Dear Patti,

My wife Leslie and I are really good, but I’m hoping you can shed some light on a problem of hers that also affects me. We’ve been married for over 10 years now and she’s my best friend. She’s good-natured, energetic, sociable, always helping everyone else and never complains. Most people don’t know this because she always keeps up such a good front, but secretly Leslie hates her body, in particular her large breasts. My wife’s very short and about 30 pounds overweight. While she can enjoy sex, she worries that her body is ugly, always wants the light off, has to be under the covers and never undresses in front of me. In fact, I confess there have been a few times when she has been asleep that I’ve untied the ribbon on the front of her nightgown and looked at her breasts. I feel guilty, but even though she doesn’t believe me, I think she’s beautiful just the way she is and always have since the day I met her. I wish she could accept her body and I don’t understand what’s wrong.
— John

Dear John,

Sadly, when people view themselves as defective they often think everyone else sees them that way, too. This negativity is a widespread condition that not only affects both sexes but also impacts their quality of life and their interpersonal relationships. Poor body image can lower self-esteem and often goes hand-in-hand with depression, anxiety and eating disorders. Your wife’s personal happiness — as well as your marriage — is seriously affected by her problem of a negative attitude about her body, and I realize how painful it is not having the expression of your love and desire accepted freely and intimately.

When individuals have a particular feature or characteristic they don’t like about themselves, they often feel frustrated or ashamed. Whether their “defect” is their nose, height, hair, muscle tone or breasts, they tend to avoid any attention on their “disfigurement.” Some have a more general negative outlook and say things like, “I look dreadful” or “I wish I were one of the beautiful people instead of dull and dumpy.”

Another common expression of poor body image is to focus on viewpoints of others with negative beliefs such as “People are passing judgment on me” or “A man will never want me looking the way I do.” These harmful self-evaluations can result in self-destructive behaviors such as spending endless time trying to correct appearance, or only going places where they can control their looks (i.e., a man who hates his undersized muscles might only socialize where he can wear a suit). As in your wife’s case, other avoidant behaviors include not taking part in sexual activities.

I’m concerned Leslie might be suffering from “spectatoring,” which is when people self-conscious about their body constantly scrutinize themselves during intimate relations. This, in turn, interferes with sexual pleasure and spontaneity. It’s also possible she has a condition called Body Dysmorphic Disorder. BDD, which affects about two percent of the general population, causes someone to severely obsess about how ugly/unattractive their body is and — as a result of their shame and disgust — go to extremes to avoid attention.

I recommend professional help for Leslie with a counselor trained in body image disorders. Leslie needs to carefully explore the historical events and connected feelings contributing to her negative self-image. It’s extremely important that she explore her critical inner voice in terms of how she perceives herself, why she engages in avoidant behavior and pessimistic beliefs, and how to overcome this narrow way of living. She needs to learn how to replace negative thoughts with more positive ones, like reminding herself of her good qualities and reacting to difficult situations with more patience and support.

After she starts getting a handle on her problems through individual counseling, it would be beneficial to go to couples counseling where you can discuss interpersonal issues. In these sessions, you’ll learn not to enable her avoidant behavior and to 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 the two of you already share can be even more wonderful when Leslie feels comfortable having a pleasurable relationship with her own body and with you.