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Analize – Journal of Gender and Feminist Studies • New Series • Issue No 2 / 2014
Why Adolescents Are Not Happy With Their Body Image?
Cristina Nanu, Diana Tăut, Adriana Băban
Adolescent girls are highly aware of their appearance and invest significant cognitive and emotional
resources in their relation with the physical body. A plethora of studies illustrate that in this
developmental period, girls are over-concerned with weight and shape and are susceptible to adopt
unhealthy appearance management strategies. The article aims to investigate characteristics of body
image in adolescence as well as factors that contribute to body image dissatisfaction. We analyze the
importance of appearance for adolescent girls by looking at its effects on self-esteem and at its role in
social relations. We also focus on the mechanisms that shape the attitude toward body image by
exploring how messages from media and significant others are received and internalized. Last, we
analyze empirical data available for Romanian girls and suggest possible key areas for interventions.
Adolescence is a time period with significant physical changes to which the person has to adjust.
Among significant challenges, first intimate relationships bring to front the relevance of physical
attractiveness in self-evaluation. This context facilitates a focus of attention on the physical body which
is analyzed, compared and evaluated against the appearance of peers and the social norms. Body
image, as “a person’s perceptions, thoughts and feelings about own body”, becomes one of the central
focuses of adolescents (Grogan, 2008, p.3). The perceptive dimension refers to the mental
representation of the physical body. Thoughts and feelings contribute to the attitude dimension.
Regarding the attitude toward body, researchers distinguish between appraisal of appearance
(satisfaction / dissatisfaction) and the importance placed on appearance (Cash & Pruzinski, 2002).
Studies show that, in adolescence, body image is more relevant for self-esteem compared to adulthood
(Grogan, 2008). Girls’ ideal of thinness becomes evident even in preadolescence with some studies
showing that around 50% of girls aged 9 to 12 years old would like to have a thinner body (Sands &
Wardle, 2003). Also, girls prefer to be underweight rather than having a weight above average: girls
aged 9 to 18 years old with BMI above the 50th percentile were more dissatisfied with their body image
compared to girls below the 50th percentile (Calso, Sonneville, Haines, Blood, Field, & Austin, 2012).
For these reasons, more and more adolescents resort to cosmetic surgeries in order to alter parts of
their body. From less invasive procedures such as Botox injections to more extensive and complicated
cosmetic surgeries, the interventions have a single purpose: to improve appearance. Studies show that
these procedures are considered an option especially when a person experiences high levels of body
shame and uses appearance fixing as a strategy to cope with dissatisfaction. In high developed
societies, cosmetic surgery is perceived as a routine if the shape of body and/or face doesn’t
correspond with the ideal standards. If in Asian societies, the tendency is to alter the traditional face
traits, in Western Europe and United States of America, teenage girls are mostly preoccupied with their
weight and body shape. They develop specific criteria of evaluating physical appearance such as a flat
abdomen or a small waist. Another criterion, with high impact due to social media is the so called “thigh
gap” which is the presence of a space between the inner thighs when a girl stands with her feet together
(Tyler, 2013). It is known as thigh gap and it can be achieved only with severe dieting and in the
presence of a specific body structure.
Facial surgery: body and soul
Isaac J Peled

Plastic surgery has developed during the past half century, widening its range and offering better
solutions to many medical and Isaac J Peled surgical problems. The main aim of this type of surgery is
to improve or reconstruct different types of defects. Obviously, exposed areas are the main concern of
the patients who seek the help of plastic surgeons, and the face, being our "introduction card",
generates "great demand for plastic surgery. The importance of looking good is already well known and
scientifically proven. Good-looking people have better chances, and this is true even very early in life.
We know that certain improvements in the appearance of children with congenital malformations result
in a positive change in the attitude of society. Let us remember Menkin's phrase: "Beauty is a letter of
recommendation that we get without asking for it." When we consider facial plastic surgery—operations
on the most exposed area of our body--we mean all the Correction of protruding ears procedures that
can and should be performed in treating the body and soul of our patients. Facial plastic surgery
includes reconstruction of facial defects after surgery for malignant or benign soft-tissue tumors,
congenital malformations such as clefts, craniofacial and maxillofacial defects, the features associated
with Down's syndrome, absence of the external ear, alopecia, and so on. Malignant skin tumors of the
face are very common, especially in light-skinned patients, and they start to appear at a relatively young
age. Surgical excision is still the best treatment. If we excise the tumor completely, the patient is
probably cured of the cancer, but the aesthetic result is also extremely important. Modern plastic
surgery consists not only of the excision and leaving the defect for secondary healing, it also includes
the immediate closure of the defect with the most suitable procedure for the best possible--or at least
a pleasant--aesthetic result. Most patients who consult plastic surgeons about malignant tumor of the
face are very concerned about their appearance after surgery and will decide about the operation in
relation to the final aesthetic result of the operated facial area. Aesthetic surgery, the importance of
which has increased substantially, offers the possibility of improvement in almost every area of the
The different procedures that are available have a sequential frequency at different ages. At an
early age we do surgery for congenital deformities, most commonly cleft lip and palate. Later on, there
is correction of protruding ears, and in the teen’s nasal surgery and removal of birthmarks and tattoos
when they become a stigma. The simplicity and safety of these procedures are well represented in the
correction of protruding ears. Corrective cosmetic tonoplast (figure) is performed with modern
techniques, without scars, under local anesthesia, on an ambulatory basis, and with simple surgical
instruments. At later ages, the most popular procedures include surgery of the eyelids, facial wrinkles,
lip enhancement, skin resurfacing, suction-assisted lipectomy (liposuction), fat injection, and hair
transplantation. Aesthetic surgery is still regarded as a non-essential procedure, which can only be
afforded by certain people. This concept is false, because aesthetic surgery is a component of almost
all procedures in plastic surgery. The reason for the different classification of plastic and Aesthetic
surgery is that many procedures classified as aesthetic are not covered by medical insurance. Women
with underdeveloped breasts can be easily and successfully treated, but augmentation mammoplasty
is an aesthetic procedure not covered by medical insurance; however, correction of gynecomastia in
men, a similar physical and psychological problem, is not regarded as an aesthetic procedure and is
covered by medical insurance. The proportion of aesthetic procedures in different countries varies
widely and is in direct relation to the economy of the country, the availability of this type of surgery at
public institutions, and surgical fees. I presume that if aesthetic surgery was covered by insurance or
was available for a minimal fee, it would be one the most common surgical procedures. Plastic surgery
is continuously changing in search of better results, safer operations, negligible or no scars, and fast
healing and recovery. Most esthetic operations do not require a sophisticated armamentarium and can
be done under local anesthesia, on an ambulatory basis, and in simple facilities. The introduction of
expensive instrumentation and procedures, for example different types of lasers, fibrotic endoscopes,
and external and internal ultrasound-assisted lipectomy, has not proved essential and often the reason
to use these is more for marketing purposes than for strict medical indications. Publicity spreads the
word and nowadays information about plastic surgery is easily available to the general population. This
spread of information may increase the interest and demand of the public in future. Modern medicine
should offer a wide range of safe and successful aesthetic surgical procedures.

The Lancet Perspectives ° 356 • December ° 2000 s46

Bullying is a widespread problem in our schools and communities and has a negative impact on
school climate and on students’ right to learn in a safe and secure environment without fear. Once
thought of as a rite of passage or harmless behavior that helps build character, bullying is now known
to have long-term academic, physical, and emotional effects on both the victim and the bully. A
student is being bullied when he or she is “exposed, repeatedly and over time,” to abuse or
harassment by one or more other students (Olweus, 1996). The goal of the bully is to gain power over
and dominate other individuals. There are three forms of bullying: physical (including hitting, kicking,
spitting, pushing, stealing, and destruction of property), verbal (such as taunting, malicious teasing,
name calling, and making threats), and psychological (including spreading rumors, manipulating
social relationships, exclusion from a peer group, extortion, and intimidation) (Cohn and Canter, 2003;
Office of Juvenile Justice and Delinquency Prevention, 2001; Koki, 1999; National Resource Center
for Safe Schools, 1999). Bullying has two key components: physical or psychological intimidation
occurring repeatedly over time and an imbalance of power. Taunting, teasing, and fighting don’t
constitute bullying when two persons are of approximately the same physical or psychological
strength. Bullies engage in hurtful behavior against those who can’t defend themselves because of
size or strength, or because the victim is outnumbered or less psychologically resilient (U.S.
Department of Justice, 2004; Northwest Regional Educational Laboratory, 2001; Olweus, 1993).
American Federation of Teachers. (2000). Building on the Best, Learning from What
Works: Five Promising Discipline and Violence Prevention Programs. Washington,
D.C.: Author. Retrieved from http://www.aft.org/pubs-reports/downloads/teachers/
Four Decades of Research on School Bullying 2007), and the National Association of School
School bullying has been around for as long as Psychologists (2012). However, assessments of
anyone can remember, featured in Western bullying do not always emphasize these
literature for over 150 years (e.g., Charles Dickens’s components (see Hamburger, Basile, & Vivolo,
Oliver Twist [Dickens, 1839/1966]; Thomas Hughes’s 2011, Compendium of Assessment Tools), making
Tom Brown’s School Days [Hughes, 1857/1892]). distinctions between bullying and other forms of
Today, bullying permeates popular culture in the aggression less clear (see Rodkin, Espelage, &
form of reality TV and violent video games, and in Hanish, 2015). Moreover, children’s descriptions of
our free-market, capitalist society. In contrast, bullying rarely include these definitional criteria
empirical research on bullying is a relatively recent (Vaillancourt et al., 2008), leading many researchers
focus, the earliest studies emerging in the 1970s in to provide definitions of bullying in their
Scandinavia (Olweus, 1978). In North America, assessments. Much debate exists regarding the best
public concern about school bullying increased method and informant for assessing bullying and
dramatically in the late 1990s, owing in large part to victimization (e.g., Cornell & Cole, 2012; Swearer,
the tragic deaths of our youth by suicide (Marr & Siebecker, Johnsen-Frerichs, & Wang, 2010), with
Fields, 2001) or murder, especially the 1997 murder measurement issues heralded as the “Achilles heel”
of Rina Virk (Godfrey, 2005) and the Columbine of bullying research (Cornell, Sheras, & Cole, 2006).
massacre in 1998 (Cullen, 2009). Since then, bullying Although some suggest use of multiple informants
has received unprecedented attention in the media to establish psychometric adequacy (e.g., Juvonen,
and in academia, both nationally and internationally Nishina, & Graham, 2001), the reality of assessing a
(e.g., Jimerson, Swearer, & Espelage, 2010; Smith, complex, underground behavior involving multiple
Pepler, & Rigby, 2004; Swearer, Espelage, participants and influenced by multiple factors is
Vaillancourt, & Hymel, 2010), and remains a that there may be no single “gold standard” for
significant concern among parents and educators. accuracy. Bullying has been assessed via parent,
Inspired by the 2011 U.S. White House Conference teacher, and peer reports, as well as direct
on Bullying, hosted by President and First Lady observations, but most rely on self-report
Obama and the Department of Education, this assessments, despite concerns about biases related
special issue was undertaken, inviting recognized to social desirability, self-presentation, and/or fear
scholars to critically review current research and of retaliation (Pellegrini, 2001). Self-reports are
theory on school bullying, in an effort to inform economical and efficient, and give youth a much-
future research and practice. Here, we describe deserved voice in the assessment process, tapping
some of what we have learned over the past 40 perceptions of both victims and perpetrators.
years, setting the stage for the five articles that Although more time consuming, peer assessments
comprise this special issue. are viewed as an alternative to self-reports (e.g.,
Cornell & Cole, 2012), especially given observational
What Is Bullying and How Do We evidence (Pepler, Craig, & O’Connell, 2010) that
Assess It? peers are present in at least 85% of bullying
Following the pioneering work of Olweus (1978, incidents. Based on information from multiple
1999, 2001), bullying has been defined as a informants, peer assessments can provide unique
subcategory of interpersonal aggression information about bullying. For example Chan
characterized by intentionality, repetition, and an (2006) identified two major patterns of bullying
imbalance of power, with abuse of power being a using peer reports. “Serial bullies,” named as
primary distinction between bullying and other perpetrators by multiple victims, accounted for
forms of aggression (e.g., Smith & Morita, 1999; nearly 70% of victim reports. Most of the remaining
Vaillancourt, Hymel, & McDougall, 2003). Scholars reports reflected “multiple victimization,” with
generally endorse these characteristics, as does the several perpetrators bullying the same individual.
U.S. Centers for Disease Control (Gladden, Vivolo- Self- and peer-reports, however, demonstrate only
Kantor, Hamburger, & Lumpkin, 2014), the modest correspondence (r range _ .2 to .4; Branson
American Psychological Association (VandenBos, & Cornell, 2009; Crick & Bigbee, 1998; Graham &
Juvonen, 1998; Österman et al., 1994; Pellegrini, report more bullying than girls, but girls report more
2001). Teacher and parent reports are more victimization (e.g., Cook, Williams, Guerra, Kim, &
suspect, given that bullying occurs primarily in the Sadek, 2010; Olweus, 1993). Developmentally, peer
peer group, especially in places with little adult bullying is evident as early as preschool, although it
supervision (e.g., Vaillancourt, Brittain, et al., 2010). peaks during the middle school years and declines
Parents often have limited knowledge of what somewhat by the end of high school (e.g., Currie et
happens at school, and teachers may not actually al., 2012; Espelage & Swearer, 2003; Vaillancourt,
witness bullying (Cornell & Brockenbrough, 2004) or Trinh, et al., 2010).
may choose to ignore it (Craig, Pepler, & Atlas,
2000). Rather than debating the superiority of one The Many Faces of Bullying
approach over another, we echo Juvonen et al. Bullying takes many forms, from direct physical
(2001) that these be considered complementary harm (physical bullying); to verbal taunts and
sources of information, each contributing to our threats (verbal bullying); to exclusion, humiliation,
understanding of bullying. Moreover, selection of an and rumor-spreading (relational or social bullying);
assessment approach depends on the nature of the to electronic harassment using texts, e-mails, or
research questions. If the accurate identification of online mediums (cyberbullying1). Although physical
victimized children is the focus, Phillips and Cornell and cyberbullying are often of greatest concern,
(2012) have demonstrated the utility of using a social and verbal bullying are the more common
combination of peer assessments, confirmed forms experienced by students. For example,
subsequently through interviews by school Vaillancourt, Trinh, et al. (2010) found that 31% of
counselors, underscoring the value of investing Grade 4 through 12 students reported being
greater efforts to assure accuracy in identification. physically bullied by peers and 12% reported being
A primary focus has been on evaluating school- cyberbullied, whereas 51% and 37% reported being
based interventions (see Bradshaw, 2015), for which verbally and socially bullied, respectively. Students
peer reports may be less sensitive to change over are often aware of rules prohibiting physical harm
time than self-reports, as they are often based on to others, but verbal and social bullying are more
reputations that may not shift despite behavior difficult to identify. Adults rely on youth to report
changes (Hymel, Wagner, & Butler, 1990;Juvonen et bullying, especially in its more covert forms, and
al., 2001). At the same time, Frey, Hirschstein, classrooms in which students are more willing to
Edstrom, and Snell (2009) found self-reports to be report bullying are characterized by less, not more,
less sensitive to change than more costly and time- victimization (Cortes & Kochenderfer-Ladd, 2014).
consuming observations. Still, across informants, it Yet youth are reluctant to report bullying, given
is clear that far too many of our youth are victims of legitimate fears of negative repercussions or
bullying at school, a place they are required by law ineffective adult responses (see Oliver & Candappa,
to attend. 2007). Positive relationships between teachers and
students may enhance the likelihood of student
How Prevalent Is Bullying reporting (e.g., Oliver & Candappa, 2007), but this
And Victimization? relationship is not always observed (Cortes &
Documented prevalence rates for bullying vary Kochenderfer-Ladd, 2014), and with age, students’
greatly across studies, with 10% to 33% of students willingness to report bullying declines steadily.
reporting victimization by peers, and 5% to 13%
admitting to bullying others (e.g., Cassidy, 2009;
Dulmus, Sowers, & Theriot, 2006; Kessel Schneider,
O’Donnell, Stueve, &
Coulter, 2012; Nansel et al., 2001; Perkins, Craig, &
Perkins, 2011; Peskin, Tortolero, & Markham, 2006).
Such variations reflect differences in assessment
approaches, as well as differences across individuals
(sex, age), contexts, and cultures. Typically, boys
Different Types of Bullies model for understanding bullying as a systemic
Over the past 40 years, stereotypes of bullies as problem, with efforts to address bullying by
socially incompetent youth who rely on physical impacting the contexts in which such behaviors
coercion to resolve conflicts have diminished as occur. Cornell and Limber (2015) review current
studies document wide individual differences efforts to address bullying in the United States
among children who bully. In his early research, through legal and policy decisions and their
Olweus (1978, 1993) distinguished between implications. Finally, Bradshaw (2015) provides a
children who bully others and those who both bully critical analysis of research on how schools can best
others and are victimized. These “bully victims” address the problem of bullying, reviewing evidence
have been characterized as hyperactive, impulsive, for the effectiveness of school-wide, universal
and as experiencing more peer rejection, more antibullying programs. Research over the past four
academic difficulties, and more stressful and harsh decades on school bullying has contributed greatly
home environments (see Schwartz, Proctor, & to our understanding of the complexity of the
Chien, 2001), but represent only a small portion (1% problem as well as the challenges we face in
to 12%) of students (Dulmus et al., 2006; Nansel et addressing it. Although questions still outnumber
al., 2001; Solberg & Olweus, 2003; Spriggs, Iannotti, answers, our hope is that this special issue serves as
Nansel, & Haynie, 2007). Over the past four an impetus for further research on bullying as well
decades, research has also shown that many bullies as greater efforts to address the problem. In the
are socially intelligent (Björkqvist, Österman, & words of one victimized youth,
Kaukiainen, 2000; Sutton, Smith, & Swettenham, In conclusion, there is no conclusion to what
1999a, 1999b) and enjoy considerable status in the children who are bullied live with. They take it home
peer group (Vaillancourt et al., 2003), leading to with them at night. It lives inside them and eats
distinctions between socially marginalized and away at them. It never ends. So neither should our
socially integrated bullies (Farmer et al., 2010). struggle to end it. (Sarah, age 16)
Adults may be less able to recognize bullying Editor’s note. This article is one of six in the “School Bullying
and Victimization” special issue of the American Psychologist
perpetrated by students who appear to be socially (May–June 2015). Susan M. Swearer and Shelley Hymel
competent, well-functioning individuals. Moreover, provided the scholarly lead for the special issue. Authors’
if bullying is viewed as a reflection of power and note. Shelley Hymel, Department of Educational and
status in the peer group, it is difficult to convince Counselling Psychology and Special Education, University of
British Columbia; Susan M. Swearer, Faculty of Education,
students to abandon such behavior. In their review Department of Educational Psychology, University of
of our current understanding of bullying, Rodkin et Nebraska–Lincoln. Shelley Hymel and Susan M. Swearer are
al. (2015) critically evaluate evidence for various Co-Directors of the Bullying Research Network (http://
subtypes of bullies and explore the mechanisms and brnet.unl.edu). The authors wish to acknowledge the support
received for this work, including support to the first author
motivations underlying them. from the Edith Lando Charitable Foundation, the University of
British Columbia Faculty of Education Infrastructure Grant,
Can We Effectively Address Bullying? and the Canadian Prevention Science Cluster, funded through
the Social Sciences and Humanities Research Council of
Given a growing body of evidence on the Canada, and support to the second author from the Andrew
concurrent and long-term consequences of bullying Gomez Dream Foundation, the Woods Charitable Fund, and
for both bullies (see Rodkin et al., 2015) and victims the College of Education and Human Sciences at the
(see McDougall & Vaillancourt, 2015), considerable University of Nebraska at Lincoln. Correspondence
concerning this article should be addressed to Shelley
emphasis has been placed on finding the most Hymel, Faculty of Education, University of British Columbia,
effective ways to address bullying, clinically, legally, 2125 Main Mall, Vancouver, BC, V6T 1Z4 or Susan M.
and educationally. This research is the focus of the Swearer, 40 Teachers College Hall, Department of
three articles in this special issue. As research in Educational Psychology, University of Nebraska–Lincoln, NE
68588-0345. E-mail: shelley.hymel@ubc.ca or sswearer@
psychology and neuroscience emphasize the
Unl.edu May–June 2015 ● American Psychologist 293
interaction of individual vulnerabilities, context
© 2015 American Psychological Association 0003-
effects, and experiences with bullying and 066X/15/$12.00
victimization, Swearer and Hymel (2015) explore Vol. 70, No. 4, 293–299 http://dx.doi.org/10.1037/a0038928
the utility of a social-ecological, diathesisstress