Obsession with Appearance

Dr. Mike,

My wife (49 years old) and I have been married for 24 years, and we have three great kids and a great relationship.  She was beautiful when I met her, and I think she’s even more beautiful today. The problem is, she doesn’t seem to think so. Over the past 7 years, she’s become obsessed (and I don’t use that word lightly) with her appearance.  She’s done cosmetic surgery on her neck because she said her “jowls hung,” the area around her eyes and forehead because she said she “frowned and looked angry all the time.” She also sees someone else for fillers and for Botox every month.  At one point, she was taking laxatives to lose weight when she wasn’t even overweight in my opinion.  She got on Ozempic last Summer because she said her body was “fat” and “felt gross,” and she was a size 8 then.   She’s a size 4 now, and she told me that she’ll stop Ozempic when she’s a size 2 and is back to her high school weight and can fit into her high school blue jeans. Now she wants to get breast augmentation to feel “empowered as a woman,” and I guess I should be happy about that as her husband, but when is enough going to be enough?  She’s also done many diets, cleanses, and has memberships to two gyms and exercises all the time, but she’s never is happy with how she looks.  I’m worried that this will never end.  Can a midlife crisis go on for 7 or more years or is this mental illness?  I love my wife and family very much, but I don’t know what to do at this point.  Anyone who sees her would think she’s attractive, so none of this makes sense to me.  Even our teenager daughter thinks her mom is “obsessed” with her appearance.  You help is appreciated. 

Concerned Husband

Dear Concerned Husband,

It’s clear to me that you love your wife deeply, and your concerns as you report them here are certainly valid.  However, it’s important to approach your concerns with your wife with empathy and understanding.  The goal isn’t to point out all the ways she is wrong or “obsessed” or all of the ways she’s gone too far to achieve greater beauty with procedures, diets or exercise routines.   The point is to let her know why you are concerned, to then listen closely to what she has to say and to then hopefully get to a better place with all of this together.

Keep in mind that many men and women go through phases where their self-perception becomes more critical, and those beliefs can be amplified by societal pressures and personal insecurities.  At 49 years of age, it’s possible that your wife is going through a midlife crisis, and yes, a midlife crisis can become protracted.  As many as 10% to 20% women experience a midlife crisis, and they occur most often between 40 and 60 years.  As you point out, it’s also possible that her motivations and incessant need for bodily and facial improvements have more to do with underlying mental health struggles – Depression (i.e. low self-esteem), Anxiety (e.g., Obsessive Compulsive Disorder) or Body Dysmorphic Disorder are few possibilities.

I recommend that you start by opening up dialogue with your wife where you engage with her in a loving and non-judgmental way about your concerns.  Share as much as you can about how much you adore her for who she is (beyond her physical appearance), and how much she matters to you, your children and others.  Listen closely to what she shares with you as you get into things.  Hopefully you can have a productive conversation that gets you to a place of shared understanding and greater togetherness.

You could also suggest to your wife that you visit a mental health professional together.  A couple’s therapist could provide a safe space to explore underlying issues, offer strategies and help your wife and you find more agreement on the topic.

Positive change in moments like this is more of a process than a moment, so don’t expect things to improve overnight.  You’ll need to be patient and supportive with your wife as she navigates through her feelings with you.  I’m hopeful that with your love and support (and professional help if needed), your wife can get to more of a balanced perspective about aging and how she looks.