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Body image concerns

Body image concerns include a broad spectrum of worry about our appearance. The presence of this worry is not determined by whether there is a visible difference or disfigurement or not, such as in the case of body dysmorphic disorder.

Seeking psychological help to address these concerns can improve quality of life significantly, whether this is alongside surgical intervention or as a stand-alone psychological intervention.

The impact of body concerns

It is common for people to think about their appearance and at times, wish that part of their body looked different. For a small proportion of people, the concern about the way their body (part) looks can become a problem. This part of their body may look obviously different. For example, there may be a scar, a skin condition, a birth mark or a missing limb. This difference may have been there since birth or as a result of ill-health, accidents or injuries. Occasionally, the part of the body you worry about may not be considered unusual by a large proportion of people and can include hair loss, a nose that is large, small breasts and much more.

Irrespective of whether the body part is obviously different or not, body image concerns can cause significant distress and impact negatively on a person’s life and relationships. In such circumstances, it is not unusual for a person to think about this part of the body frequently throughout the day. Any physical symptoms associated with this body part can make this worse. They may check it in the mirror or take selfies and may also try to make it look better. The person may also avoid certain activities that increase upset and may often feel embarrassed or ashamed.

There is now evidence that psychological treatment can make a real difference.

How therapy can help with body image concerns

Less attention

We would work towards reducing your focus on that body part and your appearance. This is important as you are likely to experience a lot of unpleasant emotions and upsetting thoughts when paying attention to your appearance. This might involve changes to checking or other behaviours that you do in an attempt to help yourself feel less upset.

Dealing with others

You may have experienced other people asking or commenting on your appearance. At times, you may also be concerned about people staring at you. We would work together on developing a repertoire of responses in these situations that enable you to manage your feelings and also get out of these interactions what you wish to.

Shame and embarrassment

You may experience strong emotions about your body, such as disgust, shame or embarrassment. These are difficult emotions to tolerate and hard to shift. If you are bothered by these feelings, you may have noticed that you are less keen to be around others and that it affects how you feel about yourself and your overall appearance. We will look at how you can respond when experiencing these emotions.

Self criticism

You may also find that you berate your body and have many negative thoughts about yourself and your prospects. You may also be bothered by strong memories where you have felt awful about your appearance or where others have commented or bullied you about your appearance. We will work to help you respond to these memories and thoughts to protect you from further distress.


The body part may need treatment or cause you symptoms, such as itching or pain. You may struggle with some of the treatments you are having or the symptoms you experience. We would find ways to reduce the negative impact of these symptoms or treatments or look at how you can manage these symptoms differently through particular skills and techniques. You may also wish to undertake treatment to the body part to improve its appearance.


You may have noticed that it is difficult to be around others when you are bothered about the way you look and you may even avoid such situations where possible. This might be because you are distracted by your mind when around others, because of how you are feeling and maybe because of how others react to you. This might be worse in intimacy. We will work on skills to help in these situations so that interactions feel less awkward and more satisfying.

My experience working with body image concerns

I have been practising in the area of body image for over 15 years. I was briefly based in an out-patient eating disorder service, which has been a helpful adjunct to the body image work I do.

I have worked with patients with a disfigurement (for example burns, necrotising fasciitis, AVMs, facial palsy, neurofibromatosis, scleroderma, and many more) or a disability that affects their appearance (for example rheumatoid arthritis, amputation).

I have developed a good understanding of what it is like to face the world when you look different and the challenges this brings at different times of life, particularly if there are restrictions to mobility or function. I am happy to be involved when there are likely to be further interventions. Knowledge of rehabilitation is also helpful in supporting you.

I have also been working with patients where the visible difference is minimal in the presence of appearance anxiety or even body dysmoprhic disorder (BDD), delivering evidence-based treatment.

I lecture on body image and have published in peer-reviewed journals and also co-written book chapters on body image.

Dr Esther Hansen


Please use the contact form to ask questions or arrange appointments. Alternatively you can email info@estherhansen.co.uk. Please note that data submitted in the contact form and via email will be processed by 3rd parties.

If you wish to discuss personal or sensitive information then you may prefer to call on (0044) 020 3637 0796.

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Private Patients, Royal Free Hospital
Pond Street




+44 (0)20 3637 0796