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Ask the Mental Health Expert Archives 2001-2004

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Body Image Consciousness

Q. My friend has some sort of body image disorder. She really isn't fat, but her body's not perfect. She's 5'4" and a healthy 125 to 135 pounds. She will not shower with the lights on. She thinks she is grotesquely overweight and she completely spazzes out when she catches someone looking at her.

She is 19 and feels bad for someone that shows interest in her, because she thinks that they pity her. She can't go shopping for pants and she won't go into dressing rooms with mirrors.

It's getting really bad now, and she won't listen to me or anyone when we tell her that she's not fat. It's getting unhealthy and crazy. What is wrong with her? Is she seeing things?

A. Your friend may well have a psychiatric disorder related to body image, though, in some ways, it sounds like an extreme form of a problem common to many women in this country--namely, the fear of being fat.

As you probably know, our American culture over the past 30 years or so has stressed the importance of being thin, along the lines of the fashion models we see on TV. This has contributed to an epidemic of body-image problems among young women. Many of these individuals simply feel bad about their body image, even when they are barely over their ideal body weight. Some will go on to develop frank eating disorders, such as bulimia nervosa or anorexia nervosa.

Reassuring individuals with these disorders that they are not fat rarely does any good, as you have discovered. I can't say what is wrong with your friend, but a distorted body image is part of these eating disorders.

Ideally, I would encourage your friend to get some professional counseling--but this will not be easy! She may become angry, defensive, and insist that you don't understand. She may even withdraw from you. So, it's important to present this in an empathic, non-judgmental way. You might say, for example, "You know, I've been really concerned about you lately. I hate to see you so anxious about how you look, since I really care about you. Is there anything I can do to help?" If your friend opens up to you a bit, you might then be able to suggest some counseling. If not, you might consider getting her The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks by Thomas F. Cash, Ph.D. Good luck with your very caring efforts!

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July 2003

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