Exploring body image as a means of preventing mental illness among south Asian young women and girls

身体不满，定义为“对自己身体的负面评价”(1)，是一个主要的公共卫生问题，具有严重的心理健康影响。对自己身体的负面感觉被认为是大多数饮食失调(ED)的“关键组成部分”，其症状可能包括：身体形象扭曲；过度节食和严重体重减轻；随之而来的对体重增加的病理性恐惧；以及频繁的“失控”暴食，有时伴随着不适当的通便，如自我诱导的呕吐或服用泻药[2]。据称，神经性厌食症(AN)的死亡率是所有其他精神疾病中最高的(3)。躯体变形障碍(BDD)是另一种精神障碍，由个人对身体的不满意所支撑，被定义为全神贯注于一种“想象的”或“感觉到的”缺陷或外表缺陷，这种全神贯注导致临床上显著的社会、职业或其他重要功能障碍的痛苦或损害(4)。据报道，自杀率是普通人群的45倍。身体不满对健康的其他影响包括增加抑郁和焦虑的风险，这反过来又增加了从事更多冒险行为的风险，如自残、滥用药物和其他冒险活动(6)。为了解决这个问题，斯提斯和他的同事开发了基于不和谐的干预措施(DBI)的证据基础，以减轻身体不满(7)。Body项目在过去16年中不断演变，并对最初的干预脚本、资源和课程计划进行了少量的改编。该项目的特点之一就是使用“同行领袖”进行干预，并对传统的身体项目进行了调整，使之适合正统的犹太青少年女孩。在对我的硕士研究(8)和随后的可行性研究进行了系统评估后，我得出的结论是，在提供身体形象干预方面，少数族裔的需求没有得到广泛的研究，因此针对这些群体可能面临的具体问题的资源不足。可行性研究在2018年1-3月，我与慈善机构ReThink精神病进行了一项小规模的可行性研究。针对黑人、亚裔和少数族裔(BAME)女孩对身体形象和饮食障碍的特定干预需求，一种普通的基于学校的健康干预措施应运而生。在一个焦点小组(n=10)之后，新出现的主题，如制度性种族主义的影响，家庭对饮食的态度和禁食宗教习俗的影响，被提出为典型的身体意象干预中没有解决的问题。这导致我们共同设计基于证据的内容，比如外表理想，而不是通过文化视角。结果，关于身体形象和行为的文化包容性研讨会被联合制作，并在伦敦的两所学校试行。结果显示，干预后，90%的参与者(n=40)感到能够使用技术更好地管理他们的身体形象，并表示他们知道应该向哪里寻求帮助。研究还表明，通过共同设计和共同交付过程中的经验，使用联合制作模式对参与者和专家都是互利的。虽然这项可行性研究尚未发表，但它证明了这一项目提案的基础，并为拟议的研究提供了理论基础。

Body dissatisfaction, defined as a 'negative evaluation of one's ownbody' (1), is a major public health concern, with serious mental healthimplications . Negative feelings about one's own body have been saidto be "a critical component" of the majority of eating disorders (ED),where symptoms can include: having a distorted body image;excessive dieting and severe weight loss; a consequent pathologicalfear of regaining weight; as well as frequent episodes of "out ofcontrol" binge eating sometimes followed by inappropriate purgingsuch as self-induced vomiting or laxative use (2). It is claimed that6 / 9anorexia nervosa (AN) has the highest mortality rate of any otherpsychiatric disorder (3).Body Dysmorphic disorder (BDD), another psychiatric disorder whichis underpinned by an individual's body dissatisfaction, is defined as apreoccupation with an 'imagined' or 'perceived' flaw or defect inappearance, where the preoccupation causes clinically significantdistress or impairment in social, occupational, or other importantareas of functioning (4). The impact of this disorder is equally asdevastating as those with an ED, with it being reported that suicidalityis 45 times higher than that of the general population (5).Other health implications of body dissatisfaction include an increasedrisk of depression and anxiety, which in turn increases the risk ofengaging in more risk-taking behaviours such as self-harm,substance misuse and other risk-taking activities (6).To address this issue, Stice and colleagues have developed anevidence-base for dissonance-based interventions (DBI) for thealleviation of body dissatisfaction (7). The Body Project has evolvedover the last 16 years, and has produced a small number ofadaptations of the initial intervention scripts, resources and lessonsplans. One of the features of the project has been the use of 'peerleaders' to deliver the intervention, as well as an adaptation of thetraditional Body Project to be suitable for orthodox Jewish adolescentgirls.Following a systematic review conducted for my MSc studies (8) anda subsequent feasibility study, I concluded that the needs of ethnicminorities have not been extensively researched when it came todelivering body image interventions, such that resources targetingspecific issues these groups may face are lacking.Feasibility StudyIn January-March 2018, I conducted a small scale feasibility study withthe charity Rethink Mental Illness. A generic school-based wellbeingintervention responded to the demand for a body image and eatingdisorder specific intervention that was suitable for Black, Asian andMinority Ethnic (BAME) girls. Following a focus group (n=10),emerging themes such as the impact of institutional racism, familialattitudes towards eating and the impact of fasting religious practiceswere raised as issues which weren't addressed in typical body imageinterventions. This led to us co-designing content based on theprinciples of evidence-based content such as appearance ideals, butthrough a cultural lens.As a result, culturally inclusive workshops addressing body image andeating behaviours were co-produced and piloted in two London-basedschools. Results showed that post-intervention, 90% of participants(n=40) felt able to use techniques to manage their body imagebetter and stated that they knew where to seek help should theyneed to. The study also showed that using a co-production modelreaps mutual benefits for both the participants and the experts-byexperience involved in the co-design and co-delivery process.Although this feasibility study is not yet published, it demonstrates afoundation to this project proposal and provides rationale to theproposed study.