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Body Image Issues? You're Not Alone

by Elizabeth Nikol, MSW, LCSW

Wellness image

Being diagnosed with breast cancer at 29 was extremely difficult. At the time of my diagnosis, I was in graduate school to begin my psychotherapy career. As I struggled with my own body image issues, I became passionate about trying to help others through the same issues after a cancer diagnosis.

Self-esteem is elusive for most of us, yet it contributes heavily to mental and physical health. Self-dislike can lead to depression, anxiety, stress, unhappy relationships, substance abuse, poor communication, and social difficulties. The interesting part is that we play a role in determining our self-esteem. As a cognitive therapist, I believe that we can evaluate our thinking (including our thoughts about ourselves) and then choose a different response than we have previously.

Cancer affects our self-esteem on so many levels. It can push it higher – we fought a dangerous disease with good outcomes and we believe we can do anything. And it can drive it lower – we have to depend on others and we may be unable to do what we used to do. It can worsen a poor body image for those of us who have always struggled with body image issues or create one for those who haven’t.

Numerous changes take place in our bodies after a cancer diagnosis – parts of our bodies have changed or are completely gone, we may have lost our hair to chemotherapy, we may have scars where there were none before, our sex lives may falter, we may feel physically weak, and overall we believe that our bodies betrayed us. These can lead to body image issues, which can cause difficulties in relationships with loved ones (particularly spouses or partners), can alter our choice in clothing, can inhibit us from being socially active, and can increase levels of depression and anxiety. For these reasons, it is critical that we work hard to improve our view of ourselves.

Cancer affects our self-esteem on so many levels.

Author of Article photo

Elizabeth Nikol

According to cognitive therapy theory, situations happen in our lives that cause us to think a certain way. And our thoughts, in turn, lead us to feel emotions. Our own “lens” colors the way we see the world. For example, a woman with breast cancer has a lumpectomy, causing one breast to be slightly smaller than the other breast. She tries on a bathing suit, thinks that everyone will notice that her breasts are different sizes, and therefore may feel sad. She may avoid the beach or may wear a coverup. Imagine how she might feel if, instead, she thought, “I am feeling well enough to go to the beach this year.” That thought may lead to happiness or excitement.

How can you work on your thoughts?
The first step is to notice the negative thoughts about your body, or what you believe other people’s perception of your body to be. Write that down, along with the associated emotion. Then ask yourself, What is true about my thought? What is NOT true about my thought? What are some alternative explanations to my own interpretation? What might I tell a friend if she came to me with this thought? What is the worst that can happen? What is the best that can happen? How is my life being affected by holding on to this thought? What could happen if I changed my thought? Write these answers down.

Most of the people I treat find that these “thought records” help them examine their thinking from a variety of angles to see that just because they think something, it doesn’t necessarily make it true. Be a defense attorney for your own thoughts. Could you defend your thought about your body to a jury beyond a reasonable doubt? If you can’t, then there is some room to create a more balanced interpretation and change your behavior. In the case of the woman with breast cancer, perhaps her alternative thought may be, “Although my breasts are different sizes, the chance of someone noticing is very unlikely.”

Tips for Improving Body Image

  • Wear clothes you feel comfortable in.
  • Stay away from the scale.
  • Think an optimistic thought before you look in the mirror.
  • Take time to do nice things for your body, like get a massage or take a walk.
  • Remind yourself that the people who love you, love you for you and not for the way your body looks.
  • Make a “why I like myself” list and read it frequently.
  • Write self-affirmations on a daily basis. The best tools you have for increasing your self-esteem and body image are a notebook and a pen.

♦ ♦ ♦ ♦ ♦

Elizabeth Nikol is a behavioral health clinician with Summit Medical Group in Berkeley Heights, NJ.

This article was published in Coping® with Cancer magazine, January/February 2009.