Self-image, body image and cancer

DEFINITION: Self-image refers to a person’s perception of their personality and physical, mental, spiritual, and social characteristics. Body image contributes to self-image and refers to how people view their physical appearance and functioning.

Cultural influences: In contemporary culture, physical appearance influences how individuals perceive themselves and how others judge them. Messages from popular media celebrate physical beauty and encourage people to aspire to idealized standards of appearance. Body image strongly influences most people’s overall self-image, and physical changes can powerfully affect how they view themselves. People with cancer commonly experience changes in their bodies resulting from the disease and its treatments. Changes may involve physical appearance, how a person feels, or how well they function. The extent to which these changes influence cancer patients’ images of themselves and their bodies is influenced by factors such as the severity and permanence of these changes, the stage of life in which they occur, and the individual's personality traits.

Changes in appearance: Visible changes in appearance, stemming from the cancer itself or its treatment, can profoundly affect body image. Overt changes may cause cancer patients to be highly focused on appearance and hypersensitive to attention from others (such as questions about health). Insecurity over appearance often leads to distress and diminished body image. Hidden or less visible changes in appearance (such as breast or testicle removal and surgical scarring) can still cause significant anxiety, alter self-perceptions, and lead to a person’s avoiding interactions and intimacy with friends and family at a time when social and family support is a vital component to successfully coping with cancer.

Changes in how the body feels: Illness-related factors (such as pain) and treatment side effects (such as fatigue) can significantly affect how cancer patients feel about themselves and their bodies. Activities previously accomplished with ease may be markedly more difficult or even impossible to perform because of pain or reduced strength. These experiences can sap cancer patients’ confidence and lessen views of themselves as competent, effective, and independent individuals. Cancer patients may feel “betrayed” by their bodies and perceive themselves as deficient, even after surviving their illness.

Changes in functioning: Changes in body functioning caused by cancer can also affect people’s self-perceptions. Some types of cancer may result in the loss of limbs or other body parts and markedly alter independence and functionality. Cancer treatment may change how patients eliminate body waste and necessitate the use of colostomy bags (for bowel movements) or urostomy bags (for passing urine). Other treatments can cause sterility or alter sexual functioning. These circumstances can shake the foundation of patients’ self-perceptions and require considerable ongoing coping and adaptation.

Permanence of changes: Whether physical changes caused by cancer are temporary or permanent affects how these changes alter body image. For most patients with cancer, altered self-perceptions resulting from temporary physical changes, such as hair loss or weight loss, are limited to the duration of treatment. Most regain former perceptions of their body and self when these changes disappear. Some individuals continue to struggle with altered body image and view themselves as “damaged” even after treatment has ended. Permanent physical changes resulting from cancer typically have a bigger impact on body image. A period of bereavement involving initial shock, “numbing,” anger, and denial may be seen in some patients. Most patients employ coping mechanisms developed before their illness to adapt to their altered physical state. Other patients have significant long-term struggles in dealing with their changed appearance or functioning and may develop psychiatric illnesses such as anxiety and depression.

Developmental considerations: The age and developmental level at which cancer occurs influence patients’ self-perceptions. Cancer-related factors causing children and adolescents to feel nauseated or weak or to look sick or what the young person perceives as different from others can make it hard for them to develop healthy self-images and body images. Young adults with cancer may feel unattractive and “damaged” and fear that they will never find a mate. Older adults with cancer may fear abandonment from loved ones or loss of social or occupational standing resulting from looking unhealthy. Cancer and associated functional loss in geriatric patients may bolster established fears of losing control and independence.

Personality factors: Personality, coping style, and self-perceptions before the illness influence how cancer affects people’s self-image. People who are optimistic, flexible, emotionally expressive, and willing to accept emotional support appear to adapt best to stressors caused by cancer, including those related to body image. Also, those with a robust self-esteem before their illness appear to cope well. People whose feelings of self-worth were closely tied to their appearance before they developed cancer, who have difficulty accepting emotional support, and who have histories of psychiatric illness appear to have the most difficulty adapting to physical changes associated with their illness.

Management approaches: Several approaches have been identified to assist individuals with cancer to maintain or enhance their self-image and body image. Participation in support groups in which cancer patients and survivors discuss their experience with illness and share methods of coping has been found to promote healthy adaptation. Using wigs, hats, scarves, or makeup may boost confidence in appearance and increase social interaction and acceptance of support. Participating in treatment and rehabilitation efforts and developing alternate interests and skills to take the place of those that are no longer possible as a result of cancer can increase physical confidence. Keeping a healthy diet, engaging in exercise, and maintaining good sleep habits help those with cancer reestablish a sense of control over their bodies. Finally, cancer patients and survivors struggling with self-image and body image concerns or psychiatric illness are advised to seek or be referred for mental healthcare, as a number of effective psychological and medical treatments exist.

As science and technology advance in cancer diagnosis and treatment, self-image and body image issues linger as problems cancer patients must confront. Understanding how and why self-image and body image remain critical concepts to individuals with cancer is essential to all involved in the process. It can be just as crucial to the healing process as medical treatments. A decrease in the well-being of the patient can lead to anxiety, depression, and despair, making cancer treatments less effective. Exacerbating this is the idea that patients may not adhere to their medical recommendations because of the changes to their bodies. These situations can further decrease the emotional and physical quality of a patient’s life and affect their intimate relationships. Finally, even when cancer treatment ends, a patient is left to grapple with a new normal in terms of self-image and body image, and, therefore, these concepts are life-long issues cancer survivors must confront. 

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