In this article, clinical psychologist and psychotherapist Nathalie Neyrolles explains the psychological aspects of lipedema.
Although lipedema can appear after a pregnancy or during the menopause, it is above all at the time of puberty that this chronic and progressive disease appears.
It is therefore not only a question of coping with the physiological and psychological upheavals that puberty imposes but also of taming this intruder that has come to live inside us.
Let us remember that puberty marks the transition between an identity formed in childhood and this new adult identity awaiting reference points to establish itself definitively.
The image of the body is disrupted, particularly as a spatial reference point:
“The adolescent is a bit like a blind man moving in an environment whose dimensions have changed.” (A.Haim).
Pulsive activity awakens psychically and physiologically, the body undergoes a metamorphosis that the adolescent must integrate without it being self-evident.
At puberty, this body, however familiar, becomes a stranger and if having and being a body, that is to say both feeling in possession of one’s body and embodying this body, experiencing oneself through it as a subject, seems to be self-evident, it is not only during the adolescent passage that this becomes all the more problematic when the subject is suffering from lipedema: With the accumulation of fat mainly in the lower limbs, leading to a dichotomy of the body, how can one make one’s own a body that does not seem unified, with blurred contours? How to appropriate this body when it seems elusive, worrying or even frightening? How can we make our own a body that does not correspond to the image of the body we would like to have? The link between the body and the ego is threatened, as is the identity of the subject.
A body to tame :
The subject suffering from lipedema will try to control this body that escapes, to have a hold on it, to control both the sources of impulsive excitations and the physiological changes that take place during the adolescent passage, but also to try to delimit these contours that have remained blurred by the lipedema.
In spite of all the efforts made to try to combine the ideal body and the real body, the body does not respond: in spite of draconian diets and physical activity, a disproportionate body remains, with areas of the body that escape all control: when the body betrays, it seems difficult to maintain the link between the ego and the body, to be well “in one’s skin”.
The transformations and oddities of adolescence already shake this narcissistic unity for a time, but lipedema amplifies this fracture and the subject risks collapse.
Deprived of his body, the subject suffering from lipedema will submit it to health professionals, not knowing what to think of him, in order to know how he functions, what his possibilities are…
Lipedema and health professionals :
Lipedema is a rare disease that is largely unknown to health professionals, who often confuse it with simple obesity. It often takes years of medical wandering before a person suffering from lipedema meets a professional specialised in this pathology and finally names it.
But the diagnosis of the disease does not erase the psychological suffering that this disease causes, it only explains it from a medical point of view, it gives a reference point that must be appropriated: being affected by this chronic disease is a characteristic that the subject will have to inscribe in his identity.
The body, our being in the world :
The body is not only this physical reality of flesh and bone, “it is also the support of the Self and the one I am for others” (Birraux, 2004). For Schilder, the body represents the vehicle of “being in the world”, it is at the centre of the affective relational exchanges between individuals.
In a society that cultivates the cult of performance, of the svelte and muscular body, the body that does not meet the standards represents an aggression, it is rejected as if it represented a threat to its own integrity:
“A feeling of aggression is imposed, as if the vision of a deviant morphology carries a violence comparable to physical aggression.” (P.Ancet, 2006).
We do not accept this damaged image of ourselves in him.
There is also a misunderstanding with regard to overweight people: the report that appears every year on the evolution of obesity in France (Obepi) correlates poverty and low level of education as determining factors of obesity. This has led to prevention campaigns focusing on nutritional education and physical activity; in other words, if a person is overweight, it is because of laziness, lack of willpower or even gluttony.
We therefore understand to what extent the relationship to the world of people with lipedema can be a source of suffering.
To conclude this article: Lipedema – psychological aspects
Lipedema disrupts the person’s image of their body and their relationship with it. This chronic disease is a particularity that the subject will have to inscribe in his identity.
The psychological suffering linked to living with lipedema can be immeasurable: the person with lipedema is often judged, mocked, misunderstood, which fosters low self-esteem and undermines confidence. Distraught by this, the person with lipedema may experience depressive episodes, anxiety and eating disorders.
The disease is a subjective experience, it is both a physical and a psychological event, which is why psychological care for people with lipedema is just as fundamental as physical care.
Psychological support throughout the surgical procedure will aim to restore the disease to life, but also to come to terms with the constraints that this disease imposes, to strengthen the identity that has remained shaky, to regain self-esteem and self-confidence and to tame and finally appropriate one’s body.