Body image and self esteem can be affected by many personal, social and health factors. Comparison, comments, relationships, illness, injury, treatment, culture, work, sport, social media and changes in appearance can all matter. A guide cannot assess the cause, severity or appropriate support for an individual, and it cannot diagnose body dysmorphic disorder or another condition. For some people, appearance related distress becomes more time consuming or restrictive. They may avoid photographs, mirrors, social settings, intimacy, particular clothes or medical appointments. Others check repeatedly, seek reassurance, compare themselves or feel critical thoughts become very persuasive. These experiences have different meanings for different people. Assessment can consider the practical impact, mental and physical health, eating patterns, medication, trauma, safety and what support is already available. CBT based or compassion focused support may be considered after individual assessment where relevant. The relevance, pace, format and likely outcome should be decided collaboratively, and exercises should not be copied from a guide without considering safety and personal circumstances. Behavioural work, including mirror or exposure related work, should be planned with an appropriately qualified clinician where it is relevant rather than attempted alone. Physical changes, pain, skin concerns, weight changes, hormonal changes or other health symptoms should not automatically be attributed to body image or anxiety. Appropriate medical assessment may be needed. Urgent appropriate help is needed if you feel unable to stay safe, have thoughts of suicide or self harm, experience psychosis, a sudden marked change in mental state or acute physical symptoms. For related information, see body dysmorphic disorder support at lyceumclinic.co.uk/therapy/body dysmorphic disorder/ and mental health, weight, diet and movement at lyceumclinic.co.uk/guides/mental health weight diet movement/. The Lyceum provides CBT based support in West London and online where clinically appropriate. Enquire directly about current arrangements and whether an assessment, medical review or another form of support may be relevant.