Lipedema: psychological aspects
In this article, clinical psychologist and psychotherapist Nathalie Neyrolles
sheds light on the psychological aspects of lipedema.
Although lipedema can occur after pregnancy or during menopause, this chronic and progressive disease mainly appears during puberty.
It is therefore a question of not only coping with the physiological and psychological upheavals of puberty, but also of coming to terms with this intruder that has taken up residence within oneself.
It should be remembered that puberty marks the transition from an identity formed during childhood to a new adult identity that is waiting for guidance in order to become fully established.
Body image is disrupted, particularly as a spatial reference point:
"The adolescent is a bit like a blind person moving around in an environment whose dimensions have changed" (A. Haim).
Instinctual activity awakens psychologically and physiologically, and the body undergoes a metamorphosis that adolescents must integrate without it being self-evident.
During puberty, this familiar body becomes foreign, and while having and being a body—that is, both feeling in possession of one's body and embodying that body, experiencing oneself as a subject through it—seems self-evident, this is not the case during adolescence, and it becomes even more problematic when the subject is affected by lipedema: with the accumulation of fat mainly in the lower limbs, leading to a dichotomy of the body, how can one truly embrace a body that does not seem unified, with blurred contours? How can one appropriate this body when it seems elusive, disturbing, even frightening? How can you embrace a body that does not correspond to the image of the body you would like to have? The link between the body and the self is threatened, as is the identity of the individual.
A body to tame
People affected by lipedema will attempt to control this body that is slipping away from them, to gain a hold on it, in order to control both the sources of impulsive urges and the physiological changes that occur during adolescence, but also to try to define these contours that remain blurred by lipedema.
Despite all efforts to try to reconcile the ideal body with the real body, the body does not respond: despite draconian diets and physical activity, the body remains disproportionate, with areas that are beyond control. When the body betrays us, it seems difficult to maintain the link between the self and the body, to feel comfortable in one's own skin.
The transformations and strangeness of adolescence already shake this narcissistic unity for a time, but lipedema amplifies this fracture and the subject risks collapse.
Dispossessed of their body, individuals affected by lipedema will submit themselvesto healthcare professionals, no longer knowing what to think of themselves, in order to find out how their body works, what its capabilities are, etc.
Lipoedema and healthcare professionals
Lipedema is a rare condition that is largely unknown to healthcare professionals, who often confuse it with simple obesity. It often takes years of medical wandering before someone with lipedema meets a professional who specializes in this condition and can finally give it a name.
But the diagnosis of the disease does not erase the psychological suffering it causes; it merely explains it from a medical point of view and provides a reference point that must be accepted: having this chronic disease is a characteristic that the subject will have to incorporate into their 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 who I am to others" (Birraux, 2004).
For Schilder, the body represents the vehicle of "being in the world"; it is at the center of emotional exchanges between individuals.
In a society that cultivates the cult of performance and slim, muscular bodies, bodies that do not meet the standards are seen as an aggression and are rejected as if they represented a threat to one's own integrity:
"A feeling of aggression prevails, as if the sight of a deviant morphology were to convey violence comparable to physical aggression"(P. Ancet, 2006).
We do not accept this damaged image of ourselves in him.
There is also a misunderstanding regarding overweight people: the annual report on obesity trends in France (Obepi) correlates poverty and low levels of education as determining factors in obesity.
This led to prevention campaigns focused on nutrition education and physical activity; in other words, if a person is overweight, it is because of their laziness, lack of willpower, or even their gluttony.
We therefore understand how much suffering the relationship with the world can cause for people with lipedema.
Finally...
Lipedema disrupts the image that the person has of their body and their relationship with it. This chronic condition is a distinctive feature that the person will have to incorporate into their identity.
The psychological suffering associated with living with lipedema can be immeasurable: people with lipedema are often judged, mocked, and misunderstood, which contributes to low self-esteem and undermines confidence. Feeling helpless in the face of this, people with lipedema may experience episodes of depression, anxiety, and eating disorders.
Illness is a subjective experience; it is both a physical and psychological event. This is why psychological care for people with lipedema is just as important as physical care.
Psychological support throughout the surgical procedure will aim to restore the disease to life, but also to help patients accept the constraints imposed by this disease, strengthen their wavering identity, regain self-esteem and self-confidence, and finally come to terms with and embrace their bodies.