9.2 Body image

Body image is complex and multidimensional. Body image is a conscious, ‘top-down’ cognitive perception of your own body. It involves the interaction of physical body appearance, and perceptual, cognitive and behavioural aspects of body experience [137]. It is also influenced by factors such as other connected health issues, cooccurring health conditions, and personal factors like age, gender, education and health literacy.

Challenges around body image are a common issue following limb amputation, particularly for people with upper limb amputations, and particularly at approximately 10 years after the amputation [137-139]. The person’s body image may not be as affected before this time, and then it recovers again sometime after 10 years [140]. The reasons for this are not clear, although the research confirms the need for lifelong monitoring of psychosocial wellbeing and mental health. People with phantom limb pain are more likely to experience body image concerns, which is supported by research on dreams and body image [138, 141].

Self-esteem seems to be independent of body image, and not affected for people with a lower limb amputation, unless there is phantom limb pain [137, 142]. There appears to be no difference in body image challenges and concerns between men and women, nor by the level of the amputation. Although women who report experiencing body image disturbance also report feeling more depressed. [130]. People with two or more limb amputations have more body image anxiety and dissatisfaction [140].

Perception of how they look seems to be a key factor in the level of body image anxiety and social discomfort the person may experience [139]. How the person perceives their appearance and body image also facilitates their active involvement in prosthetic fitting and rehabilitation [130].

Body image is also associated with how well the person has adjusted to their changed circumstances and attempted to integrate the prosthesis ‘into’ their body image [143]. In our research for the guidance, people with lived experience (experiential knowledge) confirmed this key message, with one person commenting they had “an emotional connection with my prosthesis”.

Another influence on body image is the level of physical activity the person undertakes. This is often an underestimated link for people with a limb amputation. People with amputations have reported being involved in sport because of the health benefits, social interaction and stress relief, but also because it supports their psychosocial wellbeing in terms of improving self-esteem and body image [91].

Best practice note—15

Body image

Body image is complex and multidimensional but will likely be affected following a limb amputation.

Concerns and anxiety around body image can occur in the longer term. The multidisciplinary team should not assume the person will not have body image challenges after the amputation; challenges may occur years later. The person should be referred for psychological assessment (and possibly peer support) services as appropriate.

Facilitators to minimise body image concerns include: • working towards ‘integrating’ the prosthesis as a part of their body • active engagement in their prosthetic fitting and rehabilitation • the best possible cosmetic appearance of the prosthesis • participating in exercise and sport (own exercise routine, or social or competitive sports). • Factors that are likely to negatively influence body image and self-esteem include: • the presence of phantom limb pain • amputation of two or more limbs.