This chapter is aimed at helping you to develop a new perspective on yourself. First, we’ll introduce an approach to combating low self-esteem called self-acceptance. Second, we’ll encourage you to look at your past, and to re-consider events that may have contributed to your negative self-image.
As we’ve already seen, many body image problems stem from a tendency to over-identify appearance with your ‘self’. That is, to measure, rate and value yourself according to appearance or physical attractiveness alone. In simplistic terms this can be presented as the following formula:
The danger is that such a philosophy has great potential to make a person feel unhappy if they either a) are visibly different from others in their appearance; or b) have a thought or image in their mind that their appearance is very different from and not as good as other people’s. It can also lead a person to become excessively critical of their appearance, leading them to scrutinize their appearance for any possible flaws.
Condemning yourself, overall, as repulsive, and unlovable is a form of over-generalizing called ‘labelling’(see Chapter 6 for more on this) or ‘self-attacking‘. It is this particular thinking error that people are usually referring to when they talk about ‘low self-esteem’. Labelling yourself will make you feel worse and is very likely to lead to counter-productive action such as avoidance, rituals or other safety behaviors.
Would you teach a child to value themselves according to the way they look, their popularity or their success? Or would you want them to develop an unconditional sense of self-worth? Yes, our society seems to hold beauty in high esteem (and people with body image problems tend to over-focus on this), but do you really agree with this value? Do you choose your friends solely on the basis of what they look like? Self-acceptance is part of being warm and decent to yourself and will put you in the best possible frame of mind to engage fully with life.
Accepting yourself has two important implications for overcoming body shame and body dysmorphic disorder. First, it means you are equal in worth to other human beings just as you are, and this will help to improve your self-esteem and reduce shame. Second, it means that, because you’re not distracted by attacking yourself, you’ll be better able to concentrate on facing your fears, reducing your safety behaviors, and re-focusing on the world around you and what will make life more rewarding.
Self-acceptance involves the following assertions:
1. As a human being, you are a unique, multi-faceted individual.
2. As a human being, you are ever-changing and developing.
3. You may, to some degree, be able to measure specific aspects of yourself (e.g. how tall you are), but other things are harder to place a value on (e.g. how kind you are).
4. It is in the very nature of being human to be fallible and imperfect.
5. Because you are a complex, unique, ever-changing individual, you cannot legitimately be rated or measured as a whole person.
To overcome disturbing feelings such as shame and anxiety about your appearance, it helps to regard your feature(s) as only one aspect of you, rather than defining you. (For example, you are more than your nose!) Naturally, it’s foolish to deny that some people and indeed some aspects of ‘society’ place an overly large importance on appearance, but you don’t automatically have to go along with them. Concentrate on the effect of putting yourself down based on your feature. Is it helping? If not, you can certainly develop greater levels of self-acceptance. This means accepting yourself (including your flaws), and recognizing that you are a unique, fallible, human being like everyone else, without globally condemning yourself.
Consider the ‘Big I, little i’ illustration above. This is one way of showing that each and every one of us is made up of a huge number of parts, and that appearance is only a part (or even a few parts) of who we are.
PRACTICAL EXERCISE
Take a pack of sticky notes and a large wall or a door (or another person if they’re prepared to help out). Write down on a note a characteristic that you, as a whole person, possess and stick it on the wall, door, or a volunteer. Keep doing this, trying to think of all aspects of yourself, until you run out of characteristics (or notes!). This can be a very memorable illustration of how multi-faceted you are.
Sally decided to practise the idea that her nose made her imperfect, but that she could accept herself as a person with many other good points.
George concluded that even if his eyes were bigger than he would ideally like, he was a fallible human being, not a freak.
The way to develop self-acceptance is to think more self-acceptingly and to act in a way that reflects self-acceptance.
Another important factor in body image problems is of course worries about other people’s reactions. As social animals, we human beings naturally place some importance on what other people think of us. However, like other parts of us, this can become a problem if it gets over-developed. Our patients often tell us about their fear of dropping a safety behavior (such as camouflage) and this resulting in someone responding in a way that they feel humiliated by. Their fears include:
• Someone laughing at me.
• Someone making a negative comment about a flaw in my appearance.
• Someone making a negative comment to another person about my appearance.
• Someone thinking something negative about me but not saying anything.
Psychologist Windy Dryden has provided a useful analogy to help people cope better with the idea of other people putting us down, which he calls the ‘Dryden invitation technique’. The invitation technique involves considering negative evaluation by other people as an invitation for you to evaluate yourself negatively. Think of it like an invitation to a party; at the bottom it usually says ‘RSVP’, the message being ‘let us know whether you accept or decline’. The great thing about invitations is that you can decline them, so when someone evaluates you negatively, even if they are harshly critical, you don’t have to accept their invitation to criticize yourself.
INVITATION
Dear ______________________
YOU ARE INVITED TO:
CONSIDER YOURSELF UNATTRACTIVE AND UNLOVABLE
For having an imperfect appearance
Please RSVP as to whether you accept or decline.
Remember, whatever triggers your own negative and self-critical thoughts, you can choose to recognize those thoughts as simply thoughts, not the truth. Again, we say more about this in Chapter 6.
Imagine a bowl of really good-quality fresh fruit. Now imagine that one of the apples in the fruit bowl has a bruise on it. Would you consider the whole bowl of fruit to be ruined and inedible? Of course not! It’s a delicious, nutritious bowl of fruit, with an apple that has a bruise.
Many people with body shame and body dysmorphic disorder compare themselves with highly polished celebrities or models. This puts further distance between your self-image and your ideal, making you feel more dissatisfied.
You may also be focusing on the better aspects of other people’s appearances and overlooking their flaws, whilst doing the reverse to yourself. Think about the way you look at other people when you meet them for the first time. Do you tend to focus on the part of their appearance that worries you about yourself? You’re trying to reassure yourself that you are no different from others – but this bias tends to have the reverse effect because you tend to focus on and remember those who you think look better than you. Try to focus on the whole person: they may have some very nice features but none of us is perfect. Like you, they will be a mixture.
For some readers, this will be one of the most important parts of this book. Here, we are going to encourage you to identify early experiences in your life that relate to your shame, anxiety or preoccupation about your appearance. We’ll introduce some ‘pen-and-paper’ strategies that will help you to challenge the unhelpful meanings you have in your mind related to early experiences. We will also teach you some techniques that focus more on your imagination. Remember: if you have memories of a highly painful or traumatic nature you should probably not use these techniques involving imagination without the support of an appropriately trained therapist.
QUESTIONNAIRE 8.1: IDENTIFYING EARLY EXPERIENCES THAT MAY BE RELEVANT TO THE DEVELOPMENT OF YOUR BODY IMAGE PROBLEM
1. Are there any early experiences that you can remember that may have contributed to your developing unhelpful patterns of thinking and acting about your appearance? These might be experiences of teasing, bullying, humiliation, sexual abuse, or what you learnt from your parents or peers. These links may not necessarily be about your appearance but something that you learnt about yourself that made you think you were different or abnormal. To begin with, simply list any memories that come to mind.
2. The second way to identify relevant memories is to use your experience of the picture in your mind or the felt impression you have of yourself. Try to think of a recent time when you felt upset about your appearance. What was the situation? Where were you?
3. What was happening at the time?
4. How did you feel emotionally?
5. What was the picture or felt impression in your mind? Can you draw yourself or describe the impression you had of yourself?
6. Did you have any bodily sensations? Where in your body did you feel them (e.g. tightness in your skin)?
7. How old were you when you first experienced that picture or felt impression of your feature? Please describe your experience in the first person, present tense (e.g. ‘I am about six years old and playing in a school playground. A boy who is quite popular with other girls just comes up to me and tells me I look ugly’).
8. What was the most upsetting meaning that this experience had for you? The meaning might influence your views about yourself (e.g. ‘I am ugly and I’ll be alone all my life’) or how you think others will behave towards you (e.g. ‘People will always humiliate me’).
9. Can you remember the first time you had this meaning in your mind?
There may be several painful experiences that have all contributed to the views you have of yourself and others. Try to repeat this questionnaire for the most important experiences.
This is a ‘pen-and-paper’ strategy for taking another look at distressing or unhelpful experiences. The aim is to describe the meaning you attached to an experience when it happened, and then to look at the experience as an older, wiser person and generate an alternative way of understanding the situation. To help yourself do this, use the table on page 210 and consider the following:
• What would be the effect of a kinder, more compassionate way of looking at the situation?
• How would you help a child, close friend, or loved one look at the situation?
• What is a more balanced and non-extreme point of view?
• How would someone you respect look at the experience?
This is a technique for tackling one specific memory at a time and is usually best done with a therapist with experience in this approach. The memories might be of being abused, teased, humiliated – anything you think that might have contributed to your body image problems. The principle is that you, in your imagination, go back in time to talk to your younger self and deliver a more helpful way of understanding a difficult experience.
Select a memory from those you have identified earlier in this chapter. Re-live the upsetting memory in detail, as if it were happening now, imagining that you are the age you were when the event happened. It is important to keep your eyes closed and describe it in the first person present tense so that it feels as if you are re-experiencing it.
Re-live the memory again but this time imagining that you enter the scene as an adult and intervene. You might simply observe and offer your younger self comfort, or you might actively change the course of events and help your younger self escape. The important thing is to find out what your younger self wants and help your younger self in whatever way you can. Sometimes the younger self may need you to bring with you an authority figure to stop the bad things happening.
Imagine again that you are your younger self (as in Step 1) and describe out aloud what it feels like to see your older brother or sister arriving on the scene. Consider whether your younger self would need anything else to happen to help it feel better. If necessary repeat Step 2 depending on whether the younger self needs more to happen.
Now ‘ground’ yourself back into the ‘here and now’. Look around you and remind yourself of where you are, the time, and the date.
A male client, Jim, who suffered from BDD recalled the first time he felt really ashamed about his appearance. This was when he was being hit by a bully at school. One of the bully’s friends made a comment during this upsetting experience that he remembered very well: ‘Stop hitting him, it won’t make him any better-looking.’ At the time Jim thought ‘I’m being hit because I look disgusting’, and later concluded ‘I must always look good to avoid people hurting me’. This rule drove a considerable degree of his preoccupation with his appearance. If he focused on the memory, Jim would get an image of a bully standing over him, hitting him, with a crowd of people standing around him, watching. He reported that he had the distinct impression that the onlookers were enjoying the spectacle, a bit like a Victorian freak show.
Jim considered alternative meanings using the triple column method first, and then went on to imagine himself as an older person going into the memory to intervene. He imagined himself grabbing hold of the bully and throwing him to the side. Drawing from his work on the triple column method, he then imagined himself explaining to his younger self that he was being bullied simply because he was shy and had moved from another school. He explained that the comment from the bully’s friend was the only comment of its type he’d ever been on the receiving end of in his life. As such, it was a rare, unusual event, not the norm for his life and therefore not something from which to draw general conclusions.
A fundamental process that maintains the way you feel about your body is ‘thought–event fusion’. Thus if you feel ugly or have the thought that you will be alone all your life, then that becomes very real to you. Rating yourself as ugly and the future as being hopeless is treated as a fact in the same way as ‘the sky is blue’. Sometimes other people reinforce this tendency (for example, friends or relatives who say ‘I’d be depressed too if I went through what you did’).
While you focus on your negativity, you don’t notice the process by which your thoughts and reality are becoming fused. Instead, you totally buy into the content of your thoughts as facts. These thoughts are really just mental chatter, rather than objective evidence that everyone can agree with. When the way you feel about your body is very rigid, we understand you won’t believe the alternative meanings. However, it may be more helpful to consider your relationship with your thoughts and how you react to them. If you have fused your thoughts with reality and believe them to be true, it’s not surprising that you want to escape from them or from the feeling of being ugly. Thus, in order to escape unpleasant thoughts and feelings, you might start to put in place things which seem to be protective, but which actually make your life much harder. For example, you might want to:
• avoid activities and people that you normally enjoy and become more focused on yourself
• withdraw from friends or family
• make excuses to yourself (e.g. ‘I am not in the mood’ to see other people)
• use alcohol or drugs to numb your feelings
• brood about the past and try to work out reasons for the way you feel
• avoid calling friends because you think you may be humiliated or rejected
• spend a lot of time watching TV or DVDs or spend excessive amounts of time on the Internet
• ignore the doorbell or telephone.
One of the best ways of truly viewing your thoughts as mental chatter is to act as if you already really believe the alternative. The way you act or behave has a big impact on your thinking. So if you deliberately act against your negative beliefs you are simultaneously eroding them and building up your new beliefs. This strategy is extremely helpful, so practise it often. Here is a questionnaire to help you get acting ‘as if’:
QUESTIONNAIRE 8.2: ACTING ‘AS IF’
1. Write down the new belief or attitude that you wish to strengthen (e.g. ‘I have a feature that others do not notice or believe to be that abnormal. The problem is that I worry a lot about my feature.’)
2. Now consider, if other people in your life could see positive changes in you, what do you think they might notice? How would you be behaving differently if you truly believed in your new way of thinking about yourself, others and/or the world? Think of people you know who seem to hold the kind of attitude that you wish to strengthen in yourself. How do they behave in ways that reflect that way of thinking? Write down how you can act ‘as if’ you believe in your new healthy belief:
3. Where and when could you act in the ways you have described above?
