have worked with many adolescent males who end up taking far too many stimulants so that they can look like they're ripped, just like all the guys on television who have six packs. And I've worked with many young adolescent girls who are incredibly self-conscious about their size and the shape of their body.

I think some research shows that even second and third graders are often very dissatisfied with their body size. And this leads us to some of the more significant

problems that can happen during adolescence. And one of the big problems is eating disorders. And there are two main eating disorders that we generally think about when we think about the adolescent or teen years, one being anorexia nervosa and the other one bulimia nervosa. And both of those disorders happen, they begin to happen during the adolescent years. Usually about 1% of adolescent females experience anorexia, and about 2% to 3% percent experience bulimia. Anorexia being a condition where they have dieted or they've used laxatives or they've overexercised in ways that have reduced their weight to way below what it should be for their height. And so what we find is with anorexia in particular, anorexia is well known as one of the most fatal of all mental disorders. And in fact, untreated, the fatality rate for anorexia is around 20%, which is huge. This speaks to how important it is for us to help young women--I say young women because oftentimes they like to be called that--to help them feel more comfortable with their body image.

If we think about what causes anorexia, what causes negative body image, there are a number of different factors that contribute to the development of negative body image and possibly anorexia. These include maybe some genetic predisposition. It also includes sometimes perfectionistic personality style. It might include some parents or a family system that's a little bit overly perfectionistic, overly focused on performance and control. It also is very much associated with the American culture's emphasis on thin bodies and that we have an image-based society. And we see, all the time, females in magazines, on television, in the movies who are looking incredibly thin and virtually have no pores at all in their bodies. And so they look perfect. And I think many adolescent females really try to strive toward that ideal. And it can be very destructive.

Peers are also a big influence. Young women, adolescent females, they commonly will criticize one another, and they'll comment on their body sizes. And those comments can increase the self-consciousness to even higher levels. So all those factors sort of come together to probably be some of the causal factors in anorexia as well as bulimia. And bulimia being sort of a somewhat different kind of a disorder, one that involves generally binge eating and purging, oftentimes vomiting or the use of laxatives in order to purge or to eliminate extra calories that have been eaten.

What we find in terms of base rates is that it's really hard to know exactly how many male and female adolescents are affected by these particular disorders. But it's certainly very prevalent. It tends to be on the rise. The rates have doubled since the 1960s. This is a very serious issue for us to try to assist adolescent males and females with.

FEMALE SPEAKER: Sometimes teenagers feel bad about their bodies. Have you noticed this in yourselves or in your friends?

MALE SPEAKER: Yeah. You'll see your friend one day. They could be fine. Then they rip out their hair. They have to have this. They have to have it like that. It's about their appearance instead of just being themselves.

FEMALE SPEAKER: So they're worried about if anything is just right.

MALE SPEAKER: Yeah. Have to be perfect.

FEMALE SPEAKER: Has to be just perfect.

FEMALE SPEAKER: Just being in the dorm, I have friends who come and ask me, how do I look, do I look good, and everything. And I think it's just how our society is now, like how women have to be really skinny and everything. Now it's like all girls have to be in good shape and all that. Some people are not really happy like how they look on the outside.

FEMALE SPEAKER: There's a lot of pressure to look a certain way, one certain way. You have to be thin and healthy.

JOHN SOMMERS-FLANAGAN: Another body-image-related disorder that adolescent males and females can experience is called body dysmorphic disorder. That's sort of a mouthful. But body dysmorphic disorder really involves an excessive preoccupation with some aspect of one's body. And in particular, it seems to usually be manifested through preoccupation with some facial feature, a nose, feeling like it's maybe a little bit too big, or asymmetrical size of the eyes. These kinds of preoccupations can become really debilitating when young people begin to not be able to think of much else when they're in public other than some defects in usually their face, but maybe in their whole body. And that preoccupation and that anxiety that comes up associated with thinking about that possible defect really interferes with their ability to function in many different ways. And so body dysmorphic related to body image in general, but really a very specific psychiatric condition and one that can be problematic during adolescence.

Developmentally, adolescents are especially prone to or susceptible to body image issues. And probably the biggest developmental issue that's going on for them that contributes to their sensitivity or their proneness to these problems is self- consciousness. What we find that emerges during adolescence maybe more than any other time is they are conscious of themselves. And most of us can remember back to our elementary school years when things were a little more breezy and we said and did things and we didn't worry so much. We weren't quite so self-aware. And so self-consciousness and self-awareness really begins to peak during the adolescent years.

I can remember a little story of myself as I used to, in middle school, stand in the hall and kind of act like I was cool, watching people walk by and maybe making comments about them. And I remember one time thinking, wow, that person who just walked by has terrible B.O. And I was thinking, whoa, that is just disgusting. And then somebody else walked by, and I thought, oh, man, somebody else has really bad B.O. And the next day, I noticed it again until finally, the third day, I thought to myself, oh, no, it's me. I'm the one who smells terrible. And I think, for me, that

illustrates how kind of suddenly during adolescence we, because of those physical changes, as well as the cognitive changes, become much more aware of ourselves. And we monitor our bodies in ways that we never did before.

It's also true that during adolescence, we become more capable of thinking about how we might look from someone else's perspective. It's the ability cognitively to change perspective, to look at ourselves from another person's eyes. And oftentimes during adolescence we become much more sensitive to how we might look, even though, in reality, most of the rest of the adolescents are walking around and are worried about how they look and maybe aren't as preoccupied with how we look as we think they are. And so those are couple of the main developmental factors that contribute to body image difficulties and possibly anorexia and bulimia.

Many adolescents, I think, really believe that they're alone and that nobody could really understand them and that nobody really understands how I feel, nobody understands what it's like to be me. And so I think for individuals, for professionals who work with adolescents, it is essential for us to have empathy for what it's like to be an adolescent. It's also essential because early intervention, being able to identify and intervene with body image problems and, in particular, with anorexia or bulimic behaviors, really important. Because when those behaviors take hold, when someone engages in restrained eating for long periods of time or when they periods of time, those behaviors become more and more ingrained, more and more natural to the individual who's engaging in them. And it becomes more and more difficult to change. So early intervention is important because we want to reach the adolescents before the behaviors become deeply ingrained. It's also important because, as we know, about 20% of untreated individuals with anorexia actually die from the disorder, whereas if they receive treatment, only 2% to 3% die from the disorder. That's a huge difference.

We also know that body dysmorphic disorder can result in this chronic dissatisfaction with how an adolescent views himself or herself and that body dysmorphic disorder is associated with increased rates of suicide in adolescents. So those are some of the maybe most important reasons that we need to be aware of these issues and we need to have empathy with adolescents for how it is to be an adolescent or teenager.