The body you cannot accept

Specialist CBT therapy for anxiety, OCD, depression and more in West London

The phrase “body acceptance” can sound simple until someone tries to live inside it. For a person who feels scrutinised by every mirror, photograph or piece of clothing, being told to accept their body may sound like another standard they are failing to meet. They may not want to be positive about their appearance. They may simply want to stop feeling that their body decides whether they can work, eat with others, be photographed, leave the house or be close to someone. Body image and self esteem overlap, but they are not the same thing. Body image can involve how a person sees, experiences and thinks about their body at a particular time. Self esteem often concerns the wider story they tell about their worth, competence and place with other people. A difficult body image day can affect self esteem, and low self esteem can make appearance concerns feel more convincing. But one does not automatically explain the other. It is also important not to assume that body image distress means body dysmorphic disorder. Concerns about appearance can be influenced by social pressure, illness, injury, hormonal changes, pregnancy, ageing, eating difficulties, trauma, relationships, social anxiety, depression and many other circumstances. A blog cannot diagnose BDD or determine why a person is finding their body hard to live in. Sometimes a person has noticed a physical change that is new, painful or worrying. That deserves appropriate medical advice rather than a psychological explanation from an article. If you are concerned about a symptom, change in weight, eating, exercise, medication or physical health, speak to an appropriate healthcare professional. Therapy can be part of a broader plan where appropriate, but it should not replace medical assessment. What people often describe is a cycle of attention and response. They may check mirrors, compare photographs, seek reassurance, use particular clothing to hide, avoid intimacy, restrict food, overexercise or decide not to attend an event. These behaviours can bring a short period of relief while making appearance feel more central in the long term. For someone else, the pattern may be looking away from every mirror and feeling frightened of seeing their own reflection. The details differ, and they matter. An assessment can explore the thoughts, behaviours, body sensations, emotional impact and situations that are most difficult. It can also consider what is already helping, what support is in place and whether another service, medical input or specialist support may be needed. The point is not to decide that someone is vain or irrational. It is to understand the pattern well enough to consider a compassionate and realistic next step. In CBT based work, the aim is not necessarily to make a person love every feature or abandon all interest in appearance. It may be to lessen the power of harsh rules, checking and avoidance so that valued parts of life become more available again. When behavioural work is clinically appropriate, it is planned collaboratively with an appropriately qualified clinician. It is not a self directed instruction to remove a safety behaviour, look in a mirror for a fixed time or attend a feared situation because a blog says you should. People sometimes worry that therapy will dismiss their experience with reassurance that they look fine. A thoughtful conversation should not depend on a therapist becoming another source of reassurance. It can make room for the pain of feeling seen, the fear of being judged and the wish to have a life that is not organised around appearance. That is different from pretending appearance has no meaning. You do not have to have the right language for an initial conversation. It may be enough to describe a recent moment when your body felt like an obstacle to something you wanted to do. What did you tell yourself? What did you do next? How long did the relief last? These questions can help an assessment begin without turning the conversation into a demand for instant acceptance. The related /therapy/body dysmorphic disorder/ page and /guides/bdd comprehensive guide/ offer further information. If you are in Chiswick, Ealing and the Richmond venue or prefer online sessions, /start/ is a route to discuss current options and decide whether a fuller assessment may be useful. If you are in immediate danger or have thoughts of harming yourself, call 999 or attend A&E.