Dear Therapist: I'm Turning 50 and Panicking About My Appearance

I know looks aren’t everything, but I can’t stand the way my body is changing as I age.

The Atlantic
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Dear Therapist,

I’ll be turning 50 later this year and I’m having a very difficult time with my current stage in the aging process. I’m not so much worried about the number itself but about the changes in my body and especially my looks and attractiveness, which are putting me into a kind of quiet but desperate panic. I’m entering menopause and it feels as if my face and body have changed overnight. I’ve gained weight in new places, my face and neck are beginning to sag, and I already feel as if there’s nothing redeeming about me physically. Sometimes I walk by a mirror and can barely recognize myself.

I remind myself that looks aren’t everything, that I have a loving and supportive husband, that I have meaningful work that brings me joy, satisfaction, and recognition (something I further remind myself that not everyone has), that absolutely everybody who’s fortunate enough to live long enough likewise ages, and that what I feel is part of the greater phenomenon of a misogynistic culture that has little use for women after they are no longer attractive, particularly women like me who haven’t had children. But none of those thoughts help me and I’m left with very negative feelings and fears that things will continue to go downhill (as they inevitably will).

I try to have compassion for myself, but I feel guilty that I’m being so superficial, especially as I’ve assumed some of the caretaking duties of my elderly and very ill mother. Do you have any advice for how I can pull myself out of this desperate loop?  I don’t want to lose the good, active years that I still have ahead being mired in this.


Dear Anonymous,

You’re not alone in reacting to what you see in the mirror. After all, who among us hasn’t grappled with the changes that come with age? At the same time, if you’re being plunged into a “desperate panic,” it’s possible that there’s something at play here that goes beyond your feelings about your appearance—like, perhaps, your feelings about your mortality.

Let me put this in the context of life stages. In the mid-1900s, the psychologist Erik Erikson came up with eight stages of psychosocial development that still guide therapists in their thinking today. Unlike Freud’s stages of psychosexual development, which focus on the id, Erikson’s psychosocial stages focus on personality development in a social context (such as developing a sense of trust in others as an infant, or establishing a sense of identity in society during adolescence). Most important, instead of ending at puberty, Erikson’s stages continue throughout our entire life span, and each interrelated stage involves a “crisis” that we need to get through to move on to the next. They look like this:

1. Infant: Basic Trust vs. Mistrust

2. Toddler: Autonomy vs. Shame

3. Preschooler: Initiative vs. Guilt

4. School-age child: Industry vs. Inferiority

5. Adolescent: Identity vs. Identity Diffusion

6. Young adult: Intimacy vs. Isolation

7. Middle-aged adult: Generativity vs. Stagnation

8. Older adult: Integrity vs. Despair

The seventh stage is where people generally find themselves at around your age. Erikson maintained that in this stage, we become more acutely aware of our mortality and start to think more deeply about how we might generate something or care for people that will outlive us—by, say, passing the torch to our children, mentoring future generations, or creating something professionally that makes the world a better place.

This desire to make our mark on the world helps us to accept the immutable choices we’ve already made and the limitations of the time we have left. Many people use this time to adjust expectations and create clear priorities about what they want to accomplish both personally and professionally in terms of their legacy. If, on the other hand, a person feels disconnected from a larger purpose—something that transcends her own life—she’ll feel panicked and paralyzed, leading to stagnation.

What does all this have to do with sagging flesh? That image you barely recognize in the mirror doesn’t just reflect an older face; it also reflects what that older face signifies: loss of beauty, maybe, but also loss of youth. It is a daily visual reminder of your mortality. It’s probably no coincidence that you’re having this crisis while caring for your aging mother and bearing witness to her mortality, too.

It’s true, of course, that beauty fades and is often valued differently in men and women, but it’s also true that our perception of attractiveness in ourselves and others is a combination of what’s on the outside and what’s being projected out from within. We tend to feel most attractive when we feel good about ourselves—when we have a more honest understanding of who we are and who we aren’t; when we’ve taken responsibility for creating our own lives by engaging deeply in relationships and endeavors in the world. In other words, when we fall on the side of generativity over stagnation, when we embrace our midlife station in life as an impetus for change, we can appear more attractive—to ourselves and others—sometimes in a way that no amount of Botox can achieve.

You say that you have a loving husband and fulfilling work, but maybe this despair can prompt you to ask yourself some questions: How did your mom feel about aging when you were growing up and what positive or negative attitudes about aging and appearance have you internalized? Have you considered your priorities and how they might shift at this point in your life? For instance, are there ways in which you might want to connect more to others in your community? Are there new ways of engaging in the world that would make an even greater impact or that you’d feel proud to leave behind? Is there a hole that this anxiety about your appearance has been temporarily filling—meaning, if you weren’t worrying about your appearance, what might that time be spent on? Grappling with these questions, more than with what you see in the mirror, will help you not to lose those “good, active years” you still have ahead of you.

Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition.