European Eating Disorders Review

Eur. Eat. Disorders Rev. 7, 121±128 (1999)

Paper
Body Image Assessed by a Video Distortion
Technique: The Relationship Between Ideal and
Perceived Body Image and Body Dissatisfaction
Gian Paolo Guaraldi*, Emanuele Orlandi, Paolo Boselli
and Kathleen M. O'Donnell
Department of Psychiatry, University of Modena, Italy

Current sociocultural beliefs de®ne feminine beauty as being tall and slender.
The relationship between Perceived Body Image, Ideal Body Image and Body
Dissatisfaction were assessed by the Distorting Television Image Method (DTIM) in
a sample of 78 female subjects ranging in age from 15 to 65 years. Of the sample
88.46 per cent desired a taller and thinner body than their own undistorted image as
seen on the television screen. These subjects with an Ideal Body taller and thinner
than their own, also had a Perceived Body Image which was taller and thinner than it
actually was, yet they were the most dissatis®ed with their body dimensions. The
subjects with an Ideal Body Image very different from the current sociocultural
standards showed the lowest level of Body Dissatisfaction. Copyright * c 1999 John
Wiley & Sons, Ltd and Eating Disorders Association.

Keywords: body image; body dissatisfaction assessment; sociocultural

standards

INTRODUCTION

Several studies have noted that in the last few decades, thinness has become a
guiding principle for de®ning beauty in women (Garner and Gar®nkel, 1980;
Garner et al., 1980; Morris et al., 1989; Wisemann et al., 1992; Shaw, 1995).
This aesthetic view is more typical of western cultures (Furnham and Alibhai,
1983; Thomas, 1989) although its in¯uence has begun to spread to other
geographic areas (Ohtahara et al., 1993).
The mass media plays an essential role in the promotion of the `Thin Body
Cult' (Bruch, 1978; Gordon, 1990) and the preference for a thin body has
*Correspondence to: Professor G. P. Guaraldi, Clinica Psichiatrica, Policlinico Universitario di Modena,
via del Pozzo 71, 41100 Modena, Italy. Tel: 39 59 365315. Fax: 39 59 424307.

CCC 1072±4133/99/020121±08$17.50 European Eating Disorders Review

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c 1999 John Wiley & Sons, Ltd and Eating Disorders Association. 7(2), 121±128 (1999)
G. P. Guaraldi et al. Eur. Eat. Disorders Rev. 7, 121±128 (1999)

been detected in all age groups, even before puberty (Ohtahara et al., 1993;
Feldman et al., 1998; Maloney et al., 1989). Behaviours aimed at losing weight
such as participation in sports (McDonald and Thompson, 1992) are often the
result of the desire to conform to this standard. The development of eating
disorders may also be in¯uenced by these social and cultural pressures (Slade,
1993; Akan and Grilo, 1995).
The aim of the present study was to identify the Ideal Body Image in women
of different ages using a video-comparison test, the Distorting Television
Image Method (DTIM) (Allebeck et al., 1976).
The evaluation also examined the possible relationship between Ideal Body
Image, Perceived Body Image and Body Dissatisfaction.

METHODS
Subjects
All female patients who presented to the outpatient clinic of ®ve family
physicians, in the course of 1 week, were asked to participate in the study.
Of these, 52 (26.2 per cent) agreed to participate. In addition, 26 subjects
who were recruited for previous investigations (Guaraldi et al., 1995) also
participated.
The medical and psychiatric histories were systematically assessed in all
patients. In addition, the Structured Clinical Interview for DSM-III-R Patient
Edition was administered to all subjects in order to exclude those with psy-
chotic or eating disorders (Spitzer et al., 1993). Subjects with serious medical
illnesses were also excluded.

Procedures
Distorting Television Image Method (DTIM)
Originally developed by Allebeck et al. (1976) and subsequently utilized with
various modi®cations by other investigators (Meermann, 1983; Freeman et al.,
1984; Whitehouse et al., 1986; Probst et al., 1992, 1995), the DTIM used in
this study is the result of an independent modi®cation developed by the
Division of Psychiatry at the University of Modena (Guaraldi et al., 1990,
1995). The DTIM has the advantage of allowing the subject to select, by
herself, the ideal image of her body on a television screen.
The operator asks the subject to observe her image on the television
screen and to change it to re¯ect `how you think you currently look'
(Perceived Body ˆ PB) in order to obtain a cognitive rating (Thompson et al.,
1987; Thompson and Psaltis, 1988). The subject is then asked to create a
television image of `how you wish to look' (Ideal Body ˆ IB). It is possible to
obtain a distortion percentage for the horizontal axis, which corresponds to

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c 1999 John Wiley & Sons, Ltd and Eating Disorders Association. 122
Eur. Eat. Disorders Rev. 7, 121±128 (1999) Body Image

weight (PB-H or IB-H) and one for the vertical axis, which corresponds to
height (PB-V or IB-V). However, one should note that the subject is allowed
to simultaneously distort the television image on both axes, so the actual net
distortion value, rather than the dimensional change component, is used in
calculating the ®nal distortion percentage value.
The distortion percentage is then converted into the `Body Perception
Index' (BPI) value according to Slade and Russel's formula (1973):
BPI ˆ ( perceived measure/real measure)  100. Using this index, a value of
100 corresponds to accurate body perception while values greater or smaller
than 100 correspond to over- and underestimation respectively.
The Dissatisfaction Index (DI) for the horizontal (DI-H) and vertical
(DI-V) axes is also obtained from Ideal Body and Perceived Body values. The
DI is the result of the difference between Ideal and Perceived Body values and
thus provides a measure of the degree of dissatisfaction with one's body, both in
terms of width and height (Freeman et al., 1984; Cooper and Taylor, 1988).
The DTIM is a method that `sensitizes' the subject and causes her to focus
more attention on her own body than she may normally do. This is an
important factor because Body Dissatisfaction has been found to change
according to different situations (Haimovitz et al., 1993).
In descriptive statistics, the arithmetical mean was used as a position index
and the standard deviation as a variability index. The association between
variables was assessed using the simple linear regression. The chi-square
method was used to assess differences in proportions of ideal body values. Data
processing was carried out using the statistical SPSS/PC ‡ package.

RESULTS

The sample included 78 healthy female volunteers. Age ranged from 15 to

65 years (mean ˆ 31 years; SD ˆ 13 years), height ranged from 143 cm to
178 cm (mean ˆ 162.34 cm; SD ˆ 7.39 cm) and body weight ranged from
45 kg to 82 kg (mean ˆ 58.85 kg; SD ˆ 7.99 kg). The Body Mass Index
ranged from 17.36 to 32.43 (mean ˆ 22.33; SD ˆ 3.09).
The mean Perceived Body value, expressed as Body Perception Index, was
99.44 (SD ˆ 6.17) for the horizontal axis and 103.33 (SD ˆ 5.53) for the
vertical axis indicating that the subjects perceived themselves as slightly
thinner (BPI 5 100 on the horizontal axis) and taller (BPI 4 100 on the
vertical axis) than they really were.
The mean Ideal Body value, also expressed as the Body Perception Index,
was 92.43 (SD ˆ 8.24) for the horizontal axis and 107.61 (SD ˆ 7.33) for the
vertical axis. This suggests that on the average, the subjects wished to be both
thinner and taller than they actually were (BPI 5 100 on the horizontal axis
and BPI 4 100 on the vertical axis, respectively).

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G. P. Guaraldi et al. Eur. Eat. Disorders Rev. 7, 121±128 (1999)

In fact, 69 subjects (88.46 per cent) desired a body taller and thinner than
their own as seen on television without distortion. Only one subject (1.28 per
cent) desired a thinner and shorter ®gure while two subjects (2.56 per cent)
wanted a taller and a bit wider ®gure. Six subjects desired instead to be heavier
and shorter (7.69 per cent). These differences were statistically signi®cant
(chi-square ˆ 49.7; p 5 0.0001). A subsequent analysis revealed that there
was no relationship between Ideal Body and the patient's actual degree of
tallness and thinness.
The mean Dissatisfaction Index value (DI) was ÿ7.01 (SD ˆ 8.03) on the
horizontal axis and 4.28 (SD ˆ 7.32) on the vertical axis. Since the DI is
calculated as the difference between the Ideal and Perceived Body Images, a
negative value for the DI on the horizontal axis indicates that the subject
perceives her weight as greater than she ideally would like it to be, while a
positive value for the DI on the vertical axis indicates that the subject
perceives her height as less than she would prefer it to be.
The relationship between Ideal Body values on the horizontal axis and the
vertical axis was examined. A statistically signi®cant negative correlation was
found (r ˆ ÿ 0.72, p 5 0.001) suggesting that the more the subjects wished to
be thin, the more they wanted to be tall and vice versa, the more they wished
to be tall, the more they wished to be thin.
The Perceived Body and Ideal Body values were then compared to
determine if there was a relationship between them. A statistically signi®cant
relationship was found when the Perceived Body value on the horizontal axis
was compared with the Ideal Body value, both on the horizontal (r ˆ ÿ0.32,
p 5 0.005) and the vertical (r ˆ 0.41, p 5 0.001) axes. The relationship was
statistically signi®cant as well between Perceived Body on the vertical axis and
Ideal Body, on both the horizontal (r ˆ 0.41, p 5 0.001) and the vertical
(r ˆ 0.38, p 5 0.002) axes. These data indicate that the more the subjects
desired a thin and tall ®gure, the more they perceived their own body as
thinner and taller than the undistorted image seen on the television screen.
Finally, the Ideal Body and the Dissatisfaction Index were compared. The
relationship was statistically signi®cant when these values were compared for
the same axis (r ˆ 0.71, p 5 0.0001 for the horizontal axes; r ˆ 0.71,
p 5 0.0001 for the vertical axes) as it was when opposite axes were com-
pared (Ideal Body, horizontal axis and Dissatisfaction Index, vertical axis,
r ˆ ÿ0.40, p 5 0.001; Ideal Body, vertical axis and Dissatisfaction Index,
horizontal axis r ˆ ÿ0.49, p 5 0.001).

DISCUSSION

The sociocultural model for feminine beauty is the tall, thin woman, a
standard which is encouraged by the mass media and the fashion industry and

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Eur. Eat. Disorders Rev. 7, 121±128 (1999) Body Image

reinforced through self-comparison with peers of the same age and social class
group (Miller et al., 1988; Wood, 1989; Kruglansky and Mayseless, 1990). The
desire to achieve this ideal is prevalent in many women, in¯uencing their
behaviours with respect to diet and exercise and may even be involved in the
development of eating disorders.
The majority of the sample (88.46 per cent) of this study identi®ed an Ideal
Body similar to that suggested by the mass media. These results are in
agreement with those of other studies, such as Silberstein et al. (1988), who
found that, using the Figure Rating Scale, 75.3 per cent of their female sample
chose an ideal ®gure thinner than their own. Other authors observed that
85 per cent of a sample of female students wanted to lose weight (Drewnoski
and Yee, 1987; Hesse-Biber et al., 1988).
Perceived Body Image appears to be in¯uenced by the Ideal Body Image. In
this respect, the same women who wanted a taller and thinner ®gure, actually
perceived themselves as taller and thinner than they were. It is important to
note that in our procedure, the Perceived Body test preceded the Ideal Body
test and the subject did not know that she would be asked about her Ideal
Body. This ®nding is supported by Palta et al. (1982) who observed that
perspective error of one's weight tends towards ideal weight and by Striegel-
Moore et al. (1986), who found a relationship between `feelings of fatness' and
a susceptibility to social pressure toward thinness, independent of real fatness.
In contrast, other authors such as Wardle and Foley (1989) found that
Perceived Body dimensions generally tend to be the opposite of Ideal Body
dimensions, yet many studies found that overestimation of body size among
females, with or without eating disorders, is not as widespread a phenomenon
as it was considered to be in the past.
Dissatisfaction with one's body seems to be in¯uenced by many factors
including peer pressure and may depend more on the Ideal Body model that on
Perceived Body Image.
Heinberg and Thompson (1992) found that Body Dissatisfaction was greater
when a subject compared herself/himself to a group of peers than when the
comparison took place between groups of different people. Williamson (1990)
argued that Body Satisfaction and Dissatisfaction were caused by the difference
between actual body and the ideal body image identi®ed by a group of peers.
Of note, in the present study, the highest degree of Body Dissatisfaction was
found in women with extreme values for a tall and thin Ideal Body,
notwithstanding the fact that they perceived themselves as taller and thinner
than they actually were. Interestingly, the more these women wished to be
thin, the more they wished to be tall, and vice versa the more they desired to
be tall, the more dissatis®ed they were with their width, and wished to lose
weight.
In contrast, the lowest level of Body Dissatisfaction was found among those
women with an Ideal Body image much different from the sociocultural

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G. P. Guaraldi et al. Eur. Eat. Disorders Rev. 7, 121±128 (1999)

models, i.e. the women who desired a shorter and fatter ®gure. In addition
from the present results Ideal Body appeared to be more important than
Perceived Body in the development of Body Dissatisfaction in healthy people.
It has been shown that in patients with eating disorders, body image distortion
can be better described as `concern with body shape, body shape disparage-
ment' rather than in terms of perceptive distortions (Cooper and Taylor,
1988; Whitehouse et al., 1986; Lindholm and Wilson, 1988; Fernandez et al.,
1993).
In the context of these data it can be hypothesized that the internalized
image of the Ideal Body affects the Perceived Body Image and, in those
subjects with an ideal image closely ®tting society's standards, leads to the
greatest Body Dissatisfaction. Larger multicentre studies would be important in
verifying this hypothesis.

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