The current study applied objectification theory [25] as a theoretical lens to explore associations between objectified body consciousness, depressive symptoms, emotion dysregulation, gender, and NSSI engagement longitudinally among a community sample of early adolescents. The research objectives were twofold. The first objective was to investigate group and gender differences among dimensions of body objectification (i.e., body shame, body surveillance, appearance control beliefs) among three groups of interest (i.e., NSSI Maintain group, NSSI Stop group, comparison group) over time. The second objective was to examine changes in depression and emotion dysregulation across groups and gender over time. The present findings offer the first study to examine temporal associations between body objectification, depression, emotion dysregulation, and gender among an early adolescent sample of males and females.
Body objectification
A significant group by time interaction indicated that both NSSI groups reported greater body shame and body surveillance when compared to the comparison group, however, at T2, the NSSI Maintain group reported significantly more body surveillance than both the NSSI Stop group and the comparison group. As previously summarized, a growing body of literature supports an association between body objectification, body image, and NSSI engagement among adolescents and young adults [18, 23, 24]. However, as the first longitudinal study to investigate body objectification and NSSI, findings from the present study offer an understanding of how body objectification relates to NSSI engagement over time. More specifically, our findings suggest that body surveillance, which refers to appearance monitoring and adopting an outsider’s view of the self, represents a critical variable associated with differentiating adolescence who are presently engaging in the behaviour and adolescents who have recently stopped. Our findings suggest that body surveillance may represent an important risk factor associated with the continuation of the behaviour over time, and possibly, a more severe presentation of the behaviour. Additionally, given previous findings [28] which suggest that negative body image and low self-esteem are comparable among adolescents who engaged in NSSI, and adolescents who engaged in NSSI and report a history of suicidality, it would be of interest to further evaluate body surveillance between varying presentations of self-harming behaviours (i.e., no history of self-harming behaviours, NSSI only, and NSSI with a history of suicidality) among both clinical and community samples.
In the present study, youth were transitioning to adolescence, a time where the ability to cognitively engage in body objectification also typically begins to emerge [30, 31]. Previous literature has focused on examining body objectification among young adults and later adolescents [18, 24]. Thus, findings from the current study also validate the presence of body objectification as a risk factor associated with NSSI engagement among an earlier adolescent age group than previously examined (i.e., 11 to 12 years of age). Given that adolescence is a developmental period that confers particular risk for NSSI, as it represents a time that NSSI behaviour typically manifests [11, 12], understanding core risk factors associated with the cessation and/or maintencance of the behaviour are valuable in partially explaining why the developmental period plays such a crucial role in the etiology of NSSI. Additional longitudinal studies that incorporate an NSSI onset group (i.e., adolescents who begin engaging in NSSI over the course of the study) are needed to parcel out the nature of the relationship between NSSI and the body. Specifically, this would clarify whether negative body experiences are a precipitating risk factor or in fact an eventual consequence of continued engagement in NSSI behaviour. A recent study [42] reported that self-esteem and self-efficacy were significant predictors of NSSI onset among a community sample of adolescents. Furthermore, self-esteem [28] is a critical risk factor in differentiating adolescents who engaged in NSSI and those who do not. Additionally, a substantial body of literature suggests that childhood maltreatment negatively influences how an individual views oneself [43]. As childhood maltreatment represents a robust risk factor associated with NSSI [44] future studies would be well served to explore maltreatment as a precipitating factor associated with the development of a negative relationship with the body, and eventual NSSI engagement. Given these findings, and the large degree of overlap between body objectification and self-esteem, future studies would benefit from examining the role of body objectification in conjunction with other intrapersonal variables (i.e., self-esteem, self-efficacy, emotion dysregulation) and risk factors (i.e., childhood maltreatment) to determine which variables instigate the onset of NSSI and whether the same factors dictate continuation over time.
Results indicated that the comparison group reported an increase in body shame and body surveillance over time, as well as a decrease in appearance control beliefs. These findings are congruent with previous research, which suggests that both adolescent girls and boys report significant concerns over their bodies during this time [30, 32]. As previously mentioned, body objectification typically emerges at this time, and early adolescence represents a particularly critical period for body objectification due to numerous normative developmental changes, including pubertal onset, emerging sexuality, identify formation, and gender role intensifications [30]. Taken together, these findings offer partial explanation regarding the comparison groups elevated body objectification, and highlight the importance of acknowledging body objectification as a concern among typically functioning early adolescents.
Emotion dysregulation and depression
The second objective was to examine changes in depression and emotion dysregulation across groups and gender. Findings indicated that the non-NSSI group reported significantly less emotion dysregulation and depressive symptoms when compared to the NSSI Stop and NSSI Maintain groups over time. Moreover, the NSSI Maintain group and NSSI Stop group also differed, with the NSSI Maintain group reporting significantly more emotion dysregulation difficulties and depressive symptoms at T2. It is likely that adolescents with a greater capacity to regulate their emotions and less emotional distress may be less likely to continue engaging in NSSI, resulting in the cessation of the behaviour. However, in the absence of such protective factors, these adolescents may be more likely to continue with NSSI behaviours, with potential increases in frequency and severity.
When these findings are taken in conjunction with the elevated body surveillance and body shame reported by the NSSI Maintain group, and previous findings [24], it appears that adolescents who reported an objectified body consciousness are likely to continue engaging in NSSI behaviour when confronted with overwhelming emotional distress and an inability to regulate emotions [21, 29]. These results validate the objectification theory, as a combination of emotionally based risk factors and objectified body consciousness (specifically body surveillance) appear to be related to the maintenance of NSSI behaviour among early adolescents.
Limitations
Although the longitudinal design and low attrition rate represent strengths of the study, results should be interpreted in light of the limitations of the study. To begin, the community-based sample was comprised of a homogenous group of typically functioning adolescents. It remains unclear how these findings would generalize to a more diverse group of adolescents with different pathologies, or to an inpatient or outpatient clinical sample. A second limitation concerns the use of self-report measures. Specifically, when informed consent was being explained to participants, they were notified that their school mental health professional would be contacted in the event their responses indicated a risk of self-harm or harm to others. Therefore, it is possible that a portion of adolescents may have censored their answers and chose not to fully disclose certain stress and coping strategies when completing certain measures. Furthermore, although the longitudinal nature of the study allowed for the examination of change over a 12-month time period, the two data points only provided a brief depiction regarding developmental change. Future studies would benefit from using growth curve analysis, as this would provide insight regarding both individual and group temporal growth trajectories; however, growth models typically require at least three time points per individual [45]. This would allow for the examination of change at both an individual and group level, across a broader time span of development in relation to NSSI. Furthermore, given the various alternative (e.g., “Goth” or “Emo”) subcultures within the NSSI population [46], future studies would benefit from further exploring the role of body objectification across different subcultures within the NSSI population. Another limitation concerns how emotion dysregulation was measured, as it consisted of only three items, which limited the range of information assessed. Given the well-documented association between emotion dysregulation and NSSI engagement and the results from the current study, future studies would benefit from including a more robust measure of emotion regulation. This would also provide for an in-depth understanding of how changes in specific areas of emotion dysregulation relate to body-oriented variables, depression, and the course of NSSI. Finally, future studies should include additional measures of body-related variables (e.g., interoceptive awareness, dissociation, body esteem, self-esteem, and self-concept) in addition to dimensions of self-objectification, to obtain a more comprehensive understanding of the nature of the relationship between the body and NSSI engagement.
Clinical implications and summary
Although the present results are preliminary and in need of replication, the present study findings are critical to the assessment of NSSI and directions for intervention. Findings from the current study, as well as from a growing body of research, highlight the need to include body-related variables into both risk assessment as well as treatment approaches for youth who engage in NSSI. Furthermore, with respect to risk assessment, it appears that body-related concerns are useful indicators of both a history of NSSI and current engagement in NSSI during early adolescence. Evaluation of body experiences, emotion regulation, and depressive symptoms, may assist clinicians in identifying youth at-risk for NSSI engagement, or youth who have a history of NSSI. Body and self-oriented variables, including self-concept, self-esteem, body image, and self-objectification, represent related and malleable risk factors that are subject to influence and change over the course of development. This alone has important clinical implications, as decreases in negative body image may represent one mechanism through which to achieve therapeutic change [47, 48]. Thus, treatment approaches should focus on taking a strengths based approach to repair negative body image, including fostering positive self-esteem and positive body image development to improve one’s relationship with their body [49]. For example, treatments that incorporate mindfulness training (e.g., dialectical behavioural therapy) or body image work [50] may be more effective at reducing NSSI, because they focus on improving body awareness, body acceptance, and body integrity [50]. Moreover, acknowledging the role of objectification and the broader sociocultural context in therapeutic sessions has strong implications for prevention and intervention efforts. Clinicians should focus on developing client insight regarding how socio-cultural context contributes to body objectification processes and body dissatisfactions, and the implications that this has for their self-esteem and overall self-concept. One method to do so is by priming youth and parents to be critical consumers of media [51]. Additionally, open discussions with the family as a unit could offer potentially valuable avenues in understanding the influence of objectified body consciousness on parent-adolescent relations.
This study represents a contribution to the current literature on body objectification and NSSI as it identifies body surveillance, as a critical factor associated with the maintenance of NSSI among an early adolescent community sample. Despite study limitations, the current findings provide direct support for the role of body objectification, emotion dysregulation, and emotional distress as factors associated with NSSI engagement among young adolescents. It appears that body surveillance may be a particularly salient mechanism to consider both in understanding and treating NSSI. Although further replication and continued investigation is needed, it appears that inclusion of body surveillance, as a risk factor will result in a more comprehensive etiological model of NSSI risk.