Publications from the Centre for Appearance Research (CAR)
Recent publications and key readings in appearance research.
Our research is published in leading academic journals, books, and practitioner articles. You can also view the complete list of publications in the UWE Bristol Research Repository.
Body Image
See below for the most recent CAR publications in the research area of Body Image.
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“I sometimes feel like I can’t win!”: An exploratory mixed-methods study of women’s body image and experiences of exercising in gym settings
Authors: Cowley, Emma S.; Schneider, Jekaterina
Despite an increase in gym memberships, women are less active than men and little is known about the barriers women face when navigating gym spaces. This study explored women’s body image and experiences exercising in gyms. Two-hundred and seventy-nine women (84% current gym-goers; 68.1% White) completed an online mixed-methods survey. Thematic analysis of qualitative data produced four themes and nine subthemes: (1) “Never enough” ([perceived] judgement about appearance, [perceived] judgement about performance); (2) “Often too much” (self-criticism, clothing challenges); (3) “Always on display” (harassment and safety, fighting for space, the appearance contingency); and (4) “Sometimes empowered” (empowering places, empowering self). Qualitative and quantitative data showed that women often feel judged for their appearance and performance, leading to a persistent sense of inadequacy, as well as having to fight for space in the gym and to be taken seriously, while navigating harassment and unsolicited comments from men. Despite this, women showed signs of resistance towards gendered and appearance ideals permeating gym environments and some experienced empowerment through skill acquisition, breaking gender norms, and exercising in supportive environments. Based on our findings, we suggest a multi-level approach to tackling these barriers and creating more inclusive gym spaces for women.
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Understanding fitness professionals’ weight biases and uptake of weight-inclusive practices: Findings from a mixed-methods survey
Authors: Schneider, Kat; Tinoco, Aline; Selmes, Ruby; Scott, Becky; Witcomb, Gemma; Matheson, Emily; Diedrichs, Phillippa
Weight bias is highly prevalent in the fitness industry, posing significant challenges for fat people seeking to engage in health-promoting behaviours, such as physical activity. Despite small ideological shifts in the fitness industry towards more weight-inclusive practices, little is known about fitness professionals’ engagement with such approaches. The aim of the current study was to explore weight bias attitudes among weight-normative and weight-inclusive fitness professionals and factors influencing adoption of inclusive approaches. A mixed-methods survey was conducted among 120 fitness professionals (Mage=34 years; weight-inclusive n=62 [51.7%], weight-normative n=58 [48.3%]) to gather quantitative data on weight bias and attitudes towards working with fat people, and qualitative data on motivations, facilitators, and barriers to adopting weight-inclusive approaches. Weight bias was positively associated with negative attitudes towards working with fat people. Weight-inclusive fitness professionals reported higher empathy (d=–.86), size acceptance (d=–.79), critical health attitudes (d=–.91), and attribution complexity (d=–.78) and less negative attitudes towards working with fat people (d=.81) than weight-normative fitness professionals. Thematic analysis of qualitative data resulted in four higher-order themes: (1) “It’s what the science says”; (2) “It’s what the client wants”; (3) “It’s bad for business”; and (4) “I want to, but I don’t know how”. Fitness professionals who adopted weight-inclusive practices displayed less weight bias and less negative attitudes towards working with people in larger bodies. Qualitative findings highlighted multiple barriers that need to be addressed in order to encourage more fitness professionals to adopt weight-inclusive approaches.
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Cultural adaptation and validation of the Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents
Authors: Haywood, Sharon; Garbett, Kirsty M.; Craddock, Nadia; Hayes, Chloe; Saraswati, L. Ayu; Nasution, Kholisah; Medise, Bernie E.; Vitoratou, Silia; Diedrichs, Phillippa C.
Background Although mental health issues among Indonesian adolescents are of growing concern, a psychometrically valid measure of affect in Indonesia to inform related research and prevention and treatment efforts does not exist. Methods The present study’s aim was to culturally adapt and validate the widely used Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents. The original 30-item PANAS-C in English underwent forward and back translations to Bahasa Indonesia (the national language of Indonesia) followed by cognitive interviews with private and public school students ages 12–15 (n = 18). The adapted PANAS-C and measures to assess convergent validity were completed by 704 Indonesian adolescents from Greater Jakarta and the Javanese city of Surabaya (Mage = 13.56, SD = 0.906) (56.96% girls; 42.75% boys; 0.28% other). Most participants identified their ethnicity as Javanese (72.59%), Betawi (8.24%), or Sundanese (3.41%). Results Exploratory and confirmatory factor analyses were conducted, which resulted in 26 items with a two-factor structure consistent with the original PANAS-C: A 12-item Positive Affect subscale and a 14-item Negative Affect subscale. Internal consistency was satisfactory for the Positive Affect subscale (Cronbach’s alpha was 0.88; McDonald’s omega was 0.88) and excellent for the Negative Affect subscale (Cronbach’s alpha was 0.90; McDonald’s omega was 0.89). Test-retest reliability was acceptable for all items, and convergent validity was confirmed by significant correlations with measures of distress and well-being. Conclusion The adapted PANAS-C was found to be a reliable and valid measure of positive and negative affect that can be used with Indonesian adolescent girls and boys. This is the first validated measure of positive and negative affect for young people in Indonesia, which fills a need in mental health research and practice.
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"Make sure that everybody feels there is a space for them": Understanding and promoting appearance inclusivity at university
Authors: Waite, Emma; Parnell, Jade; Guest, Ella; Harcourt, Diana; Stokes, Rachel; Slater, Amy
Appearance concerns are a pervasive issue affecting many university students and contributing to poor psychosocial and academic outcomes. To combat these, action is needed by universities to promote appearance inclusivity. The current study used inductive qualitative methods to explore students’ lived and/or living experiences and concerns relating to their physical appearance and views on how to achieve an appearance inclusive university. Seventeen students aged 19 to 55 from a UK university participated in online semi-structured interviews (n=12) and focus groups (n=5). Thirteen participants were women, three were men, and one was non-binary. Interviews and focus groups were transcribed verbatim and analysed using reflexive thematic analysis. Students identified several ways appearance concerns had negatively impacted them and supported an increased focus on appearance inclusivity at university. Three themes were developed: 1) appearance has a big impact on my university life; 2) it’s not the same for everyone (i.e., individual differences and intersectionality impact students’ experiences); and 3) intentional change is needed (i.e., change is necessary to improve appearance inclusivity, but it should be consciously thought out). Strategies to improve appearance inclusivity should be prioritised and carefully considered to avoid tokenism and ensure they centre the needs of those from underrepresented groups.
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“Change needs to start at home”: A reflexive thematic analysis of girl athletes’ and coaches’ experiences of body image in New Delhi, India
Authors: Budhraja, Mahira; Schneider, Jekaterina; Tinoco, Aline; Khanna, Preeti; Matheson, Emily L.
Despite the physical, psychological, and social health benefits of sport participation, multiple barriers keep girls and women on the margins of sport in India. Further, body image concerns are implicated globally as a hindrance to sports engagement among adolescents but are rarely acknowledged in India. Due to a lack of research, the unique restrictions to sport participation faced by girls in India are yet to be understood. Drawing on the Sociocultural Theory of Body Image, this study explored the intersection of body image and sports from the perspectives of Indian athletes and coaches. Twelve athletes (girls aged 11–17 years; football n = 6, netball n = 6) and six coaches (football n = 3, netball n = 3) from New Delhi, India, participated in semi-structured focus groups. Reflexive thematic analysis was used and we formulated three themes: 1) “To Do What We Love, We Must Struggle”; 2) “What Will People Say?”; and 3) “Hold On To Your Power, Be You”. The themes provide a nuanced understanding of the experiences of athletes and coaches on and off the playing field. The findings shed light on several individual and systemic factors, such as harassment, societal norms, feelings of empowerment, and internalising appearance ideals, that impact girls’ engagement with sport in New Delhi, India. Methods to improve sports engagement, discrepancies between athlete and coach perspectives, and recommendations for sports organisations to combat body image concerns and improve sports uptake among girls in an Indian setting are discussed.
Visible Difference
See below for the most recent CAR publications in the research area of Visible Difference.
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Body image and appearance distress among military veterans and civilians with an injury-related visible difference: A comparison study
Authors: Keeling, Mary; Harcourt, Diana; White, Paul; Evans, Sarah; Williams, Victoria S.; Kiff, James; Williamson, Heidi
Injuries sustained during military conflict can significantly impact appearance. Yet, little is known about the psychosocial experiences of veterans with conflict-related appearance-altering injuries (AAI) and whether current civilian interventions are appropriate for this group. To inform the development of acceptable and effective support for veterans with appearance–related psychosocial difficulties, this study aimed to identify factors associated with psychosocial adjustment to an altered appearance among both veterans and civilians with AAI. A cross-sectional online survey was completed by 121 veterans and 197 civilians who had sustained AAI. Multivariable regression was used to examine factors related to adjustment in the two groups. Overall, both groups reported similar experiences, with some key exceptions. Veterans reported significantly greater depression and Post Traumatic Stress Disorder, significantly lower Body Image (BI) psychological flexibility, BI life engagement, and higher perceived appearance-related stigma. BI psychological flexibility was identified as a key predictor of appearance-related outcomes in both groups. Self-compassion predicted social anxiety and depression symptoms in both groups, but only appearance outcomes among civilians. Based on these identified associated factors, it is suggested that both groups, but particularly veterans, may benefit from an Acceptance and Commitment Therapy-based intervention, including explicit self-compassion activities, and practical social skills training.
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"Make sure that everybody feels there is a space for them": Understanding and promoting appearance inclusivity at university
Authors: Waite, Emma; Parnell, Jade; Guest, Ella; Harcourt, Diana; Stokes, Rachel; Slater, Amy
Appearance concerns are a pervasive issue affecting many university students and contributing to poor psychosocial and academic outcomes. To combat these, action is needed by universities to promote appearance inclusivity. The current study used inductive qualitative methods to explore students’ lived and/or living experiences and concerns relating to their physical appearance and views on how to achieve an appearance inclusive university. Seventeen students aged 19 to 55 from a UK university participated in online semi-structured interviews (n=12) and focus groups (n=5). Thirteen participants were women, three were men, and one was non-binary. Interviews and focus groups were transcribed verbatim and analysed using reflexive thematic analysis. Students identified several ways appearance concerns had negatively impacted them and supported an increased focus on appearance inclusivity at university. Three themes were developed: 1) appearance has a big impact on my university life; 2) it’s not the same for everyone (i.e., individual differences and intersectionality impact students’ experiences); and 3) intentional change is needed (i.e., change is necessary to improve appearance inclusivity, but it should be consciously thought out). Strategies to improve appearance inclusivity should be prioritised and carefully considered to avoid tokenism and ensure they centre the needs of those from underrepresented groups.
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A multi‐centre prospective cohort study investigating the roles of psychological flexibility and self‐compassion in appearance concerns after burn injuries
Authors: Shepherd, Laura; Sirois, Fuschia M.; Harcourt, Diana; Norman, Paul; Aaron, David; Adkins, Kate; Cartwright, Anna; Hodgkinson, Emma; Murphy, Nicola; Thompson, Andrew R.
Objectives: Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. Design: A multi-centre prospective cohort study across six burns services. Methods: Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. Results: Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e., gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. Conclusions: Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e., acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.
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Early appearance concerns after burns: Investigating the roles of psychological flexibility and self-compassion
Authors: Shepherd, Laura; Sirois, Fuschia; Harcourt, Diana; Norman, Paul; Thompson, Andrew R.
Few qualitative studies have explored appearance concerns soon after burn injuries. This study aimed to understand the early experiences of appearance concerns after burns, through the lens of psychological flexibility and self-compassion. Template analysis informed data collection and analysis. Fifteen adults (nine female, six male) with appearance concerns were interviewed within three months of their burns. Three superordinate themes were identified: (1) Need for social connection; (2) Distress through difference; and (3) Experiential avoidance and self-criticism in response to early appearance concerns. Findings highlighted that early appearance concerns are influenced by the need for social acceptance and the desire to conform to societal ideals. Internalised gender and appearance ideals and concerns about rejection and stigma were activated by the burn, and individuals had difficulty responding to their early appearance concerns with psychological flexibility and self-compassion. Instead, attempts to avoid distress (experiential avoidance) occurred. Self-criticism in response to distress was evident which, for some, extended to the event leading to their burns. Early interventions to enhance psychological flexibility and self-compassion (e.g., acceptance and commitment therapy, mindful self-compassion), to help individuals respond to appearance concerns with less experiential avoidance and self-criticism, would likely promote adjustment to changes in appearance after burns.
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Cross-condition risk and protective factors for psychosocial distress in parents and carers of children and young people with appearance-affecting conditions and injuries
Authors: Thornton, Maia; Harcourt, Diana; Deave, Toity; Kiff, James; White, Paul; Williamson, Heidi
Alongside typical parenting challenges, initial condition-specific research suggests that parents of children with different visible differences may experience similar psychosocial difficulties. Despite this, large-scale cross-condition research to identify risk and protective factors for parental distress and psychosocial adjustment has been lacking. Two hundred and nine parents and carers of children with a range of visible differences completed an online survey comprised of standardised outcome measures, study-specific measures, and open-ended questions. Multiple regression modelling identified possible risk and protective factors, and data collected via open-ended questions were analysed using content analysis. Findings support themes previously identified in small-scale cross-condition qualitative research with parents of children with visible differences. Risk factors for parental negative affect and stress included parental reports of the noticeability of their child's visible difference and teasing. Protective factors included good parent-child communication, self-compassion, knowledge of their child's condition and satisfaction with treatment. The risk and protective factors identified provide important insight into the experiences of this parent population and indicate possible avenues for psychosocial intervention.
Key readings in appearance research
Below are popular publications authored by our CAR members who are experts in their field and represent best practice thinking.
- Clarke, A., Thompson, A. R., Jenkinson, E., Rumsey, N. and Newell, R. (2014) CBT for appearance anxiety. Wiley Blackwell.
- Rumsey, N. and Harcourt, D. (2012) Oxford Handbook of the Psychology of Appearance. Oxford University Press.
- Rumsey, N. and Harcourt, D. (2005) The Psychology of Appearance. Open University Press.
- Rumsey, N. and Harcourt, D. (2004) Body image and disfigurement: issues and interventions. Body Image. 1(1), pp. 83-97.
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