Curved narratives: cultural representation of spinal deformity in children's animated films and its psychosocial implications.

Abstract

Spinal deformities, particularly adolescent idiopathic scoliosis (AIS), are associated with impaired self-image. This study aimed to systematically evaluate how spinal deformities are portrayed in Disney and Pixar animated films and to assess whether recurring visual and narrative stereotypes reflect psychosocial challenges reported by adolescents with AIS. A systematic content analysis was conducted of all full-length Disney and Pixar films released from 1989 to 2025. Characters were included if they exhibited consistent anatomical features suggestive of kyphosis, scoliosis, or lordosis. Each character was assessed for physical, social, and moral traits using a standardized checklist. Clinical plausibility was confirmed by an FRCS-trained spine surgeon. Descriptive statistics were used to analyze prevalence and trait distribution. Forty-eight characters met inclusion criteria, most showing kyphosis (79%). The majority were secondary (42%) or peripheral (35%) figures. Common portrayals included clumsiness (60%), frailty (42%), and frightening demeanor (33%). Only 27% were heroes and 19% were leaders. Female characters were underrepresented (27%). Spinal deformity is frequently depicted in children's animation through lenses of physical and social inferiority. These portrayals may contribute to internalized stigma and identity challenges in adolescents with AIS. Clinicians should consider these cultural narratives when discussing appearance-related treatment options.