Limb Loss and Body Image

Abstract

Body image has been generally defined as a component of the self-concept, formed by both sensory and social experiences (1). Among health professionals working with individuals with amputations, body image changes are cited as a critical issue in adjustment to limb loss and prosthesis acceptance. Sometimes body image plays a central role in the adjustment process, and other times it is secondary to more global adjustments in self-concept (e.g., from nondisabled to disabled, independent to semi-dependent, employed to unemployed, etc.). These more fundamental changes in self-concept may take precedence over changes in body image, and body image changes may not be fully integrated until these other issues are addressed. In other cases, a focus on the tangible changes in appearance may serve as a diversion awayfromless tangibleandmoreanxiety-provoking concerns about one’s changed role or purpose in life. Although many people manage this intricate transformation of self-concept with only mild, transient distress, some individuals with amputations develop lasting negative attitudes about themselves as a result of their altered body and consequent disability. In a less extreme form, others report that they feel positive when wearing a prosthesis but prefer not to see themselves without the prosthesis or look at their prosthesis when not wearing it. Some people with amputations may express embarrassment, shame, or even revulsion about their altered bodies (2). We have viewed this as a form of self-stigmatization, in the sense that an individual is internalizing the social stigma that often is applied to individuals who are viewed as abnormal in some significant way. Body image does appear to have an important relationship to overall psychological adjustment to an amputation. Studies have shown that various measures of postamputation body image concerns were significantly predictive of depression (2,3), lower ratings of adjustment by the professional who provides the individual with prosthetic services (2), lower overall quality of life (2), and lower life satisfaction (4). Williamson (5) found that greater self-consciousness in public situations, which can be viewed as an index of body image concern, was significantly correlated with activity restriction among older adults with amputations. Similarly, Wetterhahn et al. (6) found a strong correlation between a (relatively) high level of physical activity and positive body image. Although further research certainly is needed to delineate the precise interrelations between activity and body image, a reciprocal model in which a well-integrated prosthesis facilitates an active lifestylewhich in turn reinforces an adaptive, positive body image, is certainly rationally appealing and warrants further study. The impact of limb loss and consequent prosthesis prescription on body image appears to depend on a wide range of factors. In the sections that follow, drawing from research findings, our previous writings (7), and our own clinical experience in rehabilitation medicine, we review the impact and relationship of six groups of factors on body image: amputation-specific factors, prosthesis factors, upper extremity amputation, psychological process of adaptation, developmental issues, and social perceptions.