Body Image Disturbance
Audrey Klopp, RN, PhD,
ET, CS, NHA
NANDA: Disruption in the way one perceives one's body image
Body image is the attitude a person has about the actual or
perceived structure or function of all or part of his or her body. This
attitude is dynamic and altered through interaction with other persons and
situations and is influenced by age and developmental level. As an important
part of one's self-concept, body image disturbance can have profound impact on
how individuals view their overall selves.
Throughout the life span, body image changes as a matter of
development, growth, maturation, changes related to childbearing and pregnancy,
changes that occur as a result of aging, and changes that occur or are imposed
as a result of injury or illness.
In cultures where one's appearance is important, variations from
the norm can result in body image disturbance. The importance that an
individual places on a body part or function may be more important in
determining the degree of disturbance than the actual alteration in the
structure or function. Therefore the loss of a limb may result in a greater
body image disturbance for an athlete than for a computer programmer. The loss
of a breast to a fashion model or a hysterectomy in a nulliparous woman may
cause a serious body image disturbance even though the overall health of the
individual has been improved. Removal of skin lesions, altered elimination
resulting from bowel or bladder surgery, and head and neck resections are other
examples that can lead to body image disturbance. The nurse's assessment of the
perceived alteration and importance placed by the patient on the altered
structure or function will be very important in planning care to address body
- Situational changes (e.g., pregnancy, temporary presence of a
visible drain or tube, dressing, attached equipment)
- Permanent alterations in structure and/or function (e.g.,
mutilating surgery, removal of body part [internal or external])
- Malodorous lesions
- Change in voice quality
- Verbalization about altered structure or function of a body
- Verbal preoccupation with changed body part or function
- Naming changed body part or function
- Refusal to discuss or acknowledge change
- Focusing behavior on changed body part and/or function
- Actual change in structure or function
- Refusal to look at, touch, or care for altered body part
- Change in social behavior (withdrawal, isolation, flamboyance)
- Compensatory use of concealing clothing or other devices
Patient demonstrates enhanced body image and self-esteem as
evidenced by ability to look at, touch, talk about, and care for actual or
perceived altered body part or function.
- (i) independent
- (i) Assess perception of change in structure
or function of body part (also proposed change).
- The extent of the response is more related to the value or
importance the patient places on the part or function than the actual value or
importance. Even when an alteration improves the overall health of the
individual (e.g., an ileostomy for an individual with precancerous colon
polyps), the alteration results in a body image disturbance.
- (i) Assess perceived impact of change on
activities of daily living (ADLs), social behavior, personal relationships, and
- (i) Assess impact of body image
disturbance in relation to patient's developmental stage.
- Adolescents and young adults may be particularly affected
by changes in the structure or function of their bodies at a time when
developmental changes are normally rapid, and at a time when developing social
and intimate relationships are particularly important.
- (i) Note patient's behavior regarding
actual or perceived changed body part or function.
- There is a broad range of normal behaviors associated with
body image disturbance, ranging from totally ignoring the altered structure or
function to preoccupation with it.
- (i) Note frequency of self-critical
- (i) independent
- (i) Acknowledge normalcy of emotional response
to actual or perceived change in body structure or function.
- Stages of grief over loss of a body part or function is
normal, and typically involves a period of denial, the length of which varies
from individual to individual.
- (i) Help patient identify actual
- Patients may perceive changes that are not present or real,
or they may be placing unrealistic value on a body structure or
- (i) Encourage verbalization of positive or
negative feelings about actual or perceived change.
- It is worthwhile to encourage the patient to separate
feelings about changes in body structure and/or function from feelings about
- (i) Assist patient in incorporating actual
changes into ADLs, social life, interpersonal relationships, and occupational
- Opportunities for positive feedback and success in social
situations may hasten adaptation.
- (i) Demonstrate positive caring in routine
- Professional caregivers represent a microcosm of society,
and their actions and behaviors are scrutinized as the patient plans to return
to home, work, and other activities.
Education/Continuity of Care
- (i) independent
- (i) Teach patient about the normalcy of body
image disturbance and the grief process.
- (i) Teach patient adaptive behavior (e.g.,
use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body
part or enhances remaining part or function, use of deodorants, and
- To compensate for actual changed body structure and
- (i) Help patient identify ways of coping
that have been useful in the past.
- Asking patients to remember other body image issues (i.e.,
getting glasses, wearing orthodontics, being pregnant, having a leg cast) and
how they were managed may help patient adjust to the current issue.
- (i) Refer patient and caregivers to
support groups comprised of individuals with similar alterations.
- Lay persons in similar situations offer a different type of
support, which is perceived as helpful (EXAMPLES: United Ostomy Association, Why Me?, I Can Cope,
Body Image Enhancement; Grief Work Facilitation; Coping
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