There are so many people for whom their body image is the one thing holding them back from the ability to be the person they want to be, dream to be and that absolute belief that they are not as good as anyone else in that room, being judged by others and have a total and clear picture of the person they think the others are seeing.

Body image not only stretches from what we see in the mirror ourselves, it's a 3 angle view.

Body image revolves around the 3 aspects of our "self".

1. The person you see in the mirror

2. The person you think your family and friends and those whom you feel comfortable with see

3. The person you think others see who have never met you before.

If one or 1 or all 3 of those parts of you is negative then this can in fact filter through to your self esteem, self belief, ability to interact with others, the way you read situations and how you believe others are responding to you.

Body image goes far past the skin depth - it goes into the very core of our belief systems and if you interfere with those then your perception of the world can change dramatically.

The way body image is dealt with in main stream medical intervention is often with direct psychiatric treatment, some of which can be effective but for others it is dealt with in the manner of a "disorder" on its own.

Frequently there is a misconception that this is the presenting problem - the distorted view of one's self which then leads to paranoia and depression, eating disorders etc. However, in order to deal with body image issues you need to look at the root cause of the problem, the one aspect of which, if you deal with that then the entire system and pattern of negative imagery and thoughts will collapse.

For a number of clients over the years, the initial problem started as a minor doubt. The same thing that most of us encounter at some time in that when we are in a specific state of mind, then our own internal image of ourselves will reflect the way we are feeling at that time. We then project that when interacting with others and in turn we get a less favorable response which then convinces us that our sudden negative view of ourselves must be correct.

From that one occurrence, an entirely new behavior is born. A filter of self doubt based on a image we held in our mind for a fleeting moment of time which is then confirmed by the reaction of others to us.

If I give you a simple example.

A teenager wakes up in a low frame of mind. The day before had been awful for her, her friends didn't have time for her, her boyfriend seemed to be more interested in someone else and her parents have other worries going on so no one seems interested in her. At that age, this is enough to be the world falling apart.

Her own self doubts begin to formulate putting her into a negative frame of mind. When she looks in the mirror, those insecurities change the perceived view of herself and she sees a less than perfect image. She concentrates on the parts of her she does not like which is in fact what she has been thinking about for the last hour anyway about her own personality.

When she concentrates on the negative aspects this then magnifies them and she focuses on what she doesn't want and doesn't like about her entire self.

She could feel unsure about many aspects and elements of herself and then also has a negative internal image. IE the picture she holds in her mind of herself which may be different from the one she saw in the mirror.

She then gets ready to go out - nothing looks right, nothing feels right so she then covers up to hide the imperfections she believes she has. When she does meet her friends, the image she believes they are seeing then cause her to be more withdrawn than usual.

Due to her change in her behavior and the way the girl is conducting herself with others, the reactions she gets from her friends is different, possibly distant or reserved.

So, she then has it confirmed to her that the negative image she believes they are seeing must be right due to the change in their attitude towards her and the spiral goes on.

There are so many ways this can go - eating disorders, social anxiety, aggressive behavior, low self esteem resulting in never achieving goals and so on.

So what has to change and what is the answer.

Well for each individual it is different. Frequently body dysmorphic disorder is not from a major traumatic event as so often stated. Normally there is no known "first event" and the client will state that it just started. Even with techniques designed to find the first event, there is nothing significant.

Also, each person has their own specific times and way that it occurs and almost always there will be situations where in fact it does not occur at all. It is purely individual and there is no fast and hard rule of thumb on how to treat body image issues except that it is the root cause, the self esteem issue which has to be addressed before any real effect can be made of the perception of the self.

If more time was spent on the evolution of therapy and work with the individual rather than various "authorities" looking to disprove the theories and treatment of others maybe more would and could be done in the main stream of body dysmorphia and related eating disorder patients in the UK and throughout the rest of the world .

We seem to forget about the individual and looking for the root cause, which when disconnected and dealt with will enable the rest of the chain to resolve, instead of following or disproving strict methods of others.

Only when the various main stream treatments become more flexible client orientated will our battle with the growing number of patients and clients begin to slow down. The amount of clients approaching me, having been through the normal medical system without success is rising. In the USA they have enlisted the assistance of other therapists from varying disciplines for input and treatment and we, in the UK are still stuck in the negative framework which in fact are moving us no further forward.

For further information on body dysmorphic disorder and related topics please see www.emmajames.net

Emma James MABNLP, MATLTA, MABH, Dip FTST