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Ask Dr. Andrea is a series from The Lily with Dr. Andrea Bonior, a licensed clinical psychologist and advice columnist. She answers questions about relationships, mental health, work-life balance, family dynamics and more. If you have a question for Bonior, please send us an email.

Dear Dr. Andrea,

I am getting ready to go on my first beach vacation in two years, after having spent most of my college years going regularly because I went to school on the Florida coast. I am going with friends that I haven’t had a trip with in a while, and they are people that I really like and trust. But I am sort of dreading the trip because I feel so gross in a swimsuit, and I am hating the way that my body looks. That never used to happen. It’s not that I ever loved how I looked, I just never thought about it. And it’s not that I’ve really put on weight but I just feel so gross.

It’s pretty bad and something that I’ve been noticing a lot more — I don’t like my face, which is starting to look old (I’m 27) and I am hating my nose, which has bothered me on and off for years. I have always hated my flat, thin hair and the other day I noticed that I have a whole shower full of products for it — most of which I buy and am not satisfied with so I stop using. Now that I am not wearing a mask much anymore I feel so exposed, and self-conscious. I honestly feel like I would rather wear a mask.

I know it’s not that unusual for women to hate the way they look — and that totally sucks, by the way. But I also wonder if there is something deeper with me. When do you know if it’s body dysmorphia? Where is the line between being unhappy with the way I look and a psychiatric problem? Is there a way to get on a better track here?

— Not Liking My Looks

It’s a sad state of affairs when we must acknowledge that the “norm” is seriously dysfunctional in its own right.

(Courtesy of Andrea Bonior)
(Courtesy of Andrea Bonior)

Unhealthy self-talk about one’s appearance and negative body image have become all too common among Americans, especially women, and especially in the age of Instagram-perfect beach snapshots. But it’s worth recognizing that whether it’s a cultural problem, an internal psychological problem or some combination of both, people struggling with it could still benefit from help.

As I see it, body dysmorphic disorder — like almost all psychological disorders — exists on a spectrum. For every person that spends tens of thousands of dollars on cosmetic procedures to repeatedly “perfect” their appearance and hours of their day preoccupied by what they view as their physical flaws, there is someone whose life isn’t quite as affected but who is still experiencing problems. Their struggle may gobble up fewer of their dollars and hours, but it can affect their mood, self-confidence and engagement with life all the same.

We usually think of psych disorders in terms of how much distress and daily life impairment they cause. So, if you want some clues as to the severity of this, ask yourself: Will these issues prevent you from being happy on the trip? Will you have to skimp on groceries because of the growing mountain of volumizing shampoo that occupies your shopping cart? Will you start losing productivity at work because you’re looking in mirrors all the time — or maybe obsessively avoiding them?

But even if none of these are happening, you’re definitely not feeling particularly good about your appearance. The word “hate” cropped up more than once in your letter, and so I’d argue that you could use some help, period — whether you meet a certain diagnosis or not.

To be clear, this past year has proved particularly tough for these vulnerabilities. Many people reentering social situations are finding themselves more insecure about their appearance than ever before, maybe because their bodies or grooming habits have changed over the pandemic, or maybe because they’re just out of practice with eye contact. So it’s possible that part of this is growing pains that will get better on their own.

But if these issues don’t improve, you could use some support not only identifying where the struggles originated but also targeting them with some mindfulness strategies. Try to cultivate an in-the-moment awareness of your negative self-talk, labeling the distortions where you can (“Hi, Body Bully!”), using physical relaxation techniques to gain some distance from them and then watching them pass. And try to get in touch with the deeper values that hold meaning in your life and make up your identity as a full, real person.

Your appearance is but a tiny slice of who you are — as hard as it is in our culture to remember that.

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