Social Physique Anxiety in Female Adolescents at Bandung Middle School

Adolescence is characterized by biological, psychological, socio, and spiritual changes, a period where life problems begin to increase, self-discovery, dreaded age, a period of unrealism, and the threshold to maturity (Ratnasari, 2017). Middle school students are in the early adolescent stage (Batubara, 2016). Early adolescents are unstable, very emotional, have many problems, have a critical period, have an attraction to the opposite sex, lack self-confidence, creativity, fantasize, and like to be alone (Saputro (2017). Erikson states that one of the tasks of adolescent development is determining self-identity, in which the inability of adolescents to determine their identity can lead to an identity crisis (Azizah, 2018). Adolescents tend to compare themselves with the social environment; the more significant the difference between an adolescent with his/her group members, the greater the anxiety that occurs. Female adolescents tend to be anxious when going through puberty due to changes in their physical appearance (Suyamti & Hastuti, 2018). Anxiety in female adolescents, including rapid body size changes, makes them feel awkward for daily activities. Changes in body parts such as wider waist that makes them feel uncomfortable, afraid of their enlarged vital organs which can be seen through ARTICLE INFORMATION ABSTRACT


Introduction
Adolescence is characterized by biological, psychological, socio, and spiritual changes, a period where life problems begin to increase, self-discovery, dreaded age, a period of unrealism, and the threshold to maturity (Ratnasari, 2017). Middle school students are in the early adolescent stage (Batubara, 2016). Early adolescents are unstable, very emotional, have many problems, have a critical period, have an attraction to the opposite sex, lack self-confidence, creativity, fantasize, and like to be alone (Saputro (2017). Erikson states that one of the tasks of adolescent development is determining self-identity, in which the inability of adolescents to determine their identity can lead to an identity crisis (Azizah, 2018). Adolescents tend to compare themselves with the social environment; the more significant the difference between an adolescent with his/her group members, the greater the anxiety that occurs. Female adolescents tend to be anxious when going through puberty due to changes in their physical appearance (Suyamti & Hastuti, 2018). Anxiety in female adolescents, including rapid body size changes, makes them feel awkward for daily activities. Changes in body parts such as wider waist that makes them feel uncomfortable, afraid of their enlarged vital organs which can be seen through clothes or the menstruation discharge that will leave marks on their clothes, besides that, it's also their skin that becomes rougher, darker, and enlarges pores that can cause acne (Ratnasari, 2017). Anxiety due to puberty can reduce self-confidence and cause low self-esteem, for example, fear of being pushed away by friends due to poor body shape, acne, disliked by opposite sex and fear of being bullied by friends (Suyamti & Hastuti, 2018). Bullying to school children can be physical, sexual and emotional (Hidayati, 2015).Victims of bullying often occur in girls which is mainly related to the words of verbal bullying that was very painful for them (Masruroh, Mufidah, & A, 2016).
Many adolescents may feel anxious about their physical appearance, which leads to social physique anxiety (Mumtaz & Malik, 2018). Social physique anxiety is defined as the result of other people's negative perceptions between evaluating one's body image and body appearance (Alpkaya, 2019). Factors that influence the occurrence of social physique anxiety include gender, age, and self-esteem (Jajat & Hardwis, 2020), body image and body weight (MacCracken & Stadulis, 2016), and physical changes during puberty (Mumtaz & Malik, 2018). The specific-aged population was chosen because physiological changes and emotional impacts can result from hormonal changes, peer pressure, and social stigma on the body's condition. Several female adolescents experience the majority of social physique anxiety because they have higher negative perceptions and lower physical self-esteem towards their bodies than male adolescents (Jajat & Hardwis, 2020;Kurniawan, Briawan, & Caraka, 2015). Someone who experiences social physique anxiety will form a self-defense mechanism by creating an impression related to something ideal in someone's eyes (Dobersek & Eklund, 2017).
Social physique anxiety has negative impacts, including irregular eating (Ioannidou & Venetranou, 2019), which can trigger the risk of eating disorders among adolescents (Li, 2018), experiencing increased depression (Alcaraz-Ibáñez & Sicilia, 2020), exercise dependence (Portman, Bradbury, & Lewis, 2018). Besides, awareness of other people's perceptions often causes anxiety that affecting social behavior, causing low self-esteem and avoids situations where the body might be exposed.
Research conducted on Turkish adolescents with an average age of 13 years-old had a social physique anxiety score of 30.64. In this research, differences in the respondent's characteristics were not explained other than their gender (Alpkaya, 2019). Furthermore, other studies found that women have a higher SPAS score with an average score of 30.32 out of a total score of 41.00 because women are considered to have excessive concerns due to their body shape (Portman et al., 2018). MacCracken & Stadulis (2016) researched children and adolescents aged 8-14 years-old showed that female adolescents have an average social physique anxiety score of 25.30. This result is greater than the overall average score. Research conducted in Indonesia in school adolescents shows that girls' average social physique anxiety score is smaller than the average score for boys, which is different from previous research (Jajat & Hardwis, 2020). This may be because the instrument used are instrument that are not specifically for adolescents. In this researchers used the SPAS-C instrument because this instrument was designed to measure social physique anxiety in early adolescent, especially female adolescents, where adolescents have significant physical development and changes so that they cannot be equated with adult instrument. In addition, the researcher also made a list of respondent characteristics, physical condition and attitude which aims to see the defferences in sosial physique anxiety scores with the respondents characteristic, physical condition and attitude.
The result of interviews conducted on guidance and counseling teachers at Bandung Middle School stated that students came to the counseling teacher because they became victims of verbal bullying due to their physical condition. The preliminary study on 15 female students at Bandung Middle School showed that 14 students already had their menstruation, and eight students were not satisfied with their body weight. Furthermore, 11 students had received negative comments due to changes in their body shape, eight students had a fear of getting physically negative comments, and six students experienced a decrease in appetite when they received negative comments due to their physical appearance. Therefore, this study aims to determine the social physique anxiety in female adolescents at Bandung Middle School.

Methods
This research used in this study was descriptive quantitative with a cross-sectional approach. The variable in this study was social physique anxiety. This study population was seventh and 8th-grade students of Bandung Middle School, with 360 female students. The sample obtained in this study used a total sampling technique with 331 female students with a response rate of 91.9%.
The research instrument used was the Social Physique Anxiety Scale for Children (SPAS-C) instrument to measure the social physique anxiety among female students at Bandung Middle School. SPAS-C consisted of 9 items with a five Likert scale, while items 5 and 8 have an inverse score. The interpretation of this instrument was made by looking for the respondents' average social physique anxiety score. The results were then categorized into two, namely lower than the social physique anxiety average score and higher than the average social physique anxiety score. SPAS-C is the best instrument that can be used to measure social physique anxiety in early adolescents and has strong validity because it has been proven in several countries (Stadulis, Neal-Barnett, MacCracken, & Fender-Scarr, 2014). The SPAS-C instrument used in this study resulted from a back translation done into the Indonesian version. Content validity and face validity test were carried out for this instrument. SPAS-C had a Cronbach's Alpha value of 0.82 (Stadulis et al., 2014). The author also performed the reliability test for the Indonesian version of SPAS-C with a Cronbach's Alpha value of 0.63, confirmed as reliable.
Data collection was carried out by distributing a questionnaire containing informed consent, willingness to participate, demographic data, physical health data, and a back-translated SPAS-C questionnaire. Data was collected online so that respondents could choose their spare time to fill out the questionnaire to not interfere with their study time and daily activities. Online questionnaires were distributed through Whatsapp group chat with the approval of the teacher. Data was collected from April 3, 2020, to April 14, 2020. Data were analyzed using univariate analysis by finding the average score of social physique anxiety obtained from all respondents. The results were then categorized into two, namely lower than the social physique anxiety average score and higher than the average social physique anxiety score. After that, data was calculated using frequency distribution data analysis and presented in percentage. Table 1 illustrated those female students at Bandung Middle School's social physique anxiety score showed that 176 respondents (53.2%) had a lower score than the social physique anxiety average score, while 155 respondents (46.8%) had a higher score than the social physique anxiety average score. These data showed that more than half of the respondents have a lower score than the social physique's average score.

Tabel 1 Social physique anxiety on Bandung Middle School Female Students (n=331)
Social physique anxiety Score f % Lower score than social physique anxiety average score Higher score than social physique anxiety average score 176 155 53,2 46,8 Table 2 illustrated cross-tabulation results based on the respondent's class grade; 7th grader respondents had a higher score than the social physique anxiety average score, which was more significant than 8 th grader respondents. Furthermore, according to age, most respondents aged 13 years-old had a lower score than the average social physique anxiety score. Besides, most respondents were Sundanese, and most had a lower score than the social physique anxiety average score. Based on parental latest education, most respondents' parents had finished high school education and had a lower score than the average social physique anxiety score.
As illustrated from cross-tabulation based on the respondents' physical condition, the body mass index showed that most of the extremely underweight, underweight, average weight, and overweight categories had a lower score than social physique anxiety average score. In comparison, all respondents with a significantly overweight category had a higher score than the average social physique score. The majority of respondents who were already menstruating had a higher score than social physique anxiety average score. Most respondents who had fair, golden fair, and tanned-skin had a lower score than social physique anxiety average score; 4 out of 5 darkskinned respondents had a higher score than social physique anxiety average score. The majority of the respondents stated that they did not have white spots, redness, and blackness on the face/neck, hands/legs, and a majority of the respondents had a lower score than the average social physique anxiety score.
The majority of respondents who said they had received negative comments due to their physical appearance had a higher score than the average social physique anxiety score. Then, most of the respondents who stated that they were satisfied with their physical condition had a lower score than social physique anxiety average score, and most of the respondents who stated that they were afraid of physical changes during puberty had a higher score than social physique anxiety average score. As illustrated in Table 3, there are four attitudes of respondents with the highest number when they feel anxious or afraid to get negative comments related to physical appearance, the majority of respondents chose to avoid situations where their bodies may be exposed, ignoring the comments, having trouble sleeping because they think about other people's comments, and withdrawal. Furthermore, more than half of the respondents said that the way to increase their self-confidence was by considering these comments as a motivation to improve themselves.
One of the crucial characteristics of adolescents is that they pay close attention to their appearance. A physical is one of the essential things in an appearance. In a social environment, when someone interacts, physical appearance is the main thing. Apart from one's self-awareness of one physique, other people's views are also fundamental. The anxiety that someone feels towards other person's evaluations about their physical appearance is known as social physique anxiety.
Based on the results on social physique anxiety at Bandung Middle School female students, the average score of social physique anxiety on Bandung Middle School female students was 25.01. This study showed a slightly lower score than the research conducted by MacCracken & Stadulis (2016) in the United States for female adolescents aged 10-14 years that the average score of social physique anxiety among girls was 25.30. The lower the score, the smaller the tendency to have social physique anxiety, while the more significant the score, the higher the tendency to have social physique anxiety (MacCracken & Stadulis, 2016).
This study showed that the number of respondents who had a lower score than social physique anxiety average score was more significant than the number of respondents who had a higher score than social physique anxiety average score. This result may occur due to factors that influenced respondents such as, more than half of the respondents had an average body mass index. Based on the results of research conducted by MacCracken & Stadulis (2016), respondents who had underweight and an average weight had low social physique anxiety scores.
Another factor influencing the number of respondents who had a lower score than social physique anxiety score was that most respondents do not have white spots, redness, black spots on their face/neck, hands/legs. These two factors caused the majority of respondents were satisfied with their physical condition, which means they had a good self-image related to their physical condition, which is one of the characteristics of an individual who has a low social physique anxiety score (McLester, Hicks, Miller, & McLester, 2018). Also, based on age characteristics, most respondents were 13 years old, which most of them had a lower score than social physique anxiety average score. Based on research conducted by MacCracken & Stadulis (2016) stated that 13 years old adolescents had a lower score than social physique anxiety average score of 23.75 because body composition changes from year to year, so that there is a change in self-perception of the body, so that along with the aging the chance of having social physique anxiety is increasing. Jajat & Hardwis (2020) also argued that the older you get, the higher the social physique anxiety.
As a result of this study, more than half of the Sundanese respondents had a lower score than the average social physique anxiety score. According to Aqros et al. (2016), the Sundanese has characteristics that emphasize unity, patience, avoiding disputes, and solidarity. The role, behavior, and appearance of an individual depend on the social and cultural conditions that grow in society so that this understanding will be strong and demanding to be influenced by bad experiences that occur by the individual. More than half of the respondents had a lower score than social physique anxiety average score, but not a few respondents have a higher score than the social physique anxiety average score. It was proven that more than half of the respondents said they had received negative comments related to their physical appearance, and most of them had a higher score than social physique anxiety average score. This study proves that adolescence cannot be separated from physical appearance problems, especially how other people perceive their physical appearance. This study showed that most of the respondents were very concerned about negative comments from other people related to their physical appearances, which, if it has not handled correctly, will cause more significant psychological problems. Psychologically disturbed adolescents will cause more significant problems as adults (Kumara, Wimbarti, Fajar Susetyo, & Kisriyani, 2017).
Besides, the majority of the respondents stated that they had experienced menstruation. According to Suyamti & Hastuti (2018), adolescents tend to feel anxious during puberty due to physical changes. This study showed that most of the respondents who had a higher score than social physique anxiety average score said they were afraid of changes in their bodies due to puberty.
Several anxieties in female adolescents, including rapid body size changes that make them feel awkward for daily activities, change body parts such as the broader waist that make them feel uncomfortable. They are also afraid of their enlarged vital organs, which can be seen through clothes or the menstruation discharge that will leave marks on their clothes. Besides that, their skin becomes rougher, darker, and enlarges pores that can cause acne (Ratnasari, 2017). Anxiety due to puberty can reduce self-confidence and cause low self-esteem, such as fear of being pushed away by friends due to poor body shape, acne, disliked by the opposite sex, and fear of being bullied (Suyamti & Hastuti, 2018).
Several studies have addressed skin color concerning social physique anxiety. Based on skin color, the result of this study indicated that the majority of respondents who had a higher score than social physique anxiety average score are tan-skinned respondents, and 4 out of 5 respondents were dark-skinned. This study's result was different from the research conducted by Stadulis et al. (2014) stated that black or dark-skinned women have less concern about their physical appearance than white or fair-skinned girls. Even Stadilus et al. (2014) said that being too thin is a problem for dark-skinned girls. The researcher argued that this condition may occur due to cultural differences so that the majority of dark-skinned respondents had a higher score than social physique anxiety average score caused by Indonesian culture that still perceives beauty based on fair-skinned and slim standards. This stigma must be broken because beauty cannot be generalized. An individual has different physical criteria and has unique characteristics that can make them look attractive.
From the description above, it can be concluded that the social physique anxiety at Bandung Middle School showed that the comparison of the number of respondents who had a lower score than social physique anxiety average score with the number of respondents who had a higher score than social physique anxiety average score did not have a significant difference. Therefore, preventive solutions for social physique anxiety prevention are essential. Anxiety experienced by adolescents, if being ignored, will have a worsening psychological impact (Tripriantini, Hidayati, & Emaliyawati, 2019). This study indicated that most adolescents choose to avoid places exposed to their body parts to avoid negative comments related to their physical appearance. For some people, avoiding a particular place or group as a way not to get negative comments is often an ineffective way because avoiding means not having the courage to take the opportunity to try and overcome the negative comments. Even avoidance does not make someone learn the lesson. As a result, adolescents will become fearful individuals and not make an effort to change the negative comments they received.
Schools can work together with community health nurses to provide health education to increase adolescents' knowledge of social physique anxiety so that adolescents will not be afraid of negative comments and can take appropriate actions to respond to negative comments due to their physical appearance. Besides, health education regarding growth and development during adolescence is needed in order to reduce feelings of anxiety about changes during puberty (Sudjana, Ari, & Triyani, 2015) as well as behavior development aimed at female adolescents who are healthy without experiencing anxiety, so that their condition can be maintained and fostered better.

Conclusion
Based on the study results, comparing the number of respondents who had a lower score than social physique anxiety average score with the number of respondents who had a higher score than the social physique anxiety average score did not significantly differ. Therefore, preventive solutions for social physique prevention are essential. If adolescents' anxiety is being ignored, it might have a worsening psychological impact on them. Researchers suggest that female students who experience social physique anxiety should get special attention from the school and nearest community health center. Schools can make a consultation schedule or use an online consultation system and work with community health centers to provide health education and knowledge about social physique anxiety and the influencing factors and its prevention.
Further research is needed on different subjects, such as in adults or specific groups. Other research is also needed using a different research design, such as a description of the correlation with multivariate analysis to determine the relationship between social physique anxiety and its influencing factors. Suggestions for further research can be carried out with a broader scope or related to intervention studies to prevent social physique anxiety.