Psychiatria Danubina, 2017; Vol. 29, Suppl.

3, pp 409-415 Conference paper

© Medicinska naklada - Zagreb, Croatia

PERCEPTION OF BODY IMAGE IN EARLY ADOLESCENCE. AN

INVESTIGATION IN SECONDARY SCHOOLS
Maria Rosaria Juli
Family Counseling of Foggia, Foggia, Italy

SUMMARY
Introduction: The clinical evidence shows that the onset of eating disorders is increasing in the prepubescent phase or even in
childhood. Already starting from the prepubescence the certainties related to the body start to unwind and the individual is
encouraged to build new ones, based both on the anatomic transformation of his/her own body and on the social expectation
according to the identity.
The onset of a Eating Disorders is normally between 13 and 25 years, but in the last years we recorded a lowering in the onset
threshold to an age between 11 and 13 years, with some earlier cases at 7 years (Franzoni et al. 2012).
Many theories consider body dissatisfaction as the immediate antecedent to the development of this eating disorder. Different
studies have confirmed that a strong concern for physical appearance could sometimes precede an eating disorder (Cuzzolaro 2004).
The alteration of the body image is the major predictive factor for the relapse, the patients themselves refer that it is one of the major
obstacles for the realization of a lasting recovering. In the following study one hundred kids between 10 and 15 years old, without
any Eating Disorders diagnosis, have been tested to evaluate whether if already from this age there is a concern about body image
starting at this age, the fear of gaining weight and the desire to be slimmer. It is known, indeed, that these factors, if significantly
present in a subject, can turn into predictive factors of a psychopathology.
We need to build our body image over time; changing our percertion of reality can change also what we see, in particular the
body image we strive for changes (Bianchini 2008).
Method: 100 teenagers split in 53 females and 47 males aged between 10 and 14 years, randomly picked in the secondary
school.
Results: The results of the study show that in the age between 10 and 15 years the concern for the body shape is already present,
without difference between the genders.
Although 45% of the sample is underweight, the Figure Raiting Scale test both males and females want to be of lesser weight. 91
subjects reached a BSQ test score of over 34, so most of the sample has a strong concern for their physical appearance. The results
obtained by administering the BUT test also highlighted concern about the body with moderate gravity.
Discussion: Body dissatisfaction, as so many studies have confirmed, can be considered a precursor of psychopathology.
Concerns concern both female gender and male gender. It is also necessary to pay close attention to the pressure exerted by family
members, friends and the media towards a difficult to reach thinness ideal. That is why we need to focus on strengthening protective
factors in adolescents with prevention and awareness campaigns which are properly targeted.
Conclusion: The work resulted a useful reflection on the building of the body image as an early risk factor for the onset of
pathologies linked to this concept. We need to commit to an educative practice of support for adolescent, recognition and sharing,
which does not avoid the presence of the adults, but in fact it is enriched.
It would be appreciated if we could introduce in the school, in the program of different subjects, the discussion regarding
different aspects of a healthy nutrition and the formation of a solid self-esteem in order, for the students, to have a critical
interpretation of the media message on food, body and beauty.
It is desirable to promote the emancipation of the adolescents from a condition of dependence to discover their own place in the
world. The educative action can help developing the research of the meaning of the own personality.

Key words: Teens and body image - perception of the body image

* * * * *
Introduction The current diagnostic classifications of eating
disorders (DSM V, E ICD-11) consider these disorders
Eating disorders are defined as weight-control as one unique category called “Eating disorders of the
behaviors that damage physical health and psychosocial early childhood and childhood”.
functioning and are not secondary to any known Since the ‘50s of the last century we could notice a
medical or psychiatric condition. At an early age, gradual increase of the Eating Disorders (Dalle Grave,
problems linked to nutrition are a common condition 2011) so that in the National Prevention Plan it is stated
with a very variable clinical relevance. Indeed, in addi- that: “The spread of eating disorders is really fast and
tion to temporary events that especially happen during significant: there is no other example of psychiatric
some critical evolutionary stages such as weaning, illness with such propagation and with the same
switch to eat alone, etc., there are also very serious characteristics of a real social epidemic" (Ministry of
pictures characterized by a total refusal of the food with Health 2010).
an important impact on the physical and psychological At the same time it a decrease of the age of onset has
development of the child (Juli 2016). been recorded (Favaro 2009) so that there are more and

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more often diagnosis before the first early period, the patterns of the thinness to which children are
including cases of girls 8/9 years old (Dalla Ragione increasingly exposed through the mass media, but also
2012). Therefore, currently it is necessary to pay more through the family, the school, and the aggregation
attention to the pre-adolescence period because a long sites; Bad habits and less and less regular in the family.
delay is still occurring before defining the diagnosis that This work, carried out by 100 students aged between
can have a negative impact on the therapeutic diagnostic 10 and 15 years of a first degree secondary school, used
path and on the prognosis of Eating Disorder (American the body shape questionnaire or questionnaire on bodily
Accademy of Pediatrics 2010). dissatisfaction (BSQ) Uneasiness Test (BUT), the Scale
In the sector of clinical research on eating disorders Rating Scale (FRS) test, and finally the detection of the
many useful tools for the study of body image have weight/height ratio as well as the Corporean Mass Index.
been developed together with methodologies of inves-
tigation about perceptual aspects (Thompson 1995). Methodology
Indeed, it is well known that the alteration of the image
we have about our body has an important role in the The aim of this study was to analyze, through the
onset of Eating Disorders (Dalla Ragione 2005). administration of diagnostic tests, the perception and
possible alteration of the body image, often a predictive
The scientific interest for clinical issues related to
factor for the onset of pathologies such as Eating
the body image has determined a progressive elabora-
Disorders.
tion of a wide and various number of methods, tech-
niques and tools to evaluate the different components of Specifically, fundamental aspects have been consi-
the mental representations. dered: perceptual, cognitive and affective components
of bodily representations. The use of tests (BSQ, BUT,
In line with the traditional psychology, the research
FRS) has allowed us to measure the real difference that
has been mainly focused on deeper theoretical studies
and on the measurement of the behaviors and patho- subjects have about themselves, how they are perceived
logical or anyway negative approach that some people now and how they would like to be.
have regarding their body. The sample examined presents the characteristics of
The founding father of the current theories on the a true experimental design, but it is only explorative and
development of body image is Paul Schilder, author of entirely pioneering. Nevertheless, the following results
the first work entirely dedicated to the body image have shown interesting reflection points, although fur-
called "The image and the Appearance of the Human ther investigation and significant increase in the sample
Body" (1935). Schilder can be considered as the starting size are needed to conclude a generalization of the data
point of all the next works about body image, even if he so far extrapolated.
treated the topic especially from a neurological point of
view. Description of Case Study Group
Nevertheless, the work of this author can still be The sample used for this work is 100 teenagers,
considered very valid in terms of studies about body divided into 53 females, 47 males aged between 10 and
image; for body pattern he means the mental repre- 14, casually identified in high school. Subjects were
sentation of the body in its spatial and postural tonic given a test battery in the school during the course of a
disposition, directly influenced by the related sensations; health project to which the school adhered to during the
for body image he means a further level of integration of school year.
the body pattern with the emotional/cognitive context.
The study suggests, through the use of self-admi-
Testing Instruments
nistered tests to investigate within a preadolescent
group, perception of body image, body weight dis- The intstruments used are self-administered tests
satisfaction, predictive factors for the birth of psycho- that measure the real difference that they have at their
pathology. present time and what they would like to be, that is,
In particular, we are aiming at understanding if the which should be the actual or desired image. The
perception of the body image that children themselves usefulness of these tests is supported by the hypothesis
have is the same as the real one and also how to inter- that the greater the difference between the real and the
vene in a broader perspective by raising awareness and ideal dimension, the greater will be the dissatisfaction of
promoting a primary prevention aimed at solving the one's body and consequently the alteration of the mental
problems closely related to the perception of the image image of oneself. It particular:
of the body. Adolescence represents a critical phase of ƒ BUT (Body Uneasiness Test), Cuzzolaro M, Vetrone
the life cycle, especially as regards the formation of the G, Marano G, Battacchi M. Body Uneasiness Test
self-image and the body pattern. The relationship with (2000): It is a self-assessment scale of body discom-
food in this age group is of fundamental importance not fort that provides a global index of severity (GSP)
only for the growth and development of the body, but and a series of sub-scale scores exploring different
also as a symbolic value that contributes to defining areas: weight dissatisfaction and fear of fatigue
personal identity and psychosocial autonomy. The risk (BUT scale (WP, weight phobia), excessive body-
factors for an early DCA debut are certainly increased: related concerns (BIC, body image concerns),

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Psychiatria Danubina, 2017; Vol. 29, Suppl. 3, pp 409-415

avoidance behaviors (But AA, avoidance) and

compulsive control (BUT A CSM, compulsive Self- IBM
monitoring), experiencing detachment and extra-
neousness with respect to their body (scale AD,
depersonalization); In the second part of the test
(BUT B) specific concerns about certain parts, cha-
racteristics or bodily functions are summed up by
two scores: BUT.B PST, positive symptom total and
BUT. B PSDI, positive symptom distress index).
ƒ BSQ (Body shape questionnaire), Cooper PJ,
Taylor MJ, Cooper Z, Fairburn CG (1987). Self-
administered test that evaluates the concern that the
subject has of the body image; Consists of 34 items
18,5-24,9 <18,5 25-29,9 >=30
investigating dissatisfaction with their body image in
a 4-week timeframe and based on six levels of Figure 1. IBM
severity expressed by the frequency with which the
thoughts, feelings and behaviors described in the As table 1 shows, nonetheless the 45% of the sample
individual items occur. As Cooper argues, the BSQ is underweight, in the test “Figure Rating Scale” both
questionnaire can not be used to measure the males and females would rather being slimmer; the
occurrence of DCA cases, but rather to assess the score related to the question “how I would like to be”
mental attitudes of a DCA-free population compared are for both gender lower than the ones related to the
to a DCA diagnosis with reference to their body question “How am I”. The female gender feels to belong
image. to the category “normal weight” (score=3.02) but
desires being underweight (2.46); also the male gender
ƒ The Figure Rating Scale (FRS), Thompson, JK, feels to belong to the category “normal weight” and
Altabe MN (1991). Also known as the Stunkard overweight (score=3.80) but desires belonging to the
Scale is a psychometric measurement developed in category underweight (score=2.89). In the global score
1983 as a tool to determine body dissatisfaction in between males and females there is the tendency of the
women and men. This scale has also been developed two genders to feel to belong to the category of “normal
for measuring adolescent body image. This type of weight” (score=3.38) but they would like to be in the
measurement was originally developed and validated category underweight (score=2.66).
to indicate the weight status of relatives of research What emerged is bewildering, because many studies
subjects when other specific measurements or self- agree on the fact that the lack of self-esteem, the desire
reported values were unavailable; is a visible for a different weight and so, a global dissatisfaction for
measure of how an individual perceives his or her the body is a predictive factor more reliable than the
own physical appearance. Each figure presents nine eating behaviors themselves (Cash 2002).
male and nine female schematic silhouettes, ranging
The BSQ results are quite clear because just 9 sub-
from extreme thinness to extreme obesity. For
jects reached a score equal to 34 (minimum score and
research purposes, participants are asked to self-
not significant), the other 91 individuals reached a
select the silhouette that best indicates his or her
score higher than 34, therefore the major part of the
current body size and the silhouette that reflects his
sample present a strong concern for his/her own
or her ideal body size.
physical appearance. The maximum score reached by a
male participant in the BSQ test is 148 and the maxi-
Results mum female score is 170. These scores confirm that
From a general reading of the test, the concern about also in the prepubescence phase there are thoughts,
the physical appearance, the body dissatisfaction and the sensations and behaviors concerning the weight and
fear of gaining weight are present among the adoles- the body shape.
cents in the age between 10 and 15 years. There is no In the table 2 half of the sample of males and fe-
particular evidence of the difference between males and males has a dissatisfaction score in the BSQ of 43 and 44
females. Particularly, the analyzed sample is on average respectively, at p90 among the females the dissatis-
12 years old, the 50% has an IBM between 18.5 and faction stays at 79% whereas it grows up to 89% among
24.9 (normal weight), 45% has an IBM <18.5 (under- males, therefore in this last distribution the male gender
weight) (Figure 1). results more dissatisfied than the female gender.
It seems that the IBM does not have a significance Considering the distribution, I counted the indivi-
impact on the perception of the body image, both in the duals that had a score >70 and <70, setting a cut-off that
overweight subjects (even if just 2) and in the under- can represent a significant body dissatisfaction; it results
weight ones; both resulted being dissatisfied in the same that the 15.4% has a score >70 in the BSq independently
way, independently from the gender, such as demon- from the gender and represent a significant body
strated in the study of McCabe & Ricciarelli (2004). dissatisfaction.

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Table 1. BSQ results

Scores
Gender Indicators
Media Standard Deviation Median
Females BSQ 50.61 25.30 44
like I am 3.02 1.12 3
How I want to be 2.46 0.66 2
Man BSQ 52.43 23.69 43
like I am 3.80 1.28 4
How I want to be 2.89 0.97 3
M+F BSQ 51.45 24.47 43.5
like I am 3.38 1.25 3
How I want to be 2.66 0.84 3

Table 2. Dissatisfaction score in the BSQ

Gender Media Standard Deviation max min p25 p50 p75 p90
F 50.61 25.30 170 34 37 44 53 79
M 52.43 23.69 148 34 37 43 57 89
M+F 51.45 24.47 170 34 37 43.5 54 84.5

Table 3. BUT test

Scores
Gender Indicators
Media Standard Deviation Median
Females WP 1.50 0.97 1
BIC 1.50 0.97 1
A 1.50 0.97 1
CSM 1.48 0.95 1
D 1.48 0.97 1
Man WP 1.50 0.86 1
BIC 1.50 0.86 1
A 1.50 0.86 1
CSM 1.48 0.86 1
D 1.46 0.84 1
M+F WP 1.50 0.92 1
BIC 1.50 0.92 1
A 1.50 0.92 1
CSM 1.48 0.90 1
D 1.47 0.90 1

Figure 2. % Worries about getting fat by age classes - Females

Figure 3. % Worries abaut getting fat by age classes – Men

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The BUT test, reported in table 3, highlights the self-esteem, anxiety, substance abuse and alcohol abuse.
body discomfort experienced by the individuals. The As we have seen from the results we got, the
score of the sub-scales that explore the different areas dissatisfaction about the body and the problems related
find place in scores lower than 2, therefore, indepen- to the body image are becoming quite common also
dently from the gender, the concern for the body results among men, therefore now the problem involves women
being medium seized, specifically the total score of the and men without a big difference. This is happening due
two genders is so divided: the dissatisfaction for the to the most popular magazines for men that show
weight and the fear to gain weight (scale BUT. A BIC, muscular bodies, in addition to movies where the same
body image concerns, score: 1.50), avoidance behavior thing happens and to the spread of products that are able
(scale But. A A, avoidance, score: 1.50) and the com- to increase the muscle mass. The first evidence of the
pulsive control (BUT. A CSM, compulsive self-moni- incongruous correlation between the effective weight
toring, score: 1.48). and the satisfaction about the body image appeared in
The sample is split into two age classes, respectively the literature in the mid-eighties of the last century
10-12 years and 13-15 years. As Figure 2 shows the when Rodin J. et al (1985) and Cash TF (1986) found
females of the class 10-12 result in being more concer- that among the women without any clinical issue, the
ned of gaining weight, with a score of 18.8, whereas in percentage of those who did not show concern for their
the class 13-15 4.6% is scared of gaining weight. The physical appearance was derisory. Over the last twenty
28% of the class 10-12 has never fear of gaining weight, years, thanks to numerous studies, the literature regar-
whereas, we observe a score of 59.1% for the scare of ding this topic has confirmed the popular association
gaining weight for the class 13-15 years. In the end, a between dissatisfaction about the body and eating
score equal to 12.5% is highly concerned in the class disorders, showing that attitudes about the physical
10-12 and a concerning with score 0 in the class 13-15. appearance are a more exact predictor of the deve-
Also the males, split in the same age classes as the lopment of Eating Disorders than distorted perception of
females, present the following percentage: the body. The studies conducted by Stice E. in 2002
ƒ Figure 3, in both classes no male subject present the show that the pressure coming from family members,
concerning of gaining weight, always with a score friends and media create an ideal of "subtle beauty" and
0.00. the tendency to give excessive importance to weight and
ƒ The percentage of males belonging to the 10-12 body shapes when we evaluate ourselves. The author
class answering often 5.3% results significant, whe- states that these behaviors represent the structural basis
reas the ones of the class 13-15 years result more of a distorted view of our body which increases the
concerned with a 18.5%. probability of developing the three typical symptoms of
food pathology: food restriction, over eating and
affective deficiency. Therefore, it is necessary to sup-
Discussion port prevention programs involving schools, places of
The lack of satisfaction regarding the body image is training and education in order to develop the creative
represented by the personal sorrow for the shape of the potentialities of adolescents and pre-adolescents enhan-
body in general or for the size of some parts of the cing protective factors and increasing emotional and
body. The psychological discrepancy between the per- cognitive awareness in order to finally promote identity
ception that we have about our own body and the body development.
considered as ideal can lead to a negative feeling about
ourselves and to behaviors harmful to our health (Thom- Conclusions
pson 2004). Although the dissatisfaction about the body
exists specially among young people, in its extreme As already said, pre-adolescence is characterized by
condition it is considered an essential component for the body dissatisfaction, which is closely linked to a more
start of pathological behaviors. Indeed, the dissatis- general discomfort and insecurity regarding the identity,
faction about the body can be associated with a distorted therefore it is not possible to work on these specific risk
view of the body image that can be closely related to factors without relating them to the more global identity
eating disorders. Currently we do not know exactly uncertainty.
what is the role of body dissatisfaction in causing or Therefore, in order to be able to intervene concretely
promoting the onset of Eating Disorders and whether it on "at risk" behaviors of young people, it is necessary to
is primary to the disorder or secondary to changes in work in terms of primary prevention programs that
cognitive functions determined by fasting (anorexia) or consider the disorder as an expression of a wider
abusing (bulimia). However, several studies, including psychic discomfort, developing a deeper path to spread
the one of Bruch H. (1978), highlight that there is a the concept of "bio-psychological-social wellness" accor-
close correlation between the dissatisfaction about the ding to the definition of health promotion. Currently
body and the onset of eating disorders. Some research national and international studies on the effectiveness of
conducted by Granner (2002) and Stice (2010) shows a primary prevention interventions are few and some
link between the low satisfaction for the body and many analyses have highlighted the risks associated with an
factors related to bad health such as depression, low incautious prevention.

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An important prerequisite is that practitioners are The objectives of a prevention project for Eating Dis-
highly qualified as adolescences tend to see them as orders should be:
guides and references to imitate and the topics dealt ƒ To provide information about the content and func-
with them can have a strong impact at this stage of life. tions of food and about education regarding nutrition;
In particular, it is important to talk about Eating ƒ To acquire a greater awareness of the relationship
Disorders prevention focusing on risk factors, especially between food and emotions;
strengthening protective factors.
ƒ To provide ideas to think about some risk factors and
Temperamental, traumatic, and family risk factors
the maintenance of eating disorders (cultural factors,
can be the basis for psychopathologies of various kinds
prejudices on obesity and anorexia);
(depressive disorders, anxiety disorders, dissociative
disorders), especially when they are really strong. ƒ To stimulate a good acceptance of ourselves, of our
When they are combined with risk factors for body and our image.
dissatisfaction and discomfort for the body, then they This type of intervention should have the main scope
can determine the onset of eating disorders (Dalla to reinforce self-esteem and to counteract the negative
Ragione, 2005). Now many agree with the need of impacts of the culture on health in general and can be
preventive interventions to increase protective factors included in a wider prevention project of disorder that
already in early childhood. And it is also necessary to involves young people that often, especially in cases of
involve the parents of the children and to have the eating disorders, are also victims of some behaviors
primary goal of creating a good ability to recognize closely related (alcohol abuse, drugs, etc.). It is crucial
internal motivations. that this kind of educational intervention stimulates
In the light of these considerations, it is necessary to knowledge, attitudes and behaviors that promote self-
define the prevention measures according to the acceptance and psycho-physical well-being in the
guidelines of the National Health Plan of 2003: "A teenagers helping them to better understand the close
characteristic of the prevention of diseases linked to relationship between food and emotions.
nutrition is the necessity to involve the majority of the
population and not only the high-risk groups. The
Acknowledgements: None.
prevention strategy should be addressed to the entire
population, where recommendations for healthy Conflict of interest: None to declare.
nutrition and healthy dietary choices, also consistency
with cultural and socio-economic factors should be
disseminated” (National Health Plan, 2003); and the References
recommendations are offered by Neumark–Sztainer
(2009). In particular: 1. American Accademy of Pediatrics, (2010). Committe on
ƒ Taking into consideration the disorder as expression Adolescence. Identification and management of eating
disorders in children and adolescents. Pediatrics.
of a wider adolescent psychic discomfort and organi-
2. Bianchini, P., DallaRagione L. (2008). A cura di: Il vaso
zing prevention as a large project for the dissemi- di Pandora. Guida ai DCA per pazienti, familiari ed
nation of the concept of psycho-physical well-being insegnanti. Collana dei quaderni del volontariato Cesvol,
according to the idea of promotion of the health Perugia.
from the WHO; 3. Bruch H. (1978). Patologia del comportamento
ƒ Taking into consideration these disorders as corre- alimentare. Feltrinelli, Milano, 1978
lated and enhanced by the current socio-cultural con- 4. Cash T.F et al., (1986). Body image suvery report: the
text and then defining a prevention plan that takes great American Shape – up. Psychology Today, 24.
5. Cash T. F., Pruzinsky T., (2002). Body image: a handbook
into account these external influences (mass media,
of theory, research, and clinicalpractice. Guilford Press,
modes), but without focusing only on this; New York.
ƒ Eating in a healthy way, promoting a healthy life- 6. Cooper P. J., Taylor M. J., Cooper Z., Fairburn C. G.,
style and enhancing psychic, physical and social (1987). The development and validation of the body shape
well-being. A balanced dietary style is also effective questionnaire. International Journal of Eating Disorders.
to avoid the onset of many pathological conditions. 7. Cuzzolaro M., Vetrone G., Marano G., Battacchi M.
(2000): Body Uneasiness Test, BUT. In: Conti. L. (2000)
ƒ As part of a prevention project, it is essential to work Repertorio delle scale di valutazione in Psichiatria, vol. 3,
on personal aspects (body stimuli, habits), physio- Firenze.
logical aspects related to nutrition, collective aspects 8. Cuzzolaro M: Anoressie e bulimie. Il Mulino. Bologna,
as the sociocultural ones; 2004.
9. Dalle Grave R., (2011). Eating Disorders: progress end
ƒ We have to face together the problem that charac- challenges. Eur J Int Med.
terize human existence, ranging from insignificance 10. Dalla Ragione L., (2005). La casa delle bambine che non
to significance, from time lived to the one planned, mangiano. Identità e nuovi disturbi del comportamento
from protection to disposition to risk. alimentare. Il Pensiero Scientifico Editore, Roma.

S414
 Maria Rosaria Juli: PERCEPTION OF BODY IMAGE IN EARLY ADOLESCENCE. AN INVESTIGATION IN SECONDARY SCHOOLS
Psychiatria Danubina, 2017; Vol. 29, Suppl. 3, pp 409-415

11. Dalla Ragione L., Mencarelli S., (2012). L'inganno dello 18. Piano Nazionale della Prevenzione, Ministero della
specchio. Immagine corporea e disturbi del Salute, (2010). Roma.
comportamento alimentare in adolescenza. Edizioni 19. Piano Sanitario Nazionale, Ministero della Salute, (2003),
Franco Angeli. Roma.
12. Favaro A., Santonastaso P. (2009). Anoressia e bulimia. Gui- 20. Rodin J.et al (1985). Women and weight: a normative
da pratica per genitori, insegnanti e amici. Positive Press. discontent, in Sonderegger T.B. Psychology and gender,
13. Franzoni E. et al, (2012). Il coraggio di Guardare - University of Nebraska Press, Lincoln.
Prospettive e incontri per la Prevenzione dei Disturbi del 21. Stice E., Shaw H.E. (2002). Role of body dissatisfaction in
Comportamento Alimentare, Collana Mettere le Ali, the onset and maintenance of eatingpathology. A synthesis
Presidenza del Consiglio dei Ministri, Dipartimento della of research findings. Journal of Psychosomatic Research.
Gioventù. Roma 22. Stice E: A meta-analyticreview of eating disorder preven-
14. Granner et al (2002). Levels of Cigarettes and Alcohol. tion programs: encouraging findings. Annual Rewiew of
International Journal of Psychology and Psychological clinical Psycologist, 2007.
Therapy, 4. 23. Schilder P., (1935). Immagine di sé e schema corporeo.
15. Juli, M.R., (2016). Childhood obesity: global issues. Franco Angeli, Milano.
Psichiatria Danubina vol, 28. 24. Thompson JK, Altabe MN: Psychometric qualities of the
16. Neumark – Sztainer, D., (2009). Preventing Obesity and figure rating scale. International Journal of Eating
Eating Disorders in Adolescents: What Can Health Care Disorders 1991; 10:615-619.
Providers Do? Journal of Adolescent Health. 25. Thompson John B: Media e modernità: una teoria sociale
17. McCabe MP & Ricciarelli LA: Body image dissatisfaction dei media. Stanford, 1995.
among male across the life spam. A review of 26. Thompson JK: Handbook of eatingdisorders and obesity,
pastliterature. Journal of Psychosomatic Research, 2004. Wiley, New York 2004.

Correspondence:
Maria Rosaria Juli, MD
Clinical Psychologist, Psychotherapist, Specialist in Alimentary Behaviour Disorders
Family Counseling of Foggia
via C. Baffi, 1, Foggia, Italy
E-mail: [email protected]

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