A person suffers from disturbed body image when one has a distorted perception about the mental image of their own physical self. Some signs that a patient may be experiencing this is when s/he refuses to look at or touch their body, verbally expresses negative feelings about their body, experiences a change in social involvement, expresses fear of reaction by others, focuses on their past appearance, past functions or past strength, or expresses depersonalization of their body part(s) by using impersonal pronouns. Individuals may be more at risk of this when going through developmental changes.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are revised, added, or retired by the NANDA International Diagnosis Development Committee (DDC) to coincide with shifts in language standardization. “Disturbed Body Image” has been renamed to “Disrupted Body Image”. Students and seasoned nurses alike may be unfamiliar with this change, and thus NurseTogether has chosen to continue to use the diagnostic label “Disturbed Body Image” in this article until the recent relabeling receives wider adoption.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
Disturbed body image is often related to complex risk factors and circumstances. There are various reasons a person may experience a disturbed body image. Below is a brief list of potential causes:
Signs and Symptoms (As evidenced by)
Signs and symptoms of disturbed body image vary between patients. While some patients may be forthcoming with their perceived body image, other times the nurse may need to ask exploratory questions based on observed behaviours. The following are common signs and symptoms of disturbed body image:
- Preoccupation with real or perceived change in body structure or function
- Reporting negative feelings towards body
- Change in socialization habits
- Not touching or looking at body part
- Self destructive behaviors
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for disturbed body image:
- Patient will verbalize a realistic self-image.
- Patient will demonstrate an acceptance of their self instead of an idealized image.
- Patient will be able to recognize health-destructive behaviors and demonstrate a willingness to follow a treatment plan that will promote overall health.
- Patient will be able to describe, touch, and/or observe the affected body part.
- Patient will be able to demonstrate social involvement.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to disturbed body image.
1. Assess the patient’s current view of one’s body.
This allows the nurse to determine a baseline and is able to gauge if the patient’s current self-image is realistic. The nurse may also ask the patient if how they feel about their body has changed recently and how long these thoughts and feelings have persisted. It is important to also assess if there have been any large life or health changes that may have triggered the disturbed body image.
2. Assess the patient’s basic sense of self-worth.
This allows the nurse insight into how the patient currently views himself/herself and will help in making an individualized treatment plan.
3. Assess for signs/symptoms of social withdrawal.
Patients with disturbed body image may begin to limit their social interactions and seclude themselves from others.
4. Assess the patient’s current coping patterns.
This will allow the nurse to individualize the patient’s plan of care and ensure proper coping patterns are being utilized to improve the patient’s image of self.
5. Assess the patient’s relationship history and possibility of any abuse.
History of relationship or sexual abuse can result in a disturbed body image. The nurse should be aware of this and if present for the patient ensure the appropriate resources are being utilized.
6. Assess the patient’s current support system.
Having a network and support system will greatly help in the patient’s recovery process.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with disturbed body image.
1. Encourage open communication with patient.
Providing open communication and an environment that is free from judgement will allow the patient to feel more comfortable and will increase the patient’s sense of control and willingness to engage in activities with the nurse.
2. Educate the patient on healthy coping patterns.
Patients with disturbed body image may have unhealthy coping patterns. Educating the patient on healthy coping patterns will allow the patient more control and independence in their daily life.
3. If weight loss or gain is needed create a weight graph.
This will allow the patient a visual in how s/he is progressing towards her/his goal.
4. Identify and encourage the patient to participate in community support groups.
Community support groups can help motivate patients and decrease their loneliness and isolation.
5. Encourage a regular exercise routine for patient.
Regular exercise can improve the patient’s ability to function and improve mood and mental state.
6. Provide appropriate assistive devices.
If assistive devices are needed for patient ensure these are available to guide the patient towards becoming more independent.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for disturbed body image.
Care Plan #1
Diagnostic statement:
Disturbed body image related to changes in appearance secondary to severe trauma, as evidenced by verbal reports of revulsion and hiding of the affected limb.
Expected outcomes:
- Patient will verbalize acceptance of physical changes.
- Patient will describe, touch, or observe the affected limb.
Assessment:
1. Assess the patient’s positive and negative attitudes towards self and their beliefs on how others see them.
This allows the patient to identify their self-image and if there is a discrepancy between their views, how they are affected by social media, or how they believe others see them. These views affect how the patient perceives changes in appearance.
2. Assess the level of knowledge of and anxiety related to the situation.
Emotional changes conveyed by the patient are signs of acceptance or non-acceptance of the change in appearance.
Interventions:
1. Reassure that the emotional response to the change in body appearance is normal.
Grief over the loss or change of a body part is normal and typically involves a period of denial.
2. Encourage verbalization of positive or negative feelings about the change.
The patient should realize that self-worth does not rely on a change in appearance. Expression of feelings can enhance the patient’s coping strategies.
3. Encourage the patient to look at/touch the affected limb.
Acceptance may begin by looking at or touching the affected limb and may help to incorporate changes into body image.
4. Demonstrate a positive, caring attitude in routine activities.
Positive and caring comments help the patient respond more positively to changes in appearance.
5. Teach the patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, and clothing that conceals the altered body part or enhances remaining parts or functions).
Adaptive behaviors help the patient compensate for the changed body structure and function.
Care Plan #2
Diagnostic statement:
Disturbed body image related to surgery as evidenced by fear of rejection and withdrawal from social involvement.
Expected outcomes:
Patient will demonstrate social involvement rather than avoidance.
Patient will use cognitive strategies to improve the perception of body image and enhance functioning.
Assessment:
1. Assess social withdrawal and the use of denial.
This may be a normal response to a situation or indicative of mental illness such as depression or generalized anxiety disorder.
2. Assess the level of knowledge and anxiety of the patient towards the effect of surgery on body appearance.
Understanding what the patient feels, knows, and expects regarding the surgical change may direct nursing interventions and other cosmetic management.
3. Observe the interaction of others with the patient.
Others may unconsciously reinforce distortions in body image and interfere with accepting changes in body appearance.
Interventions:
1. Assist the patient in incorporating changes into ADLs, social life, interpersonal relationships, and occupational activities.
Patients are highly concerned about how others see them, especially if the changes in body appearance are apparent. Positive feedback and opportunities to engage in social situations help the patient to adapt to changes.
2. Visit the client frequently and acknowledge the worth of the patient.
Frequent visitations provide opportunities for listening to concerns and questions.
3. Teach appropriate care of the surgical site.
Aside from cosmetic concerns, care for the surgical site to prevent complications must be emphasized to the patient.
4. Encourage family and friends to offer support.
Knowing that there are constant people who accept body changes and provide support is helpful to encourage social engagement and fast adaptation to the situation.
Care Plan #3
Diagnostic statement:
Disturbed body image related to developmental changes secondary to pregnancy as evidenced by undereating and reported revulsion to weight gain.
Expected outcomes:
- Patient will demonstrate adaptation to changes in physical appearance as evidenced by adjustment to lifestyle changes.
- Patient will recognize health-destructive behaviors and demonstrate a willingness to adhere to health promotion.
Assessment:
1. Assess the perception of change in the body part.
The nurse should have an exploratory conversation with the patient exploring their current feelings regarding body image. The nurse should maintain empathetic and nonjudgmental communication during the conversation.
2. Assess the perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.
Body image alterations may impact the patient’s ability to perform ADLs. Some patients with disturbed body image isolate themselves or struggle in their relationships.
3. Assess the patient’s comments regarding the actual and perceived body changes brought by pregnancy.
Negative remarks about the body changes indicate that the patient may find integrating the change into the patient’s self-concept challenging.
Interventions:
1. Help the patient identify actual changes.
Patients may perceive changes that are not present or real, or they place an unrealistic value on a body structure or function. The nurse can have a conversation about setting realistic expectations for body changes during pregnancy.
2. Encourage the expression of feelings about the actual or perceived change.
Verbalization of feelings can enhance the patient’s coping strategies.
3. Educate her about the normal physiologic changes in pregnancy.
The nurse can educate the patient about what to expect at each stage of pregnancy including the post-partum period. The nurse should emphasize the importance of healthy eating and movement appropriate to the stage of pregnancy.
4. Refer the patient counseling if distress is severe.
The patient may benefit from receiving professional mental healthcare if they are severely distressed.
References
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th edition). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Townsend MC, Morgan KI, ProQuest (Firm). Pocket Guide to Psychiatric Nursing. 10th ed. Philadelphia, PA: F.A. Davis Company; 2018.
