Feeling Good about the Way You Look: A Program for Overcoming Body Image Problemsby Sabine Wilhelm
In a society where a blemish or “bad hair” can ruin an otherwise perfect day and airbrushed abs dominate the magazine rack, many of us feel ashamed of our bodies. If dissatisfaction with your looks is a distressing preoccupation, this compassionate book offers a way to break free from the mirror. Harvard psychologist Sabine Wilhelm leads you through a
In a society where a blemish or “bad hair” can ruin an otherwise perfect day and airbrushed abs dominate the magazine rack, many of us feel ashamed of our bodies. If dissatisfaction with your looks is a distressing preoccupation, this compassionate book offers a way to break free from the mirror. Harvard psychologist Sabine Wilhelm leads you through a step-by-step program that helps you fight the urge to spend hours “fixing” your skin and hair, working out, or shopping for flattering clothes. Reality-check exercises based on cognitive-behavioral therapy demonstrate how to identify unfounded beliefs about your appearance. Once you understand the negative thoughts and feelings that distort your self-image, you’ll be able to shed lengthy grooming rituals and overcome the embarrassment that keeps you from enjoying life. With Dr. Wilhelm’s expert guidance, you’ll learn to replace self-doubt and insecurity with confidence and a positive outlook. Whether you’ve spent thousands on plastic surgery or avoid trips to the beach, dating, or socializing, you owe yourself this opportunity to make peace with your looks. If you or someone you care about is struggling with a body image problem, effective care is finally at hand.
Health care professionals, see also the related treatment manual: Cognitive-Behavioral Therapy for Body Dysmorphic Disorder.
Description: This is an exceptionally well written and much needed book on body image that presents a step-by-step program to fight the urge to "fix" your skin, hair, etc. The author's approach is based on cognitive-behavioral therapy and focuses on the irrational thoughts, distorted beliefs, and all-or-nothing thinking that is prevalent among those obsessed with body image.
Purpose: The purpose is to help people recognize, identify, and alleviate the distress and excessive amount of time and energy on body appearance. It is written for individuals with concerns about body image, as well as for their family and friends. It is also a defense against the barrage of "perfect" images, ads, and television shows. The book fully meets the author's objectives.
Audience: Because the book is written in such a friendly, straightforward manner, it would be easy to recommend it to clients or friends. Those suffering with body image issues, their family and friends, and even therapists will find this to be a most worthwhile reading experience. The author is the founder and director of the Body Dysmorphic Disorder Clinic and Research Unit at Massachusetts General Hospital.
Features: The book is well structured and reader friendly for all levels. The program is built on cognitive-behavioral therapy, presenting a straightforward and realistic approach. Notably, the irrational, illogical thinking patterns are discussed with specific focus on one's core beliefs. An unbiased discussion on whether to take medication or not is refreshing. Therapist readers will especially appreciate the chapter on comorbidity.
Assessment: The author has given both the general public and the mental health community a wonderfully useful and worthy compendium of information on body image.
"Millions of people suffer from body image concerns. Some are paralyzed by them. Here, Dr. Sabine Wilhelm offers a systematic, scientifically based program of self-treatment. For many, this will be a welcome alternative to expensive professional therapy."--Harrison G. Pope Jr., MD, Harvard Medical School; coauthor of The Adonis Complex "Dr. Wilhelm, one of the few experts on the treatment of body dysmorphic disorder (BDD), has written a landmark book for the millions who suffer from this under-recognized and often disabling illness. For those struggling to overcome the torment of BDD, this book offers invaluable guidance and hope."--Katharine A. Phillips, MD, author of Understanding Body Dysmorphic Disorder "Dr. Wilhelm is one of the world's experts in body image and a pioneer in the treatment of body image disturbance through cognitive-behavioral therapy. This is an authoritative, lucid, wise, and engaging book. More than that, it is an important book--it will change lives. If you are constrained by anxiety and shame about your appearance, Dr. Wilhelm maps out the road to freedom--to feeling truly and authentically good about the way you look."--Nancy Etcoff, PhD, Harvard Medical School; author of Survival of the Prettiest "As someone who experienced body dysmorphic disorder (BDD), when you’re at your lowest, you really believe you will never have a normal life...This book can and will help many people. I wish there had been a book like this when I was at my lowest points!"--LG, Massachusetts "Until now, very little self-help material was available on body dysmorphic disorder, a distressing condition that can lead sufferers to depression, unnecessary cosmetic surgery, and even suicide. If you are struggling with body image problems or care for someone who is, this excellent book offers very helpful guidance."--David Veale, MD, London, UK
"Wilhelm offers step-by-step guidelines to the BDD reader for a self-administered cognitive-behavioral treatment program....Wilhelm also provides a motivational chapter designed to move the client from the preparation stage to the action stage....A useful self-help guide for the highly motivated individual with BDD. This book can also be used as a resource for clinicians who want to learn more about BDD or for clinicians and graduate students who are looking for a BDD manual for individual or group therapy."
"Step-by-step guidelines can help you transform both your thinking and your behaviors concerning your appearance."
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Read an Excerpt
Feeling Good about the Way You Look
A Program for Overcoming Body Image Problems
By Sabine Wilhelm
The Guilford PressCopyright © 2006 Sabine Wilhelm
All rights reserved.
For the Sake of Appearance
Emily, a beautiful 23-year-old medical student, is preoccupied with her skin. She does fine talking to others when she thinks her skin is clear. But when she has a pimple, even speaking to friends makes her nervous—she's sure they're staring at her face. "Why can't my skin look like hers?" she asks herself constantly. "Why can't it be smooth?" Unfortunately, looking at others usually doesn't help, because they seem to look so much better, and this just reinforces her feelings of defectiveness. Emily spends a lot of time checking her appearance in mirrors, and what she sees determines how she feels. Whenever she discovers a new imperfection on her skin, she feels anxious and disappointed, and thinks she looks "repulsive." Blemishes are "really disgusting" to her, and she tries to remove them by picking at her skin. Sometimes the picking itself causes skin irritations, which she then covers up with makeup. She feels particularly bad about some scars she caused during a recent picking episode, because now she's "responsible for making the problem even worse." She blames herself and now thinks even more about her imperfections. "I have these deep holes in my skin. This looks so abnormal. Really disfigured. Everyone will think: Look what she did to her face! What a freak!"
When Emily feels really bad about the scars or a pimple, she keeps asking her boyfriend, "Can you see it? How bad is it?" He usually tells her he can't see anything and she looks great, but lately he's been getting fed up with having to answer the same questions over and over. Emily doesn't believe him anyway: "He's just trying to be nice," she explains. He's also getting tired of missing out on social events because Emily won't leave the house if she feels her appearance isn't perfect. Now she's afraid he might break up with her if all this keeps up, but she doesn't know how to stop worrying so much about the way she looks.
Peter is a smart young lawyer with an attractive smile. He's a high achiever and well liked by his colleagues, who sometimes wonder why he always attends movies and parties alone—when he shows up at all. Peter claims that he has too much work to socialize. The truth is, he's afraid to meet new people. He hates his hair and is thoroughly convinced that no one could ever be attracted to him because of his receding hairline. So he avoids asking women for dates, going out only when someone pursues him, then wondering why anyone would pursue him: "What's wrong with her? Does she feel sorry for me?" Once he's on a date, he can't concentrate enough to converse, because all he can think is "She's staring at my hair ... I'm the only one here who's balding ... I wish I were invisible." Needless to say, second dates are few and far between.
Now Peter's obsession with his hair is starting to affect his job. Trying Rogaine and joining a hair club only left him glancing furtively into every reflective surface to check on the effects of the Rogaine. He inspects his hair from different angles and under different light, and sometimes even counts his hairs, which gets him stuck in front of the mirror for so long before work that he's often late. Recently he's started missing appointments with colleagues because he got mired in counting his hair in the office bathroom mirror. It bothers him that he's so obsessed with his hair, but he just can't stop thinking about it.
For Katie, a 40-year-old mother of three, her nose is the problem. She's already had two nose jobs and is considering a third. If only her nose were fixed correctly, she tells herself, her life would be OK: "I just can't tolerate being so ugly. I'd give anything to look pretty." Everyone else thought each nose shape she's had has looked fine. But after each surgery, Katie has gotten more preoccupied with her nose. Now she feels that her nose "looks really unnatural" and the surgeons "only made the problem worse and really screwed up my life." Over the years, her husband has tried reassurance, anger, pleas, and stony silence to change Katie's belief that her nose is repulsive—all to no avail. She worked as a nurse until about 5 years ago, but after the first nose surgery, she got so upset by her appearance that she couldn't go to work anymore. "My family is really hurting for the extra income, but I've declined many requests from my previous boss to come back. I just don't want my colleagues to see how I look now. I looked bad before the first surgery, but now I'm really repulsive."
At the gym, Ahmed is known as a serious weight-lifter who knows the correct protein supplement to take and the optimal strategy to develop one's "abs." He works out for hours with a detached seriousness that leaves him lonely in the gym despite his being a "regular." His workouts have swelled his chest and arms to the point that his dress shirts fit poorly, but what he sees in the mirror is "puny," "scrawny," "weak," or "unmanly." "Initially, the exercise was just meant to be a healthy thing, to stay in shape, you know?" he says. "But over time it got out of control. I needed to do more and more repetitions to get the feeling that I had completed a workout. I felt like I needed to spend every free minute working out. It sounds crazy, but lifting destroyed my marriage. I really loved my wife, and I still do, but after the lifting took over I never had time for her. I was always in the gym! You see, about 90% of my life revolves around my looks and my exercise. I'd much rather go to the gym than to a romantic dinner. If I ever had to miss a workout because I had to leave town or something, I got really depressed! So I simply would avoid anything that kept me away from the gym.... She didn't understand why we could never go out, never travel, and why I'd rather be at the gym than with her. So finally she divorced me! On top of that, I recently injured my knees from overtraining. I knew I had a problem because I just could not stop working out, even though the pain got really bad. Now it's so bad that I need surgery!"
As anyone who knows Emily, Peter, Katie, or Ahmed could tell you, they aren't crazy. They want the same things most of us want: to be happy, to have meaningful relationships, and to be productive members of society. But they are all struggling with a disturbed body image, and their lives are suffering as a direct consequence. Their body image problems are destroying their social relationships, their health, and their careers. Peter avoids dating and social activities, which isolates him increasingly, and now he's losing the goodwill of friends and colleagues, who are tired of his showing up late or canceling at the last minute because he's stuck in front of the mirror. Emily fears that her boyfriend will break up with her, and Ahmed's wife has already left him. Katie doesn't work even though the financial need is clear, and she can't tolerate being looked at by others.
They all know that something in their lives isn't as it should be. "Recently I got stuck in the office bathroom," says Peter, "and one of my coworkers saw me go in and not come out until 1 hour later! I was so embarrassed! I told him I had a stomach bug. But I'm tired of making excuses. I need to find another way to deal with this." Emily agrees, saying that she really doesn't want to lose her boyfriend but doesn't know how to stop obsessing and asking him for reassurance: "It feels out of my control." Ahmed knows that his appearance obsessions are responsible for his divorce and knee injury: "I've already messed up my health and my marriage because of being so worried about how I look. I need to do something about this now, because if I don't, I'll just keep lifting and ruin my knees again right after this surgery. I also want to date again at some point. But right now I'm way too shy to ask anyone out—and I can't imagine that any woman would tolerate my behavior!" Katie tells me, "I know I'm smart and I used to do a great job at work, but now I just sit at home and think about how ugly I am and how to fix my nose. I don't bring in any money, and believe me, we really need it! I feel like I let my family down.... I'd also be a much better wife and mother if I didn't always think about my nose. It's hard to focus on your family when your mind is always racing with thoughts about your looks. I am sick and tired of this! I want my life back!"
While these four are very aware that something is wrong in their lives, they don't know what to do about it. They can't free themselves from the hurtful perception that they are deformed, ugly, or repulsive. However, there's a difference between their perception (that is, their body image) and reality (their actual appearance), and the gap between that perception and reality is where the problem lies.
Your Word against Theirs: Body Image versus Appearance
Your body image is an inner view of your outer physical body. It's the perception you have of your own body, the way it appears to you. Your actual appearance has little relation to your sense of attractiveness. Being handsome or beautiful doesn't guarantee a good body image, and being homely doesn't automatically lead to a bad one. You can meet high standards of attractiveness without a flaw and still be dissatisfied with your looks, like the models I've worked with who were beautiful but still excessively concerned with some aspect of their appearance. Antonio, who works as a model, has told me, "I'm obsessed with my hair, in particular the sideburns. I want them to look stylish, so they have to be exactly symmetrical, not too long and not too short. Also, I can't have any thin spots. But if parts of my sideburns are too thick, it bothers me. I always give my stylist detailed instructions about how I want her to shape them. She probably thinks I'm nuts, because it takes forever until I'm satisfied with her work. But often she doesn't get it just right, and I then have to spend hours fixing them at home. I cut them and tweeze them. Usually I mess them up even further in this process and need to color in the parts that I don't like with an eyebrow pencil. I'm very ashamed of this! Nobody has ever said anything negative about my appearance, and I often get compliments about my looks. But still, if I think my sideburns are imperfect, it's difficult for me to leave the house. I guess I'm just terrified that anyone could notice that they aren't shaped correctly. I rarely miss work, but I'm trying to hold my head in a certain way to hide the bad spots if at all possible. I've disappointed my family so many times because I couldn't come to birthday parties or weddings because my sideburns weren't perfect."
You can be told repeatedly that you're good looking, yet you see an entirely different picture in the mirror. Why don't you see what others see when they look at you? Body image has only to do with how you see yourself, and people with a poor body image tend to focus only on the body parts they dislike, and disregard the ones they like or find acceptable. As a result, they get a very distorted view of themselves. One man once told me, "When I look in the mirror, my nose is all I can see. I feel like I'm nothing but a huge nose." Jorge, a successful, 38-year-old business owner, is certain that his skin is too red. He's very careful not to sit under bright lights and often applies cover-up. He is so preoccupied by worry about his skin tone, in fact, that he never pays attention to his nice build or attractive smile, features that everyone else sees immediately.
If Jorge's best friend told him to stop harping on his red skin and start noticing how many single women react so positively to his smile, his muscles, his great personality, and his impressive job, Jorge would say that it's only natural to notice your own flaws and do what you can to correct or hide them. It would be hard to argue with that response. What Jorge wouldn't admit, however, is that his skin can't really be flawed if no one else sees it that way. And even if it were flawed, should his dissatisfaction with it rule—and ruin—his life?
Your body image will affect how you think, feel, and act in certain situations. Jorge always notices men with paler skin and wishes he could look like them. Around others with "perfect" skin he feels inadequate and frustrated. If you have a good body image, you may be more self-confident, your self-esteem may be higher, and you might just like yourself better overall. If your body image is negative, you'll feel dissatisfied and preoccupied with your looks. You are likely to be self-critical and mentally beat yourself up for your flaws. You may monitor your environment closely for cues that relate to your appearance and may be very sensitive when anybody comments on it. You are likely to be insecure or anxious in certain social situations, and there are probably some things that you just avoid because they make you feel too uncomfortable. You may not feel as masculine or feminine as you wish, which may reduce sexual pleasure. You may feel that you are less acceptable as a person, or you may even feel discouraged about your future. On days when you think you look particularly bad, you may even have a hard time leaving the safety of your own home. You may compare yourself with people you consider more attractive, and spend a lot of time and effort trying to improve your looks. These patterns of thinking, feeling, and behaving will inevitably result in a sense of failure or inferiority. The more extreme your dissatisfaction and distress over your looks, and the longer you go on feeling this way, the more your life is likely to suffer as a result.
You're Not Alone
Hardly anyone goes through life completely satisfied with his or her appearance at all times. Dissatisfaction with appearance tends to arise at certain stages of life, such as puberty and middle age, and some people seem to fuss with their hair, skin, or clothing pretty much all the time, as a way of life. But chronic dissatisfaction or concern with appearance is a different matter, and it's alarmingly common.
Recently, Dr. Thomas Cash averaged body image questionnaire scores of students who participated in a variety of his research studies from 1996 to 2001. He found that 29% of nonblack women, 16% of nonblack men, and 17% of black women are dissatisfied with their looks. The sizable percentages of women and men who struggle with body dissatisfaction are likely related to the unrealistic body ideal being promoted by the media. We live in an image-conscious society that glorifies physical perfection. TV, radio, and magazines remind us daily to ensure that our breath is fresh, our hair is well styled, our stomachs are flat, and our blemishes are hidden. In a culture where bad hair can ruin a good day, body image distortions seem an almost natural, but tragic, outgrowth of constant attention to appearance. These body image distortions are an extreme magnification of normal concerns about appearance and cause a lot of suffering. What causes them is, of course, a lot more complicated than this brief recitation indicates, as discussed more fully in Chapter 2.
What's Normal and What's Not?
I've been working with individuals with body image disturbances since 1995. As a psychologist, naturally I see more people whose appearance concerns are severe than mild. But many people with body image concerns have relatively mild disturbances and lead relatively normal lives. Usually people with milder degrees of body image dissatisfaction don't consider their problem severe enough to initiate psychiatric treatment, but they still suffer. They think they have an embarrassing secret that no one can ever understand. They often fear that others might think of them as vain. And if they ever muster up the courage to disclose their secret, and others cannot see their flaws, they feel even more isolated. They may be our friends, our neighbors, or even family members.
If you have body image concerns, you're better off trying to set aside concerns about normality for now and instead examine how these concerns are impacting your own life. Discontentment with appearance extends from none or mild to moderate or severe. Thoughts about looks can occur several times per week and may happen many hours per day. Rituals performed in the name of beauty can range from eyebrow plucks to plastic surgeries. Checking the mirror can take several minutes to several hours per day. Some people spend a few dollars per month on cosmetics or hair replacement products; others spend several hundred dollars. Some individuals try to exercise occasionally, because they consider it healthy to train their heart and build their muscles. Others spend several hours per day in the gym and abuse steroids. For you, the important factor should be how much your preoccupation with your appearance is affecting your life. The difference between severe body image disturbance and other appearance concerns is merely a matter of degree, and the borders between normal and not can be blurry, especially in a society where most people are dissatisfied with some aspect of their appearance. It's sometimes difficult to decide whether distress and impairment as a result of appearance worries are still to be considered ordinary or should be classified as a psychiatric illness.
Excerpted from Feeling Good about the Way You Look by Sabine Wilhelm. Copyright © 2006 Sabine Wilhelm. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author
Sabine Wilhelm, PhD, is Professor of Psychology in the Department of Psychiatry at Harvard Medical School and Chief of Psychology and Director of the Obsessive–Compulsive Disorder (OCD) and Related Disorders Program at Massachusetts General Hospital. She is Vice Chair of the Scientific Advisory Board of the International OCD Foundation, serves on the Scientific Council of the Anxiety and Depression Association of America, and is on the editorial boards of eight journals. Dr. Wilhelm's clinical work and research focus on body dysmorphic disorder, OCD, and tic disorders. She is the author of more than 200 articles and book chapters and several books, including the self-help guide Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems, which was cited as a Self-Help Book of Merit by the Association for Behavioral and Cognitive Therapies (ABCT). She is a Fellow of ABCT and the Association for Psychological Science.
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