posted 22nd June 2025
At some time in our lives most of us will look in a mirror and cast a critical gaze at the image that we see. Self image is understandably important to us and this is where some confusion can arise for people who are suffering with body image concerns. It can be extremely hard for suffering individuals to determine whether their degree of concern is a reasonable reaction to what they see in the mirror, or whether it might be a problem that is more psychological in nature.
As conscious, self-aware social beings, we conceive of our own existence as separate selves, who must navigate the complexities of life and relationships, often alone. We tend to think that we are rational, sensible people, who make decisions as wisely as possible, however the field of psychology teaches us that the conscious component of our awareness is largely a story which we tell ourselves as a means to make sense of how the underlying dynamics of our instincts, primal drives, emotions and the hidden structures of our thinking, meet the circumstances of life and form habits, or simple rules of engagement. Yes we have awareness, but actually, this awareness exists within the predetermined parameters of our evolution and our conditioning and limited awareness can give rise to beliefs and behaviours which do not serve, or harm us.
People with body image concerns have often experienced times of significant stress and alienation, which may have seemed so normal and commonplace that perhaps they weren't even recognised. Children in particular lack perspective on life. For this reason, those who suffer with body image preoccupation may see their symptoms as divorced from any underlying causes. They may know that their preoccupation is harmful, but they rationalise the concern and feel it to be an urgent and profound reality, which simply must be faced, dealt with and fixed. The inner voice of BDD says things like ‘I can’t live like this’.
When we begin to uncover the true causes we can see that this is a compelling simplification to what is likely a complex challenge. BDD identifies a problem but it is not the true problem. Whilst the true issue is overshadowed by the urgency of BDD, the sufferer remains caught. Like a child who lacks the perspective, the BDD part of us needs support.
I have worked with many people who arrive in therapy with the question ‘Do I have BDD?’. I usually think to myself, what would be the function of introducing this concept or validating it as a truth. Instead I choose to simply ask whether their concerns about appearance are interrupting their ability to live their life.
It may be worth noting that this way of addressing appearance concerns embraces individuals who do not necessarily even admit to themselves that they suffer, who may mirror gaze and spend great amounts of time, energy and money invested in admiring and perfecting their image. These are very shaky and unreliable foundations for self-esteem and a very limiting perspective on what potential value one has.
The goal of some spiritual practice is to achieve immortality. Rather than being a literal physical immortality, this means discovering the immortal part in oneself, that which remains unattached, or is beyond grasping to the particularities of ones established sense of self. The closer that we can get to identifying and living from this expansive place, the more natural or authentic we become. In a sense, the challenge of spiritual practice is to fix the primary problem arising from self-awareness, that we conceive of ourselves as fundamentally separate, when actually, every component of self is made of non-self elements and we are in continual dynamic relationship with life.
This is not to say that we must become something else than what we are, or must remove our character. It merely sets the context for us to recognise that which no longer serves us and for letting this go. It also unburdens us of limitations on our creativity and playfulness, which are both the antidote to stagnation and the spirit which renews us.
This perspective, although perhaps somewhat esoteric seeming, is the foundational starting point when evaluating addressing BDD. The most productive way to approach an individual suffering with BDD, or appearance concerns of any type is with the respect of seeing their full potential and their symptoms as an obstacle to be reconciled. When we look closer, beyond diagnosis and rationalisation, then we may begin to uncover what is really going on. Adam Penkul