If you have been experiencing panic attacks, you are likely already familiar with just how physical they feel. Your heart races. Your chest tightens. You feel short of breath, dizzy, or like your hands and feet have gone numb. A wave of fear washes over you that can be genuinely terrifying. And then, often just as suddenly as it started, it passes.

Panic attacks are real, they are intensely physical, but they are not dangerous. For the vast majority of people who experience them, there is no underlying medical condition driving the symptoms. But as part of responsible, thorough care, we always recommend that clients have a medical evaluation alongside their mental health treatment. Not because we expect to find something wrong, but because ruling out medical contributors is simply good clinical practice and because in most cases it provides meaningful reassurance that your body is healthy and allows you to move forward with treatment with confidence.

This blog is meant to be informational and educational, not a substitute for medical advice. If you are experiencing symptoms that concern you, please reach out to your doctor.

What Panic Attacks Feel Like
According to the DSM-5, a panic attack is a sudden surge of intense fear or discomfort that peaks within minutes and includes at least four of the following: a racing or pounding heart, sweating, trembling or shaking, shortness of breath or a feeling of being smothered, chest pain or discomfort, nausea or stomach distress, dizziness or lightheadedness, chills or hot flashes, numbness or tingling sensations, a sense of unreality or feeling detached from yourself, fear of losing control, and fear of dying.

That is a striking list of symptoms, and you can immediately see why panic attacks feel so alarming in the moment. These same symptoms can occasionally have a medical origin, which is one of the reasons a medical evaluation is a meaningful part of the process and important to rule out. In most cases, that evaluation comes back normal and simply confirms what was already suspected. Occasionally it identifies something that needs its own attention. Either way, having that information is valuable.

To learn more about Panic Disorder, click here. 

Why a Medical Evaluation Is Part of Good Care
Responsible mental health care includes ruling out medical contributors before or alongside a mental health diagnosis. This is not unique to panic disorder. It is simply good clinical practice. A thorough evaluation by your primary care physician typically includes a physical exam, routine blood work, and a review of your symptoms and their patterns over time. In many cases, everything comes back normal and the picture becomes much clearer. In some cases, a medical condition is identified that needs its own treatment, or that helps explain part of what you have been experiencing.

The relationship between physical health and anxiety is genuinely complex. Medical conditions can trigger anxiety and panic. Anxiety can worsen physical symptoms. And both can exist at the same time. Having a medical provider and a mental health provider working in coordination is often the most effective approach.

Medical Conditions Worth Discussing With Your Doctor
The following conditions are among those that clinicians typically consider when evaluating someone with panic-like symptoms. This list is not meant to send you down a rabbit hole of worry. It is simply meant to help you understand what your doctor may be looking for and why that conversation is worthwhile.

Thyroid Conditions
The thyroid gland helps regulate heart rate, metabolism, and energy. When it becomes overactive, a condition called hyperthyroidism, it can produce a racing heart, sweating, trembling, heat intolerance, and a persistent sense of being keyed up that can look a great deal like anxiety or panic. The good news is that thyroid function is easy to check with a routine blood test, and treatment is straightforward when a thyroid condition is identified.

Heart Rhythm Irregularities
Certain irregularities in heart rhythm can produce sudden episodes of a pounding or racing heart, chest discomfort, and lightheadedness, symptoms that are also among the most common features of panic attacks. An EKG or other cardiac evaluation can help a physician assess whether a heart rhythm issue may be contributing to what you are experiencing. This is one of the most common reasons people end up in the emergency room during a first panic attack, and having a cardiac evaluation can provide meaningful reassurance as well as ruling out a medical contributor.
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Blood Sugar Fluctuations
Low blood sugar, known as hypoglycemia, can produce a sudden onset of heart pounding, sweating, shakiness, dizziness, and a sense that something is wrong, symptoms that overlap considerably with panic. This is particularly worth discussing with your doctor if your symptoms tend to occur when you have not eaten in a while, or if you have any history of diabetes or blood sugar regulation concerns.

Autonomic Nervous System Conditions
Postural Orthostatic Tachycardia Syndrome, more commonly known as POTS, is a condition in which the heart rate spikes significantly when moving from lying down to standing up. This can produce dizziness, a racing heart, lightheadedness, brain fog, and fatigue that can resemble panic. A notable feature of POTS is that symptoms tend to be triggered by or worsen with positional changes and may improve when lying down, a pattern that differs from typical panic. POTS is often underdiagnosed, and many people with POTS have been told their symptoms are anxiety-related before a correct diagnosis is made. If your symptoms consistently relate to changes in position or standing up, it is worth mentioning this to your doctor.

Vestibular and Inner Ear Conditions
The vestibular system governs balance and spatial orientation. When it is not functioning as it should, it can produce dizziness, vertigo, a sense of unsteadiness, and nausea that can be quite frightening and can overlap with panic symptoms. Some vestibular conditions involve structural problems in the inner ear itself. These include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease, all of which are considered peripheral vestibular disorders and are typically evaluated by an ear, nose, and throat specialist or vestibular specialist.
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Persistent Postural-Perceptual Dizziness, known as PPPD, is a different kind of vestibular condition and worth knowing about separately. Rather than involving a structural problem in the inner ear, PPPD is classified as a chronic functional vestibular disorder, meaning it involves the way the brain processes balance and spatial information rather than a problem with the ear itself. PPPD produces chronic dizziness, unsteadiness, and a sense of non-spinning vertigo that persists on most days and is worsened by upright posture, movement, and visually complex environments. It frequently develops following an acute vestibular event, a medical illness, or a period of significant psychological stress, and anxiety is closely intertwined with its development and maintenance. Because of this, PPPD can closely resemble or co-occur with panic disorder, and the two can reinforce one another in a cycle that can be difficult to untangle without proper evaluation. Treatment for PPPD typically involves vestibular rehabilitation, medication, and cognitive behavioral therapy, making collaboration between medical and mental health providers especially valuable.

Respiratory Conditions
Difficulty breathing is one of the most distressing symptoms of a panic attack, and it is also a feature of several respiratory conditions including asthma. The relationship between respiratory conditions and anxiety is well established and genuinely bidirectional -- each can worsen the other. If you experience episodes of shortness of breath, chest tightness, or a feeling of being unable to get a full breath, it is worth discussing with your doctor whether a respiratory evaluation makes sense.

A Note on Less Common Conditions
There are some less common conditions that clinicians may also consider in certain presentations, including neurological conditions and adrenal conditions such as Addison's disease, in which insufficient production of cortisol can produce episodes of fatigue, dizziness, and feeling acutely unwell that may resemble anxiety or panic. Your doctor is the right person to determine which evaluations are appropriate for your specific situation. The goal is not to work through an exhaustive checklist of everything that could possibly be wrong. The goal is a thoughtful, individualized evaluation that helps paint a clear and complete picture.

What This Means for You
If you have been experiencing panic attacks, seeing your primary care physician is a meaningful first step alongside pursuing mental health support. Share your symptoms openly, describe when they happen and how long they last, and ask whether any medical evaluation is warranted. In most cases, a medical workup provides reassurance that your body is physically healthy and helps you move forward with treatment with more confidence and clarity.

Panic disorder is highly treatable. The research on Cognitive Behavioral Therapy and Panic Control Treatment is robust and genuinely encouraging, and most people who engage in evidence-based treatment see significant improvement. Getting there starts with making sure you have an accurate, complete picture of what is going on -- and that is something your medical provider and mental health provider can work on together.

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Tunnell, N. C., Corner, S. E., Roque, A. D., Kroll, J. L., Ritz, T., & Meuret, A. E. (2024). Biobehavioral approach to distinguishing panic symptoms from medical illness. Frontiers in Psychiatry, 15, 1296569. https://doi.org/10.3389/fpsyt.2024.1296569

​One of the most powerful tools available to individuals living with bipolar disorder is also one of the most underutilized: the ability to recognize when a mood episode is beginning before it fully takes hold. Early warning signs, sometimes called prodromal symptoms, are the subtle shifts in mood, thinking, behavior, sleep, and energy that often precede a full manic, hypomanic, or depressive episode. Learning to identify your personal early warning signs, and knowing what to do when they appear, is a cornerstone of effective bipolar disorder management and a central component of Cognitive Behavioral Therapy (CBT) for bipolar disorder.

Why Early Warning Signs Matter
Mood episodes in bipolar disorder do not typically appear out of nowhere. In most cases, there is a window of time, sometimes days, sometimes weeks, during which early signs are present and intervention is possible. Research consistently supports the value of early intervention in bipolar disorder. Catching an emerging episode early can mean the difference between a brief period of increased symptoms and a full-blown episode that significantly disrupts your life, relationships, and functioning.

The challenge is that early warning signs can be subtle, easy to rationalize, and can even feel good at first. This is why developing awareness of your personal pattern is so important. What triggers your episodes? What are your first signs? How long is your typical warning window? These are questions worth exploring with your therapist.

Early Warning Signs of a Manic or Hypomanic Episode
While early warning signs vary from person to person, some of the most commonly reported signs that a manic or hypomanic episode may be emerging include:

Changes in sleep: Needing less sleep than usual without feeling tired is one of the most reliable early warning signs of an emerging manic or hypomanic episode. You may find yourself waking up earlier than usual feeling energized, or staying up later without experiencing the fatigue you normally would. It is worth noting that sleep disruption is not just a symptom of mania, it can also trigger and accelerate a manic episode. The relationship between sleep and mood in bipolar disorder is bidirectional, interconnected, and critically important.

Increased energy or activity: Feeling unusually energized, productive, or motivated, particularly in ways that feel out of proportion to your circumstances, can be an early sign. You may notice yourself taking on more projects, making ambitious plans, or feeling like you can accomplish more than usual.

Racing or sped-up thinking: Thoughts that feel faster than normal, jumping quickly from one idea to the next, or difficulty slowing your mind down can be an early indicator of an emerging elevated episode.

Increased talkativeness: Talking more than usual, feeling like your words can not keep up with your thoughts, or others commenting that you seem more talkative or difficult to interrupt are worth paying attention to.

Elevated or irritable mood: Feeling unusually elated, confident, or "on top of the world," or conversely, feeling more easily irritated or agitated than usual, can both signal an emerging manic or hypomanic episode. It is important to recognize that mania does not always feel good. Irritable mania is a real and common presentation.

Increased impulsivity or risk-taking: Making impulsive decisions, spending money more freely than usual, engaging in uncharacteristic risk-taking behavior, or feeling unusually uninhibited socially are all worth noting.

Decreased need for food: Some individuals notice changes in appetite or a decreased interest in eating as an early sign of an elevated episode, often related to increased energy and activity.

Heightened sensory experience: Some individuals report that colors seem brighter, music sounds better, or the world generally feels more vivid or intense in the early stages of an elevated episode.

Early Warning Signs of a Depressive Episode
Just as important, and often more difficult to catch early because the changes are quieter and more gradual, are the early warning signs of an emerging depressive episode. These may include:

Changes in sleep: In contrast to manic episodes, emerging depression often brings increased sleep, difficulty getting out of bed, or hypersomnia. Some individuals experience insomnia during depressive episodes as well.

Withdrawal and isolation: Pulling away from friends, family, or activities you normally enjoy, even in subtle ways, like responding to fewer texts or skipping social plans, can be an early sign.

Decreased motivation or energy: Feeling more fatigued than usual, procrastinating on tasks that are normally manageable, or noticing a drop in your overall drive and initiative.

Slowed thinking: Thoughts that feel heavier, slower, or harder to organize than usual. Difficulty making decisions that are normally straightforward.

Increased negativity or hopelessness: A subtle shift in your overall outlook, things feeling harder, less enjoyable, or less worthwhile, even before full depressive symptoms set in.

Changes in appetite: Eating more or less than usual, or losing interest in foods you normally enjoy.

Increased irritability: Like manic episodes, depressive episodes can also present with irritability, feeling more easily frustrated, short-tempered, or emotionally reactive than your baseline.

Your Warning Signs Are Personal
It is worth emphasizing that early warning signs are highly individual. While the list above covers commonly reported signs, your personal pattern may look different. Some individuals have very reliable, consistent warning signs that appear in the same order every time. Others have more variable patterns. Part of the work of therapy is helping you develop an individualized understanding of your own mood episode patterns, including your triggers, your early warning signs, your typical timeline, and the interventions most likely to help at each stage.

What to Do When You Notice Early Warning Signs
Noticing early warning signs is only half of the equation. Having a plan for what to do when they appear is equally important. Some evidence-based strategies to discuss with your therapist include:

Contact your treatment providers. If you notice early warning signs, reaching out to your therapist and/or medication provider promptly gives your treatment team the opportunity to intervene before a full episode develops. Do not wait until things feel out of control.

Prioritize sleep. Given the bidirectional relationship between sleep and mood in bipolar disorder, protecting your sleep is one of the most important behavioral interventions available. If sleep is being disrupted, addressing it quickly is a priority.

Reduce stimulation and stress. During the early stages of an elevated episode, reducing your exposure to stimulating environments, decreasing your commitments, and building in rest can help slow the momentum of an emerging episode.

Engage your support system. Trusted friends, family members, or partners who are educated about your warning signs can be invaluable. They may notice changes before you do, and having someone you trust who can gently flag what they are observing can be an important safety net.

Use your coping plan. If you have developed a mood episode action plan with your therapist, which is a standard component of CBT for bipolar disorder,  this is the time to put it into action. Do not wait for certainty that an episode is coming. Acting on early warning signs, even if it turns out to be a false alarm, is always the right call.

Avoid alcohol and recreational substances. Substance use can accelerate and worsen mood episodes and significantly undermine the effectiveness of your medications. This is particularly important during periods of elevated warning signs.

Building Your Personal Warning Signs Profile
One of the most valuable things you can do, ideally in collaboration with your therapist, is to develop a written personal warning signs profile. This is a document that outlines your specific early warning signs for both manic and depressive episodes, your known triggers, your typical timeline from first warning sign to full episode, and your personalized action plan for each stage. Having this document in place before an episode begins means you are not trying to create a plan when your judgment may already be compromised.

Some individuals also find it helpful to involve a trusted person in their life in this process, sharing your warning signs profile with a partner, family member, or close friend so that they can serve as an additional layer of awareness and support.

The Bottom Line
Early warning sign recognition is not about living in fear of the next episode or constantly monitoring yourself for signs of instability. It is about developing the self-awareness and the tools to respond quickly and effectively when your mood begins to shift, so that you spend less time in episodes and more time living your life.

If you are living with bipolar disorder and would like support in developing your personal early warning signs profile and mood management plan, we are here to help. At OakHeart, Center for Counseling, our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based treatment for bipolar disorder to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs. We also offer telehealth services throughout Illinois.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

National Institute of Mental Health. (2023). Bipolar disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder

Most people are familiar with the more commonly depicted presentations of Obsessive Compulsive Disorder (OCD) — hand washing, checking locks, needing things to be symmetrical or "just right." What is far less talked about, and often misunderstood, is a presentation of OCD that targets some of the biggest questions humans have ever grappled with: Why am I here? Does any of this matter? Is any of this even real? This is Existential OCD.

What is Existential OCD?
Existential OCD involves intrusive, repetitive, and distressing obsessions centered on philosophical questions about existence, reality, meaning, and purpose. Obsessions can also involve obsessions about one's own existence. The questions that are posed are inherently unanswerable with certainty.

Common obsessions include thoughts such as:

• What is the point of doing anything if we are all going to die eventually?
• How do I know that anything is real?
• What if life has no meaning?
• Do I actually exist, or is this all an illusion?
• What if I am living in a simulation?
• What is consciousness, and how do I know I am truly conscious?
• Why does anything exist at all?
• What happens after death?
• What if I am the only one that is real?
• What if I get stuck trying to answer these questions and lose my mind?
• What if even small decisions I make change the course of my life in drastic or negative ways?

It is important to note that these questions are not unique to people with OCD. Most humans have pondered existential questions at some point in their lives. The difference is that individuals without OCD are generally able to sit with the uncertainty these questions produce, shrug, and move on. For individuals with Existential OCD, these thoughts and doubts become stuck. They are intrusive, unrelenting, and produce significant distress and anxiety. The person feels compelled to figure out the answer, even though, by the very nature of existential questions, no definitive answer exists. They search for certainty and answers that never come. 

How is Existential OCD Different from Normal Philosophical Thinking or Depression?
This is an important distinction, and one that is often missed. Existential OCD can be confused with:

General philosophical curiosity: Many people enjoy contemplating the big questions of life. The key difference is that philosophical curiosity is generally experienced as interesting or stimulating, while Existential OCD is experienced as distressing, intrusive, and impossible to turn off. Philosophical curiosity may temporarily elicit some anxiety or dread, but people without OCD can tolerate that discomfort and move on. In addition, if someone with philosophical curiosity is engaging in thought exploration, they can be interrupted or stop without significant distress. 

Depression: Individuals experiencing depression may also ruminate on themes of meaninglessness and hopelessness. However, in depression, these thoughts tend to be mood-congruent and tied to a generally negative emotional state. In Existential OCD, the thoughts are ego-dystonic, meaning they feel intrusive and inconsistent with how the individual wants to be thinking. The distress comes from having the thought, not from a pervasive low mood.

Generalized Anxiety Disorder (GAD): Because of the worry-like quality of existential obsessions, Existential OCD is sometimes misunderstood to be GAD. However, there are some important distinguishing features. With OCD presentations, the thoughts themselves often triggers distress, which drives compulsive, repetitive, or ritualistic behavior aimed at reducing the distress or obtaining certainty. In GAD, the worry themes tend to center around worries that most people have such as finances, health, or concern for the safety of loved ones. In OCD, the themes tend to focus on highly specific content that the individual finds intrusive, unacceptable, or deeply threatening; content that often feels inconsistent with who they are and what they value. Additionally, in GAD, worry is typically experienced as an attempt to problem-solve or prepare, whereas in OCD, the obsessive thought feels uncontrollable and is followed by a compulsive urge to neutralize, undo, or resolve the distress.

The OCD Cycle in Existential OCD
Like all presentations of OCD, Existential OCD operates within a well-established cycle. An intrusive existential thought triggers significant anxiety and distress. The individual then engages in compulsions in an attempt to neutralize the thought, reduce the distress, or obtain a sense of certainty. These compulsions may include:

• Mental reviewing and ruminating: going over and over the question in one's mind in an attempt to "figure it out" or reviewing the past to try and prove one's existence
• Reassurance seeking: asking others what they think, looking for validation that life has meaning, asking other's what the answers are
• Researching: reading philosophy, science, or religious texts in an attempt to find an answer
• Testing reality: engaging in repeated mental or physical checking behaviors to confirm that the world, one's experience, or one's own existence is real (e.g., touching or interacting with objects to confirm they are solid, staring in the mirror to verify one's own existence, or repeatedly checking whether one's own thoughts and feelings feel 'authentic' or 'real'
• Avoidance: avoiding movies, books, conversations, or topics that trigger the obsessions
• Thought suppression: trying to push the thoughts out of one's mind

Unfortunately, as is the case with all OCD compulsions, these behaviors provide only temporary relief. Over time, they actually reinforce the cycle, teaching the brain that the thought is dangerous and must be dealt with, which makes the thoughts more frequent and more distressing.

Why is Existential OCD Particularly Challenging?
One of the things that makes Existential OCD especially difficult is the nature of the obsessions themselves. Existential questions are, by definition, unanswerable with certainty. There is no fact, study, or expert that can provide the 100% certainty OCD demands. This makes the compulsive drive to "figure it out" an endless urgent loop. Every answer generates a new doubt. Every reassurance eventually wears off. This is a hallmark feature of OCD that I discuss in my blog on Thinking Errors in OCD; specifically, Intolerance of Uncertainty. OCD demands certainty that simply does not exist, and existential questions are perhaps the most unanswerable questions humans have ever asked.

Treatment for Existential OCD
The good news is that Existential OCD responds to the same gold-standard treatment as all other presentations of OCD: Exposure and Response Prevention (ERP), a form of Cognitive Behavioral Therapy (CBT).

In ERP, the goal is not to find the answer to the existential question. It is to build tolerance for the uncertainty and distress that the question produces, and to break the compulsive cycle that is maintaining the OCD. This involves:

Exposures: deliberately and gradually confronting the existential thoughts, rather than avoiding or neutralizing them. This might include reading or listening to content that triggers the existential thoughts, writing out the feared thoughts, or deliberately sitting with the uncertainty without engaging in compulsive responses.

Response Prevention: resisting the urge to mentally review, research, seek reassurance, or otherwise compulse in response to the obsession.

ACT components: Acceptance and Commitment Therapy (ACT) can be a particularly useful complement to ERP for Existential OCD. ACT encourages individuals to accept the presence of uncertainty and uncomfortable thoughts without needing to resolve them, and to move toward a valued life even in the face of unanswered questions.

The goal of treatment is not to convince the individual that life has meaning, or to answer the unanswerable. It is to help the individual develop a different relationship with the uncertainty itself. To be able to have the thought, feel the discomfort, and choose not to engage with it compulsively.

You Do Not Have to Suffer
If you find yourself spending significant time each day consumed by existential questions, if these thoughts feel intrusive and distressing rather than intellectually stimulating, and if you notice yourself engaging in mental reviewing, reassurance seeking, or avoidance in response to them, it may be worth speaking with a clinician who specializes in OCD.

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Penzel, F. (2013). To be or not to be, that is the obsession: Existential and philosophical OCD. International OCD Foundation. https://iocdf.org/expert-opinions/to-be-or-not-to-be-that-is-the-obsession-existential-and-philosophical-ocd/

Spring is upon us, and as the season changes, this may be a good time to stop and check in with how a New Year's resolution is progressing (is the motivation where it was in January), or is this an opportunity to set a new personal goal? Utilizing SMART Goals can be a skill to help provide the structure needed for implementing long-term change while breaking up the process into more manageable pieces.

What are SMART Goals?
The SMART acronym is a roadmap to help change turn into concrete actions.

S - Specific: Clearly define what you want to achieve. Instead of "I want to be less stressed," try "I want to stop screaming when I become angry".

M - Measurable: Find a way to track your progress. How will you know you are making progress? (e.g., using a mood tracker, counting the number of social interactions, or rating anger on a 1-10 scale).

A - Achievable: Set realistic expectations. Goals should challenge you but not lead to burnout. If you haven't journaled in years, aiming for daily journaling might fail. Start with a few times a week.

R - Relevant: Ensure the goal aligns with your core values and overall mental health needs. Is this goal truly important to you right now?

T - Time-bound: Set a deadline or timeline to create a sense of urgency. For instance, "I will learn two deep-breathing techniques by the end of this month."

Why SMART Goals Matter.
They Provide Direction and Focus: Rather than wandering through emotions, SMART goals give you a concrete map for where to focus your energy to work on implementing change.

They Boost Motivation: When you can tangibly see that you've accomplished a small goal, it increases your motivation to keep going, preventing discouragement.

They Enhance Accountability: Regularly reviewing your SMART goals helps you stay on track and allows for adjustments if life changes.
They Prevent Overwhelm: Breaking large issues into small steps makes the process feel manageable.

Guiding clients to learn and implement SMART goals to help them achieve change is only one way I support my clients. If reading the information provided above resonated with you and you may be a good fit for one of my specializations, reach out. I'd like to connect and find out more about how I can support you on your journey.

​If you are interested in counseling with Lee Ann or any other clinician, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

What is body image?
According to Cash, 2004, “Body image is a multi-faceted psychological experience incorporating perceptions, thoughts, feelings, and behaviors related to one’s body.” Essentially, the human experience and everything involved with that can shape one’s perception of their body.

What is Body Positivity?
Body positivity spawned from the need to understand negative body image and focus on decreasing the symptoms of negative body image without focusing on increasing positive body image (Cash & Smolak, 2011; Tylka, 2011). However, Tylka et al., 2015, argue if therapists focus on reducing negative body image and do not also incorporate body positivity, treatment may only promote a neutral body image and make statements such as, “I don’t hate my body anymore. I merely tolerate it.” Technically, they argue that the lack of promoting body positivity has to be added on top of decreasing negative body image; that merely decreasing negative body image does not inherently increase body positivity. Body positivity is both a social movement and a personal practice centered on the belief that all bodies deserve respect and acceptance. It challenges cultural ideals that equate worth with physical appearance, and encourages people to reject shame and judgment about their bodies. While promoting positive sentiments and thoughts about one's body is positive, it is also not always realistic or sustainable to expect oneself to love every aspect of their body at all times.

What is Body Neutrality?
Body neutrality states that it is okay if you do not always love or even like aspects of your body, and that it can be okay. Anne Poirier, an author, defined body neutrality as, “Not supporting the hatred of our vessel or the love and adoration of our vessel” (Shaping Perspectives, 2023). Mink & Szymanski, 2022, determined that the new movement of body neutrality on social media such as TikTok, may be a protective factor against body dissatisfaction in the treatment of eating disorders (Pellizzer & Wade, 2023). Author, Jessi Kneeland of Body Neutral: A Revolutionary Guide to Overcoming Body Image Issues stated, “Neutrality gives you space for everything that previously felt like a huge problem to kind of just be… It gives you the ability to see yourself and the world clearly, which means you can take your emotional power back from the places that don’t deserve it” (Kneeland, 2023).

Social Media and Body Image
Social media has been a driving force for both good/bad and healthy/unhealthy perceptions of body image. Some of the biggest and most widespread trends in social media have been surrounding body positivity. The initial goal was to both challenge and replace negative ideals and perceptions of body image. To challenge the “ideal” body size as thin and move toward love and acceptance of all body types. On TikTok alone, #bodypositivity has accumulated over 23 billion views, and the hashtag has appeared on tens of millions of Instagram posts

In a study conducted by Davies et al.,(2020) and Fioravanti et al., (2021) compared body-positive, fitspiration, and neutral Instagram posts and found that body positive posts led to higher esteem about one’s weight, mood, and body satisfaction while posts with messages centralized around rigorous exercising and diet (fitspiration) led to poorer esteem about one’s weight and negative mood. However, Mehdi and Frazier (2021) argue that the body positivity movement has been co-opted over time, shifting away from its original focus on social equality for marginalized bodies toward a commercialized message of self-love that now primarily centers thin, able-bodied, and conventionally attractive bodies, ultimately further marginalizing the communities the movement was created to serve. 

Some research actually suggests that the effects of body positivity can be complicated. A survey of 778 undergraduate women found that exposure to body positivity content on TikTok actually worsened body dissatisfaction for some users, particularly through upward social comparison and increased body monitoring (Mink & Szymanski, 2022). Given the mixed findings in the research, it is clear that social media's impact on body image is highly individual, and that therapeutic support can play an important role in helping people develop a healthier relationship with their bodies regardless of what they encounter online.​

How Can Therapy Help?
Here at OakHeart, Center for Counseling, you will receive integrated and evidence-based approaches like cognitive behavioral therapy and acceptance and commitment, as well as emotional-focused therapy interventions. Additionally, OakHeart’s values are rooted in integrity, kindness, courage, genuineness, respect, and empathy. Equally important and relevant to body image is the Health at Every Size (HAES) model. This model focuses on developing healthy behaviors without prioritizing weight loss. In particular as stated by researchers Phelan et al., (2015), “First and foremost that health care must be accessible to people no matter their size, and no matter why they are any given size. This disproportionately affects large bodied people because our current societal norms prioritizes and normalizes slender and thin bodies. Anti-fat bias has created an environment where even in health care (where we expect people of all ability levels and health statuses to be included) equipment, gowns, and seating is not designed for all bodies.” Essentially, rather than center health around being thin, or losing weight, we create an environment free of judgement and stigma, promoting body acceptance and without exceptions (Puhl & Heuer, 2009; Association for Size Diversity and Health, 2026). 

If you are interested in counseling with Dr. Hamor or any other clinician at OakHeart, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.