Facing great expectations
The question on the lips of many people worried about their self-image - particularly adolescents - is whether they are regarded as 'OK' by their peers.
For teenagers, the period when they are developing from being a child into an adult - and becoming conscious of their image - is a critical stage in their lives, says Eve Wong Wai-lan, clinical social worker and hospital manager of the Adolescent Medical Centre (AMC) at Queen Elizabeth Hospital.
Wong, who has worked at the AMC since it opened in 1995, helps those aged 12 to 19 with a range of physical, social and psychological problems. On an average day, she and her colleagues deal with between seven and 10 cases, which have been referred by doctors, social workers, schools and families. Some adolescents also choose to come to seek help themselves.
Wong says a person's self-image is affected by many things, including family expectations and peer influences. Media and culture also play a part in shaping a person's perception of themselves.
One example includes teenagers diagnosed with anorexia nervosa (AN), which involves a severe distortion of body image - an important part of self-worth. Anorexics starve themselves in the belief that they are fat.
In the AMC's first four years, it treated 37 teenagers with AN, 35of whom were females. Wong says the number of teenage cases is growing - with patients getting younger. 'Part of the problem is that puberty is coming earlier and earlier,' Wong says.
Causes of AN are complicated and can be linked to brain dysfunction, she says. But messages that people receive from the outside world also play an important part in setting standards of self-image.
'We're told we have to be thin to be beautiful and successful,' says Wong. 'Media is constantly surrounding us, telling us how we should look. We are forced to fit into a mode set by others in order to feel OK about ourselves.' Wong says AMC treated one girl who thought she was too fat. 'She'd been told she was too fat for years; the person telling her this was her maid.'
In another case, Wong helped a girl who had trouble accepting her looks. 'She is like a 'tom boy', but her mother is very feminine and dresses like a real lady, from head to toe. This caused a lot of problems for her. But her mother wasn't aware of that until we talked to her.'
Wong says parents and family therapy have crucial roles to play in the development of self-image.
'I do see that all parents love their children,' she says. 'But they may not be doing the right thing [when interacting with their children]; some might overlook the emotional needs of their children.
'A harmonised family is the key to building resilience among teenagers facing growing-up problems.'
Wong says another problem teenagers face is the narrow definition of success, based on academic achievement in Hong Kong.
'We don't value or recognise other talents in music or sports in the way we do academic success. If we're not good in school, we're not considered any good. Even if we let our children learn to play the piano, we want them to compete and win medals, rather than play for sheer pleasure. In fact, we're never good enough under this kind of social value.'
Wong says having only one definition of success means that teenagers who fail to meet that standard will start to think they have failed. Eventually, they reach a stage where they will never feel good about themselves, she says.
'A healthy self-image is about feeling good about ourselves - seeing life in many aspects. We need to find the things we like to do and spend time doing them - not for getting a certificate or being successful - but for fun and enjoyment.'