(AGENPARL) – mer 28 settembre 2022 Body image disorders in adolescence. We talk about it with Dr. Adelia Lucattini
Interview By Marialuisa Roscino
Emotional dysregulation in Body Image Disorders, what structural approach can be used with patients through psychoanalysis? What are the therapeutic possibilities?
We recently witnessed an important statement from the experts of the Italian Society of Cardiovascular Prevention: “Valuing body positivity and condemning body shaming is sacrosanct if understood as ‘inclusivity’ and war on discrimination of the ‘different,’ of the non-aligned to mainstream aesthetic standards. But under no circumstances should we pass the message that obesity should be regarded as a ‘normal’ condition, even an alternative to excessive thinness or normal weight. In this field ‘one does not equal one’.”
Body positivity, Eating Disorders, structural diagnosis and psychoanalysis are the focus of this interview, but not only. All this and more, we asked Dr. Adelia Lucattini, a Psychiatrist and Psychoanalyst of the Italian Psychoanalytic Society and the International Psychoanalytical Association expert in developmental age.
Dr. Lucattini, when can we talk about body image disorders?
Among body image disorders we have Dysmorphophobia Disorder, which is a psychological condition in which a person spends a lot of time dealing with and worrying about flaws in his or her body and appearance. These flaws are often imperceptible to others. This disorder can occur at any age, but it is more common in adolescents and young adults. Scientific studies have shown that this disorder affects both men and women equally. Adolescents with dysmorphic obsession should not be mistaken for being vain or self-obsessed; it is really a disconnect between one’s real body and one’s psychic representation of oneself, between how one is and how one sees oneself. The sufferer is a prisoner of his or her disorder, which can have a major impact on life.
Another large group are body image disorders related to eating disorders. In these cases, there is an alteration in the perception of one’s body that leads patients to overestimate their body shapes, to perceive and define themselves as “fat” or “bloated” in patients with mental anorexia or to underestimate them by perceiving themselves as “too thin” or “wasted” in patients with uncontrolled eating disorder or bulimia.
What is the specificity of psychoanalytic treatment in adolescents?
Adolescents have to go a long way in integrating their body image as they transition from childhood to adolescence with the pubertal spurt and sexual maturation. This is clearly seen in the frequent changes in looks, in hair color and cut, in the onset of tattoos and piercings. These are all ways that are part of the experimentation of the adolescent who wants to recognize himself and assert his own existence, differentiating himself from his parents by conforming to one or more groups of peers, the “peer” group. The panniculus adiposus, subcutaneous fat and skin are a shell onto which many entirely natural psychological processes of growth are projected and recognized, but also those that are dysfunctional or an expression of a psychological, personality or mood disorder.
Psychoanalysis allows one to get in touch with one’s own suffering, to learn about the workings of one’s own mind together with an adult who accompanies one on this path of maturation, abandonment of symptoms, recognition and sometimes “construction” of oneself.
Why is adolescence a critical time for body image disorders?
When a crisis, a developmental breakdown, occurs during adolescence, teens’ minds unconsciously tend to find points of weakness in the body and project their “failures” onto it, as the body is seen and felt. By working simultaneously on the mind and its representation on and in the body, it is possible to complete the maturative journey leading to one’s individuation, that is, to become an “individual” with its uniqueness and specificity. In addition, during adolescence it is necessary to mourn the childhood unconsciously experienced as a “golden age” of which one occasionally feels nostalgic and to separate from one’s parents in order to retrieve them later in a more adult way. All those steps necessary to become an autonomous and independent person are facilitated or permitted by psychoanalytic treatment that should be undertaken at the onset of symptoms. Turning to a psychoanalyst helps to overcome problems, discomforts and difficulties. Getting help makes one stronger and freer to be oneself.
A lot has been said about body positivity, can you explain what it consists of?
It is a social movement focused on the acceptance of one’s own body and the bodies of others regardless of size, shape, skin tone, gender and physical abilities/disabilities, challenging certain standards and prototypes of beauty as a social superstructure that conditions and makes those who deviate from contemporary and societal standards uncomfortable. The movement advances and supports the idea that people should not be ashamed of their looks and bodies understood both as a whole and for some specific characteristics.
It began with the early feminist movements around 1850, the Victorian clothing reform movement aimed to end the tendency of women to alter their bodies through the use of corsets and strings to fit the social standard of a tiny waist.
Currently, the movement aims to change social and individual perceptions of weight, size and appearance to be more accepting of all bodies, regardless of their different characteristics. Because, everyone’s perception of their body can greatly affect mental health and overall well-being particularly in adolescents, advocates focus more on the functionality and health of the body rather than its outward appearance.
Why is it considered effective?
First, because it aims to combat certain stereotypes that negatively affect psychological balance and personal well-being. It also promotes inclusivity by combating the stigmatization of people, groups, minorities, ethnicities, religions, etc., based on both physical and psychological characteristics. Through acceptance of aspects of oneself usually not considered “fashionable,” it promotes self-acceptance as a factor of psychological health and in a broader sense, prevention against dysmorphophobia or certain types the socially determined reactive eating disorders. We know well, that beauty standards are cultural, varying from era to era, currently almost from year to year.
Certainly, it is not proposed to affect disorders that have deep reasons in the individual unconscious or in interpersonal and family relationships, which may underlie some serious forms of dysmorphic and eating disorders.
What is the difference between women and men?
Body positivity is aimed at all people, regardless of gender. Like women, men can be victims of beauty standards, which do not respect diversity, individuality, and sometimes, even the physiology of the human body, if we think of the supermodels suffering from anorexia in the 1980s or the body-builder actors of the same period. Women and men can suffer the same social pressures to fit into “ideal prototypes,” some times, artificially created, especially in a media society such as the contemporary one with extensive and overt use of Photoshop for professional or “game” purposes on Social. When the dimension of play, of “pretending to” is lost but the manipulation of one’s body image is taken seriously, as can happen to adolescents in search of models to refer to in the search for and definition of their own identity, then there even major psychological problems can be created.
Dr. Lucattini, in the 1980s and 1990s there was a push toward anorexia, now the risk is a legitimization of bulimia, what can you tell us about this?
Body positivity combats the dangerous phenomenon of body shaming, or mocking someone for their physical appearance, especially online and on Social. Body shaming is a cyclone of insulting, sarcastic and venomous comments about those who show themselves to be “too fat,” “too thin,” or simply have a body that does not fit the parameters imposed by society. It is one of the social plagues of the new millennium that can affect anyone that starting with people exposed for professional reasons (singers, actresses, journalists), has also become very widespread among pre-teens and teenagers.
In fact, however, at present, we are faced with some misunderstandings of the purposes of the body positivity movement that come to support unhealthy lifestyles, for example, pathological overweight, dermatological diseases such as severe forms of acne that need specialized care or encourage “unkemptness,” which can be an expression of a depressive symptom, but which in this way, is not intercepted and correctly interpreted.
Regarding specifically, obesity, what kind of psychological intervention do you recommend?
Never forget how relevant is Juvenal’s maxim “Mens sana in corpore sano.” A good psychological balance allows one to take care of one’s physical health, therefore, to do everything necessary to keep fit and well: a good diet, daily physical activity, avoiding alcohol and substance use, taking care of one’s body through prevention screenings, having a good sex life and protected relationships. Equally, good physical condition does not create discomfort in daily life. An eating disorder that leads to obesity causes deep discomfort even if food is experienced as a consolation in moments of loneliness. If the environment in which we live is characterized by the worship of good food and good eating, however, it should not be abused. It can be risky to mistake body positivity for an ode to obesity.
On the other hand, people who have diseases that alter their metabolism or require therapies that increase their body weight should not be stigmatized or isolated but understood and helped by everyone around them.
It is always difficult to live with excessive weight gain, so resorting to a psychoanalyst is always advisable. Being well, improving oneself and striving to be happy is a right, and everyone must be enabled to exercise it, including by resorting to psychological support in times of difficulty.