The Impact of Childhood Adversities on Body Image Dissatisfaction in Teenage Girls

Background and Purpose: Teenage years are characterized by a tumultuous period of self and identity exploration (Erikson, 1994), where adversarial events can trigger an identity crisis and cognitive dissonance regarding body appearance and function (Vartanian, 2023). Body image dissatisfaction is a significant health concern associated with depression, anxiety, low self-esteem, binge eating, and substance abuse for teenagers. While it has been found that adversarial childhood events correlate with negative body image (Vartanian & Hayward, 2017; Vartanian et al., 2018), no studies have examined the association between ACEs and body dissatisfaction in U.S. teenage girls, and this study explores that association using nationally representative samples.

Methods: This study derived data from the 2023 National Survey of Children's Health (n=7682), using teenagers aged 13 to 17 years. The dependent variable was body image dissatisfaction, which was assessed by asking parents whether their child was concerned about weight, body shape, or body size. Adverse childhood experiences (ACEs) served as an independent variable, calculated by summing nine domains of individual ACE constructs (i.e., economic hardships, parental divorce, parental incarceration, parental death, household mental illness, substance use, discrimination, witnessing domestic violence, and experiencing violence/neighborhood violence). These were categorized into several ACE scores (0 ACEs, 1ACE, and 2 or more ACEs). The child’s race, body mass index (BMI), participation in physical activities, general health status, insurance coverage over the last 12 months, visits to specialist doctors, caregiver education, caregiver marital status, and household poverty threshold were adjusted for. Chi-square tests (cross-tabulations) were used to obtain prevalence estimates, and complex logistic regression was performed to determine the significant association between exposure to ACEs and body image dissatisfaction in teenage girls. SPSS version 29.0 was used for data analysis, and the p-value was set at .05

Results: Out of 7682 teenage girls, 39% (n=2,961) were reportedly dissatisfied with their body images based on parental reports. The prevalence of body image dissatisfaction was higher for teenage girls who were exposed to two or more ACEs (51.1%, p<.001) and one ACE (37.8%, p<.001) compared to those without ACEs (33.5%, p<.001). In an unadjusted regression, teenage girls with at least one ACE (aOR = 1.21, 95% CI = 0.97–1.51, p<.001) and two or more ACEs (aOR = 2.10, 95% CI = 1.72–2.56, p<.001) were significantly associated with increased odds of body image dissatisfaction compared to those without ACEs. Similarly, after controlling for other factors, teenage girls with at least one ACE (aOR = 1.12, 95% CI = 0.91–1.38, p<.001) and two or more ACEs (aOR = 1.93, 95% CI = 1.53–2.43, p<0.001) were more likely to have body image dissatisfaction compared to those without ACEs.

Conclusion and Implications: This study underscores the need for evidence-based interventions to prevent and manage body image dissatisfaction in teenage girls. These interventions should include psychoeducation to address cognitive dissonance, promotion of physical activity involvement, and implementation of cognitive behavioral therapy (CBT), which has been proven effective in improving teenagers' perception of themselves (Arip et al., 2011; Chase-Wise, 2021).