Dear Therapist:

My 13 year old son is very busy with how he looks. He is my oldest so it's hard for me to get a sense of what's normal for this age. My friends say it's just a stage but I am worried about it becoming a problem. He has taken up exercising and dieting and is very into it. He spends quite a bit of time each day getting dressed. He has made a few cracks to my husband about how he looks. I would appreciate any guidance you can give me as to how to manage this.

Response:

There are a number of external factors that can affect a teenager’s actions with regard to his appearance.  (Yes, you now have a teenage son!)  These include school, community, peers, and media.  In addition there are often emotional needs that manifest as fastidiousness in areas related to appearance.  Since you didn’t mention a specific concern, I’ll speak to a few areas that can relate to your son’s interest in his appearance. 

A relatively rare example is body dysmorphic disorder.  People with BDD are obsessed with a perceived flaw in their appearance.  They spend an inordinate amount of time avoiding others or attempting to “correct” the defect in their appearance.  A more common—and more general—problem is obsessive compulsive disorder.  Although those with OCD can obsess about pretty much anything, including fear of illness, contamination, and loss of control, the need for perfection is often an underlying factor.

Likely the most common cause of the need for perfection is low self-esteem.  Since most of us don’t have a truly good intrinsically-based sense of self, we base positive (and negative) feelings about ourselves on external factors.  Our sense of identity is usually based on things like family, career, accomplishments, and possessions.  At different periods of our lives, we focus on different things to help define ourselves. 

Teenagers are generally in the stage that psychologist Erik Erikson referred to as “Identity vs. Role Confusion.”  During this stage, according to Erikson, teenagers struggle with their sense of identity, and may feel uncomfortable about their bodies until they resolve this struggle.  As such, many teenagers become concerned with their appearance.  This is a concern that usually fades as they begin solidifying their sense of identity.  More often than not teenagers’ focus on their appearance is something that fades as other areas demand their attention.

Generally speaking, when considering whether someone else has a problem it’s important to ask yourself two questions.  The first is whether their actions are causing problems for them, or if you‘re the one who has an issue with their actions.  The second question is whether the person is acting largely due to a need (emotional) or a want (logical).  If, for the most part, your son simply enjoys dressing well and looking good, this is likely a normal, healthy form of expression.  If, however, his actions are based mostly on an emotional need, he might have a harder time developing a clear sense of identity. 

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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