Something I’ve struggled with for most of my life, like many others, has been my (mostly negative) relationship with how my body looks. When it comes to body image and taking medication, this can make matters worse. Some medications to treat mental health conditions cause weight gain — sometimes dramatically so. Sometimes that has made me feel like I’m being kicked when I’m already down and trying to get up. I still wrestle with accepting my body for what it is today, but I’ve discovered a few techniques and perspectives that have helped. Most of what I offer is for those who are cisgender women, as that’s my experience. So there are some specifics in here, but I hope some of it translates to others who this is not necessarily intended for:
It’s That Time of the Month
It was a recent realization for me that there are certain times of my menstrual cycle when I’m most likely to think negatively about my body. Turns out I’m not alone: One study of adolescents found a link between certain phases of the menstrual cycle and viewing one’s body negatively, after controlling for a variety of factors. When I was in attendance at the International Society for Bipolar Disorders conference, someone remarked to me how little female-specific (as in XX chromosomes) health issues are included in bipolar research. Often the abstracts I’ve found for this topic have been clinical in terms of “how does menstruation affect symptoms” or “what medications change the menstrual cycle.” Personally, the most meaningful information would come from a question like this: “How does the menstrual cycle affect a woman who has bipolar in everyday life, and what can we do to help her cope with those thoughts and feelings?” I’m sure there are better ways of putting it, but the essence points to quality of life. On the ground level, I already know medications influence my body image. What I need is help not feeling like I have to avoid mirrors.
One tool I’ve found helpful is an app called Clue, which is available for both Apple and Android users. I’ve been using it for years and it’s not perfect for the mentally extraordinary mind, but it provides a useful way to monitor one’s period. What I’ve been doing recently is making correlations between my pre-menstrual symptoms and — for the lack of better words — how much I dislike my body. There are definitely trends that I didn’t think about before, but of course make sense now. For example, when I’m bloated and gassy, obviously I’m less likely to think I’m attractive. Even though being aware of that hasn’t completely whisked away my worries, it does help me implement some CBT strategies so I don’t linger on these thoughts too long.
There are, of course, many studies on body image, the culture of “thin,” and other intersecting issues. But the medication, menstruation, bipolar, and body image connection? Someone please point me in that direction.
The Obvious: Exercise!
Sometimes this is a loaded word when it comes to mental illness because of the different “places” people are at in their journeys back to wellness. Exercise is helpful at every point in one’s journey. A meta-analysis (a study of many studies) of university students found that exercise greatly improved symptoms of depression; another large study of studies found that people with bipolar have improved quality of life when exercise is thrown in the mix; and there is a greater than ever push to see exercise as part of treatment. While there can be barriers to exercise, or to exercising regularly, it is a top health priority for whole-body health.
In terms of body image, I know I feel better about myself when I have a regular exercise routine. On average, I work out 5 days a week and spend time outdoors if weather permits. I can afford a studio membership that gives me access to many classes at many times of the day, so I don’t have a lot of excuses not to exercise. However, there was a time when I didn’t have that. At one point in my life, a thirty minute run in the neighbourhood was all I had. But sometimes that’s great — it takes away potential anxiety from going into a gym environment. And even when I didn’t have money for group classes, I used online videos like Do Yoga With Me, which offers free yoga classes in the form of recorded videos. Sometimes, it just takes a little bit of creativity to find an exercise regime that works for you.
Where does the self-loathing come from?
Since I started taking medication, I’ve noticed a steady increase in weight gain. There are some reasons for this: Depression makes exercise pretty difficult, medications can mess with metabolism, an erratic exercise schedule, and an injury all contributed to my current state. That being said, this year I made it a point to get in better shape, which I’ve been fairly successful at. I wish I could say that I’m at peace with my body that’s physically stronger and in better shape than it’s ever been — but it’s simply not so. For me, “self-loathing” is how I describe my feelings; it will surely be different for others. Ironically, it fuels my motivation for exercise — almost like I’m running away from myself. What I really need to do is run toward myself and give myself a hug, because these feelings really do hurt.
In Western culture, we are seeing a movement to body positivity — accepting our bodies for what they are. Yet, there is still a huge emphasis for women to be thin and sexy, and sexy is a fairly narrow category. From a young age, girls are exposed to these standards and taught to believe in these range of ideas. So there’s a large cultural component to the body image conversation — large enough to warrant books and many heated debates over it. What’s important for me in adding this in is to contextualize my feelings in the bigger picture. I’m not alone in thinking and feeling these things. This is not just a mental illness issue (though it certainly could use more research). This is a worldwide issue.
There are certainly mental illness-specific tips and suggestions for navigating body image issues, and the last one I’m presenting is, for many, the tough one. Facing myself, my feelings of inadequacy — these are difficult realities to face. This needs to be done with the proper supports; if possible, with a caring healthcare professional. At the very minimum, with loved ones who will listen non-judgmentally, or even peer support groups. Talking about the effects of medication on one’s well being is a proper conversation to have in a psychiatrist’s office. The take home message is this: Just because someone with a mental illness needs to take medication, that doesn’t mean the medication should impede on quality of life. Medication is a negotiation, not a life sentence.