Body dysmorphia: looks are not the real issue

Lately, I have been noticing more body dysmorphia in my practice.

Clients have been trying to convince me that they are too ugly to have a relationship, when there is no apparent evidence. We are makers of meaning, so it is very easy to focus on one aspect of physical imperfection and to believe that is what causes the lack of romantic connection in one’s life.

I have found that the physical features clients are focusing on are not the real issue. The real issue is most often deep-seated self-hatred that people developed in childhood as a result of having been deeply shamed.  Positive affirmations, cosmetics, and plastic surgery will not address these debilitating feelings of worthlessness.  

People feel very different about their appearance, depending upon their mood.  A mirror reflects reality. That reality can be distorted by how one feels about oneself in the moment. This is another instance in which addressing the symptom superficially is ineffective.

When clients work through their feelings of self-hate and inadequacy, their unrealistic, negative evaluations of how they look generally lessen and/or disappear. For example, in a previous gay men’s therapy group, every man in the group talked about how ugly they were as teenagers. I asked them to bring in photos from their teenage years and share them with the other group members. They were all surprised about how physically attractive they had all been when they were young, but so emotionally insecure.

How nice to be surprised about what is actually true!