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Don’t let body dysmorphic disorder and other negative self-images ruin your relationship

By Patti Carmalt-Vener 03/12/2014

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Dear Patti,
Ever since I met my wife and best friend, Melody, 10 years ago, I thought she was the most beautiful woman in the world. I still think so, but every time I compliment her, she says things like, “Oh, you’re just saying that to be nice. You know I’m short and fat and I look awful compared to all my friends.” She also makes comparisons to rail-thin, skinny models in fashion magazines and catalogues and doesn’t believe me when I say I wouldn’t trade her for any of them.   

Melody has waged a war with her bathroom scale ever since high school, and while I agree that losing those extra pounds would be good for her health, this is a lady who’s full of energy, generous in helping others and is that proverbial “life of the party” that everyone is always happy to see. 

When it’s just us, though, she suffers from really low self-esteem about her body image and this carries over to our lovemaking because — although she likes sex — she never wants me to see her naked with the lights on. I wish my wife could look in the mirror and see the same gorgeous human being that I do. Why is it so hard for women to accept that they don’t have to be perfect?

— Bradley

Dear Bradley,
It’s not just women who embrace the negative mindset that if they picture themselves as flawed in any possible way everyone else is probably honing in on those imperfections, too, and judging them accordingly. Poor body image doesn’t just lower a person’s self-esteem/self-confidence and impact relationships with others; it can also lead to anxiety, depression, substance abuse and eating disorders. There’s no question that you love Melody deeply and having your heartfelt compliments repeatedly rejected by her is very painful. 

When there’s a physical feature or trait that individuals don’t like about themselves — be it their height, weight, hair, muscle tone, facial characteristics — they usually feel ashamed, angry or frustrated. It’s not uncommon for them to verbalize their disgust or wish aloud that they could trade places with one of those “beautiful people” they so envy. There’s also a tendency to ascribe negative beliefs to other people such as, “They’re laughing at me behind my back because I’m bald” or “My boss will never promote me because I’m fat and frumpy.” The harmful nature of these critical self-evaluations can lead to self-defeating behaviors such as avoiding situations where they think they’ll be scrutinized too closely (including in the bedroom) or becoming obsessive about self-improvement activities. I’m concerned that Melody’s self-consciousness about her weight could interfere with the spontaneity and sexual pleasure the two of you should be enjoying. She may also be suffering from body dysmorphic disorder, a condition in which someone obsesses so severely about how unattractive they think they are that they’ll go to extreme measures to avoid the attention of others.

My recommendation is that Melody pursue professional help with a counselor trained in body image disorders. In therapy sessions, she’ll be encouraged to explore past events and connected feelings that have contributed to her negative self-image. It’s extremely important she explore her critical inner voice in terms of her self-perceptions and pessimistic beliefs, why she engages in avoidant behavior, how to overcome this narrow way of living, and how to replace negative thoughts with positive reminders of the many good qualities she possesses. 

After she starts getting a handle on her problems through individual counseling, it would be beneficial for you to attend couples counseling. In these sessions, you can discuss interpersonal issues as well as learn not to enable her avoidance behavior and allow her to experience the painful feelings she needs to acknowledge. With time, she can learn to accept, enjoy and even love her own body. The wonderful love and partnership you already share can grow even deeper when she feels comfortable having a pleasurable relationship with her own body and with you.  

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her Web site, patticarmalt-vener.com.

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