PAPER

BODY IMAGE / BODY IMAGE

Arranged by :

Name : KHOIROTUN MAULIDA

NIM : 151911913014

Class : 3A GRESIK

NURSING DIII STUDY PROGRAM

VOCATIONAL FACULTY
AIRLANGGA UNIVERSITY
IN 2020
 FOREWORD

Praise the presence of God Almighty for the completion of this paper. This paper we
made in fulfilling the assignment of the subject "Mental Nursing I". We created this paper to
help understand the "Body Image Disorders" both theory and Mental Nursing which are
based on case examples.

With this paper, readers are expected to be able to develop and add to their knowledge
in addition to books. - Reference books and other papers, this paper is not a perfect result,
given the times to come, it needs a process of improvement and refinement

If this paper has deficiencies, then we as the compilers of this paper expect criticism
and suggestions from readers. We hope that this paper is useful for all readers. We really
hope for constructive criticism and suggestions for the next lesson.

thanks.
 TABLE OF CONTENTS

COVER PAGE...............................................................................................

FOREWORD..................................................................................................

TABLE OF CONTENTS...............................................................................

CHAPTER I INTRODUCTION

A. BACKGROUND..................................................................................
B. FORMULATION OF THE PROBLEM.............................................
C. DESTINATION....................................................................................

CHAPTER II THEORY BASIS

A. DEFINITION OF BODY IMAGE.......................................................

B. DEVELOPMENT OF BODY IMAGE MODEL................................
C. BODY IMAGE COMPONENTS........................................................

D. EFFECT OF BODY IMAGE ON

DEVELOPMENT OF PERSONALITY.......................................
E. ETHYLOGY........................................................................................
F. BODY IMAGE INTERFERENCE.....................................................
G. AFFECTING FACTORS
BODY IMAGE.....................................................................................
H. NEGATIVE AND POSITIVE BODY IMAGE...................................
I. CLINICAL MANIFESTATIONS OF BODY IMAGE.......................

CHAPTER III NURSING CARE

A. ASSESSMENT.....................................................................................
B. DIAGNOSIS.........................................................................................
C. IMPLEMENTATION..........................................................................
D. EVALUATION.....................................................................................

CHAPTER IV CLOSING

A. CONCLUSION.....................................................................................
B. SUGGESTION.....................................................................................

BIBLIOGRAPHY...........................................................................................
 CHAPTER I

PRELIMINARY

A. BACKGROUND
Beauty, or an attractive physical appearance, is an important aspect of
making a first impression and can also attract other people to us. Even though
this kind of assessment is certainly very superficial and does not seem to see
'content' or other things outside of appearance, it cannot be denied that people
do tend to see physical appearance or outward appearance.
In the opinion of researchers, we will feel more happy if we see people
who have a 'pleasing' and clean appearance than people who are 'filthy', dirty
or unkempt. One of the most important and visible aspects of physical
appearance is the body. A body that is slim, slender, toned for women or a
muscular body for men, tall, 'hard' for men is everyone's dream. When
compared to a body that is 'thin', emaciated or a fat body that is ugly, 'lazy'
and looks not agile, people would prefer to have an ideal body that is slim and
toned, which indicates health and also makes a person look more confident
and attractive
Physical appearance is also an important aspect of attracting the
attention of the opposite sex. From a physiological perspective, research on
animal behavior by zoologists suggests that both male and female animals
undergo physiological changes that occur unconsciously when they try to
attract each other's attention. The same behavior occurs in humans, because
they occur unconsciously and cannot be explained, these behaviors are likely
to be innate.

B. FORMULATION OF THE PROBLEM

1. Explain the concept of body image?
2. Describe nursing care about self-concept namely body image?

C. DESTINATION
1. Students are able to know and understand the concept of body image.
2. Students are able to know and understand about nursing care about body image
 CHAPTER II

THEORETICAL BASIS

A. DEFINITION OF BODY IMAGE

Body image is a combination of images, fantasies, and individual meanings
about the parts and functions of the body that is owned which is part of the
components of self-image and the basis of self-representation (Cash and Pruzinsky,
1990).
Schilder defines body image as a picture of an individual's body that is formed in our
minds, or in other words, an image of an individual's body according to the individual
himself (Glesson & Frith, 2006).
Body image is the mental image we have of our body. This mental image
includes two components, namely the perceptual component (size, shape, weight,
characteristics, movement, and body performance) and the attitude component (what
we feel about our bodies and how these feelings lead to behavior) (Rudd and Lennon,
2000).
Body image is a person's perception, thoughts, and feelings about his body
(Grogan, 1999).
According to Honigman and Castle, body image is a person's mental image of
their body shape and size, how a person perceives and gives an assessment of what he
thinks and feels about his size and body shape, and how other people think about him.
Actually, what he thinks and feels does not necessarily represent the actual situation,
but rather is the result of subjective self-assessment (Dewi, 2009).
Body image shapes one's perception of the body, both internally and
externally. These perceptions include feelings and attitudes aimed at the body. Body
image is influenced by personal views of physical characteristics and abilities and by
perceptions of the views of others (Potter & Perry, 2005).
Body image is an individual's attitude towards his body, both consciously and
unconsciously, including performance, body potential, body functions as well as
perceptions and feelings about body size and body shape (Sunaryo, 2004).
From birth the individual explores parts of his body, accepts his body's
reactions and receives stimuli from others. Realistic view of yourself, accepting and
liking body parts will give you a sense of security, avoid feelinganxiety and boosts
self-esteem. Individual perceptions and experiences of their bodies can dynamically
 change body image. The perception of other people in the patient's environment
towards the patient's body also influences the patient's acceptance of him (Keliat,
1998).
Body image is how an individual perceives his body, both consciously and
unconsciously, which includes the size, function, appearance and potential of the body
and its parts. In other words, body image is a collection of individual attitudes,
whether consciously or not directed towards him.
Based on the definition above, it can be concluded that body image is a
combination of mental images, fantasies, attitudes, thoughts, feelings, meanings, and
perceptions and evaluations of a person about his body which includes shape, size,
weight, characteristics, and body performance. Individuals can have both positive and
negative assessments of their body image. Several things related to body image
include:
1. Individual focus on physical form.
2. The way the individual sees himself has an important impact on the psychological
aspects of the individual.
3. A person's body image is influenced partly by the attitudes and responses of others
to him, and partly by the individual's exploration of himself.
4. A realistic image of accepting and liking parts of your body will provide a
sense of security and prevent anxiety and increase self-esteem.
5. Individuals who are stable, realistic and consistent with their body image
can achieve success in life (Mubarak, Wahit & Chayatin, 2008).

B. DEVELOPMENT OF BODY IMAGE MODEL

The idea that a thin body is an ideal body is heavily influenced by the values
of American culture. American cultural values teach individuality, hard work,
self-control, and success. Individuals get the message that with adequate diet
and exercise, anything can be overcome. Women in particular get the message
that with a perfect body, their work and personal life will be successful
(Barnard, 1992).

Beauty standards are constantly changing. Each era has its own body image
model. Along with the changing picture of beauty, a woman's body is also
 expected to change according to the ideal body image of that era. Cohen
(2001) provides an overview of
changes in body image models that are influenced by economic and
political conditions in America, namely;
a. In the 18th century, the ideal woman's body was one that was
muscular, big, strong, and very fertile.
b. In the 19th century, the ideal body of a woman was a body that was
weak, lethargic, and pale.

c. In the 20th century, the ideal body for women has changed several
times, starting from being slim, strong and muscular, maternal,
fertile, and very thin with large breasts.
d. In the 21st century, the image of a woman's ideal body is a thin body,
like a model. A thin body is the ideal standard. It is not uncommon
for women to do liposuction to make the hips and buttocks look
thinner.
Hernita (2006) argues that the development of ideal body standards
that are continuously presented by the media has an impact on women in
various parts of the world, including Indonesia. The ideal body shown by
the media in Indonesia today is a slim body and pure white skin.

C. BODY IMAGE COMPONENTS

There are several experts who argue about the components of body image.
One of them is Cash (2000), which states that there are five components of
body image, namely:

a. Appearance Evaluation (Appearance Evaluation), which is an

individual's assessment of the whole body and his appearance, whether
it is attractive or unattractive, satisfying or unsatisfactory.
b. Appearance Orientation (Appearance orientation), the individual's
attention to his appearance and the efforts made to improve and
enhance his appearance.
c. Body Areas Satisfaction (Satisfaction with Body Parts), namely
 individual satisfaction with specific body parts, such as face, hair,
breasts, lower body (hips, buttocks, legs), midsection (waist,
stomach), and the whole body.
d. Overweight Preocupation (Anxiety Being Fat), namely anxiety of
being fat, individual awareness of body weight, having a strict diet,
and limiting eating patterns.
e. Self-Classified Weight (Perception of Body Size), namely the
perception and assessment of individuals regarding their body weight,
ranging from underweight to being overweight.

Based on Cash's opinion stated above regarding the

components of body image, it can be concluded that the components of body
image include evaluation and individual orientation towards body appearance,
satisfaction with certain body parts, and perception and assessment of body
weight.

D. EFFECT OF BODY IMAGE ON PERSONAL DEVELOPMENT

Body image, namely individual subjective feelings towards the body is
theorized as a major component of personality (Freud in Rierdan & Koff,
1997). Body image is considered the basis of personality development. This
has led to variations in body image being associated with individual
differences in personality and life experiences.
Peto (in Rierdan & Koff, 1997), for example, proposes the
theory that differences in body image are associated with differences in
levels of self-esteem and levels of individual depression. Individuals with a
positive body image tend to have higher self-esteem and lower propensity
for depression than individuals with a negative body image.
In line with that, Keliat (1992) states that body image is
related to personality. The way the individual views himself has an
important impact on his psychological aspects. A realistic view of self and
the ability to accept the condition of the body will prevent individuals from
feeling anxious and increase individual self-esteem. This statement is
corroborated by research by Casper & Offer (1990) that in women, the
desire to change the body and appearance is associated with decreased levels
 of self-esteem. This can lead to eating disorders.
In some cases, this disorder can progress to pathology, such
as anorexia or bulimia (Casper & Offer, 1990). Negative perceptions of the
body prevent women from appreciating themselves. A woman who focuses
only on her body will not be able to use her energy in any other aspect of her
life. Constant efforts to achieve the ideal body can lead to an obsession with
food. In addition, other psychological problems arise, such as irritability,
feelings of failure and inferiority, memory problems, anxiety, and
adjustment disorders (Barnard, 1992).
Berscheid (Papalia & Olds, 2004) states that women who
have positive perceptions of body image are more able to respect
themselves. These individuals tend to judge themselves as people with
intelligent, assertive, and fun personalities. Dacey and Kenny (1994) argue
that perception is negative adolescents against body image will inhibits the
development of interpersonal skills and the ability to build positive
relationships with other adolescents. Based on the description above, it can
be concluded that individual body image has an influence on personality.
Individuals who have a positive body image tend to have healthy
personalities that are associated with improved quality of life, such as
increased self-esteem, self-confidence, and mental health. Conversely,
individuals who have a negative body image tend to develop unhealthy
personalities, such as decreased self-esteem, poor interpersonal skills, and in
many cases develop pathologies, such as anorexia and bulimia.

E. ETIOLOGY
Pathophysiological and Psychopathological conditions and therapeutic
procedures that can cause body image disorders:
1. Surgical excision or disruption of body parts
a. Enterostomy
b. Mastactomy
c. Hysterectomy
d. Cardiovascular surgery
e. Radical neck surgery
f. Laryngectomy
2. Surgical or traumatic amputation
3. Burns
4. Facial trauma
5. Eating disorders
a. Anorexia nervosa
b. Bulimia
6. Obesity
7. Musculuskeletal disorders
a. Arthritis

8. Integumentary disturbance

a. Psoriasis

b. Scars secondary to trauma or surgery

9. Brain lesions

a. Cerebrovascular accident

b. Dementia

c. Disease parkinson's

10. Affective disorders

a. Depression

b. Schizophrenia

11. Endocrine disorders

a. Acromegaly

b. Syndrome chusing

12. Chemical abuse

13. Diagnostic procedure

14. Loss or reduction of function

 a. Impotence

b. Movement / control

c. Sensory / perception

d. Memory

15. Therapeutic modalities

a. High technology (eg dream defibrillator, joint prosthesis,

dialysis).

b. Chemotherapy

16. Pain
17. Psychosocial change or loss

a. Voluntary change or imposed in a work or social role

b. Support of the closest people

c. Divorce

d. Private ownership (house, household items, finances)

e. Translocation / relocation

18. Community response to aging (agetasim)

a. Negative interpersonal feedback

b. Emphasis on productivity

19. Knowledge deficits (personal, caregiver, or community)

F. BODY IMAGE INTERFERENCE

Body image constructs a complex that is defined by us

"perceptions, thoughts and feelings about body experiences" which are
embedded and shaped in our socio-cultural context not only provides a sense
of self, body image also influences how we think, act and relate to other
people, which Sudden changes in one's physical appearance as a result of
work-related amputation can present significant and complex psychological
challenges (Wald & Alvaro, 2004).

Body image disorders usually involve distortion and negative

perceptions about their physical appearance. Strong feelings of shame, self-
awareness and social discomfort often accompany this interpretation. A
number of avoidant behaviors are often used to suppress negative emotions
and thoughts, such as visually avoiding contact with the remaining limb,
neglecting the self-care needs of the remaining limb and hiding the remaining
limb. Ultimately these negative reactions can disrupt the rehabilitation process
and contribute to increasing social isolation (Wald & Alvaro, 2004).

Individuals with disordered bodies may be hidden or invisible or

may include a part of the body that has changed significantly in structure due
to trauma or illness. Some individuals may also express feelings of
helplessness, hopelessness, and weakness, and may also exhibit behaviors that
are destructive to themselves, such as decreased diet or suicide attempts
(Kozier, 2004).

A body image disorder can be identified by the nurse by

interviewing and observing the patient carefully to identify the form of the
threat in his body image (significant function of the parts involved, the
importance of vision and the physical appearance of the parts involved); the
meaning of the patient's closeness to family members and other important
members can help patients and their families (Kozier, 2004). The patient's
response to deformities or limitations includes a change in freedom.
Dependency patterns in communication and socialization. Response to
abnormalities
form or limitation can be:

1. Adjustment response: shows feelings of sadness and grief (shock,

doubt, denial, anger, guilt or acceptance).
2. Mal-adaptive response: continuation of denial associated with
deformities or limitations that occur in oneself. Destructive
behavior, talks about feelings of worthlessness or changes in
 ability to adapt to the environment.

Responses to patterns of freedom - dependence can be:

1. Adjustment response: is the responsibility for a sense of caring

(making decisions) in developing caring behavior
new to yourself, using existing resources, mutually supportive
interactions with family.

Mal-adaptive response: shows a sense of responsibility for a sense of concern

for others who constantly depend on or strongly refuse help.

The response to socialization and communication can be in the form of:

1. Response adjustment: maintain pattern social

general, needs communication and receive offers of help, and
act as
support for others.

2. Mal-adaptive response: isolates oneself, shows the superficial

nature of self-confidence and is unable to express feelings (being
oneself, resentful, embarrassed, frustrated, depressed) (Carol,
1997).

G. FACTORS AFFECTING BODY IMAGE

Body image is influenced by cognitive growth and physical
development. Normal developmental changes such as growth and aging have
a greater visceral effect on the body than any other aspect of self-concept. In
addition, cultural and social attitudes and values also influence body image.
Personal views of physical characteristics and abilities and by the perceptions
and views of others.
The way individuals see themselves has an important impact on
their psychological aspects. A realistic view of himself, accepting and
measuring his body parts will make him feel more secure so he will avoid
 anxiety and increase self-esteem. The process of physical and cognitive
development of normal developmental changes such as growth and aging has
a greater appearance effect on the body when compared to other aspects of
self-concept (Potter & Perry, 2005).

H. NEGATIVE AND POSITIVE BODY IMAGE

A negative body image is a misperception of an individual's shape, a feeling
that is contrary to the actual condition of the individual's body. The individual
feels that only other people are attractive and the individual's body shape and
size is a sign of personal failure. Individuals feel shame, self-conscious, and
worry about their bodies. Individuals feel awkward and restless with their
bodies (Dewi, 2009).
Positive body image is a correct perception of the individual shape,
the individual sees his body in accordance with the actual conditions.
Individuals value their natural body / body and individuals understand that a
person's physical appearance has only a minor role in showing their character
and the value of a person. Individuals feel proud and accept their unique body
shape and do not waste time worrying about food, weight, and calories.
Individuals feel confident and comfortable with their body condition (Dewi,
2009).

I. CLINICAL MANIFESTATIONS OF BODY IMAGE

Signs and symptoms of body image disorders (Harnawatiaj, 2008), namely:

a. Refusing to see and touch body parts that change

b. Not accepting body changes that have occurred / will occur

c. Refuse to explain the changes in the body

d. Negative perceptions on the body

e. Preoccupation with missing body parts

f. Expressing hopelessness
 g. Express fears

CHAPTER III

NURSING CARE

A. ASSESSMENT
 Assessment of changes in body image is integrated with other
assessments. After diagnosis, surgery and therapy programs usually
do not show the patient's immediate response to changes. But
nurses need to assess the patient's ability to integrate body image
changes effectively (Keliat, 1998).

B. DIAGNOSIS

While the patient is being treated, the nurse takes action for potential
diagnoses, and will be followed by the nurses in the Outpatient Unit to
monitor the possibility of actual diagnoses. Some of the diagnoses of body
image disturbance are potential effects related body image
disturbancessurgery and withdrawal associated with changes in appearance
(Keliat, 1998). The diagnoses that may appear include:

1. Self-concept disorders: Body Image Disorders

2. Social isolation: withdrawal

C. PLANNING
1) General purpose:
Is increasing self-actualization of patients by helping to grow, develop, realize
potential while seeking compensation for their disabilities.
2) Special purpose :
It is so that patients can recognize the support needed in solving problems
related to self-concept and help patients better understand themselves
properly.

Nursing actions:

Nursing actions taken are to help patients identify related situations and feelings in order to
improve their self-assessment so that they can change their behavior. This problem-solving
approach requires gradual action. The focus of action is on the level of cognitive assessment
of life, which consists of perceptions, beliefs and convictions. The client's awareness of his
emotions and feelings is also important. After evaluating cognitive assessments and feeling
awareness, clients begin to become aware of the problem and then change their behavior. The
principle of care given is solving problems that can be seen from the progress of the client
increasing from one level to the next.

Nursing actions are divided into 5 levels (Stuart and Sundeen, 1991):

1) Expanding self-awareness (expanded self awareness)

2) Investigating or self exploration (self exploration)
3) Self evaluation (self evaluation)
4) Realistic planning
5) Disorders and answers to action (commitment to action)

1. Expanding self-awareness (expanded self awareness)

N Principle Rational Nursing actions

O
1. Increase openness Lowering the threat from the 1. Listen to the client
and trusting nurse's attitude to the client
2. Encourage the lien to discuss
relationships and helping the client to
the client's thoughts and feelings
expand and accept all aspects
of his personality 3. Give a non-judgmental
response
2. Work with clients The client's level of ability is 1. Identify the client's abilities
at the client's level treated as the basis of nursing
2. A non-demanding approach
of ability care
3. Accept and try to clarify
verbal and non-verbal
communication

4. Put boundaries in
inappropriate behavior
3. Maximize client Cooperation is important for 1. Gradually increase the client's
participation in clients to accept participation in making decisions
therapeutic responsibility for themselves about his care.
relationships and maladaptive coping
2. Show that the client is a
responses
responsible person.
 2. Investigate yourself

NO Principle Rational Nursing actions

.
1. Helping clients to If the nurse shows concern 1. Encourage clients to express
accept their feelings and acceptance of the emotions, beliefs, behavior and
and thoughts client's feelings and thoughts verbally and non-
thoughts, the client does verbally.
too
2. Use therapeutic
communication and empathic
responses

3. Write down logical and

illogical thoughts
2. Helping clients to Openness and 1. Get a perception of strengths
explain their self- understanding of one's and weaknesses
concept and own perceptions are
2. Help clients to describe their
relationships with prerequisites for change
ideal self
others through
openness 3. Identify self-criticism

4. Help to describe relationships

with other people
3. Respond to empathy, Sympathy reinforces the 1. Use methods of empathy, self-
not sympathy, and client's negative view, the evaluation of sympathy
emphasize that the nurse must say that the
2. Reinforce the client that he is
power to change is client's life must be under
useful in solving his problems
with the client his control
3. Show verbally and in behavior
that the client is responsible for
his behavior including
maladaptive and adaptive
 responses

3. Evaluate yourself

N Principle Rational Nursing actions

O
1. Helping clients to Only by knowing the 1. Identify stressors with the
clearly define problem clearly, efforts or client and how the client assesses
problems alternative solutions can
2. Explain that the client's beliefs
be implemented
influence feelings and behavior

3. Together identify false beliefs,

illusions, unrealistic goals

4. Together identifying client

strengths

5. Research the client's coping

sources
2. Research adaptive It is important to examine 1. Describe to the client that the
client coping to the the client's preferences for coping is free to choose and the
problem at hand coping and evaluate the coping is positive and negative
positive and negative
2. Compare adaptive and
maladaptive responses

3. Discuss the consequences of a

maladaptive response

4. Realistic planning

N Principle Rational Nursing actions

O
1. Help clients identify Only by evaluating all 1. Help clients understand that
alternative solutions alternatives can solutions only clients can change, not other
be transformed effectively people.

2. If the client has an inconsistent

perception, help him see that he
can change it as follows:

a. Beliefs and ideas can bring it

to reality

b. The environment can be

consistent because of client
beliefs

3. If the self-concept is
inconsistent with behavior, it will
change as follows:

a. Their behavior is adjusted to

their self-concept

b. Beliefs underlying the concept

of self are embedded in behavior

4. Together look at how coping

resources can be better used
2. Help clients Setting goals includes 1. Encourage clients to formulate
conceptualize realistic clearly defining their own goals
goals expectations for change
2. Discuss the emotional
consequences, in practice, of the
basic reality of each goal

3. Help the client to clearly

define the expected changes

4. Encourage clients to start new

 experiences to develop their
potential

5. Responsibility for action

N Principle Rational Nursing actions

O
1. Help the client take The ultimate goal is that 1. Provide opportunities for
the necessary actions the client replaces success
to change the maladaptive coping with
2. Strengthen and acknowledge
maladptive response adaptive coping
the strengths, skills and healthy
with adaptive coping
aspects of the client's personality

3. Help clients get the help they

need

4. Use groups that can give self-

esteem to the client

5. Give enough time to change

6. Provide the client with

positive support to help maintain
his progress.

D. EVALUATION
Some things that need to be evaluated in nursing care for patients with self-concept
disorders are:
1. Is the patient's feelings of security against the threat of physical integrity, or
has his self-respect returned to normal, both in integrity and in time.
2. Does the client's behavior show that his self-esteem, self-acceptance has
increased, and his feelings of guilt have disappeared.
3. Whether the patient has been able to expand his self-awareness and evaluate
himself appropriately
 4. Does the patient have a strong source of coping and has been mobilized
5. Does the patient have adaptive coping
6. Whether the patient has taken advantage of the increased self-understanding to
promote personality changes and growth.

CHAPTER IV

CLOSING

A. CONCLUSION
Body image is how an individual perceives his body, both consciously and
unconsciously, which includes the size, function, appearance and potential of the body
 and its parts. In other words, body image is a collection of individual attitudes,
whether consciously or not directed towards him.
B. SUGGESTION
Everyone must be able to accept whatever is in him, so that if there is
dissatisfaction with his perception of his body it does not make the individual change
himself in a negative direction. So when the individual succeeds in accepting himself
and can achieve this. And in the end, the human view in describing the view of his
body image is not even worse, but hopes for the better.

BIBLIOGRAPHY
https://repository.usu.ac.id/bitstream/123456789/23054/3/Chapter%20II.pdf
Susilawati, et al. 2005. Basic Concepts of Mental Health Nursing. Jakarta:
EGC
Stuart, Gail W. 2002. Mental Nursing Pocket Book Edition 5. Jakarta: EGC
Stuart, Gail W and Sandra J. Sundeen. 2002. Mental Nursing Pocket Book
Edition. Jakarta: EGC