by Sandra Houston, PhD

Altered States. Our Body Image, Relationships and SexualityOur body image (the attitudes we have about our body) and our self-perception (our thoughts, feelings and reactions to our selves) profoundly impact our relationships with others, especially our intimate relationships.

Though we are taught to be aware of our body shape, size and physical attributes early in life, our body image changes as we go through life and is shaped by our interactions with others, both good and bad.

We are most keenly aware of others' opinions and social feedback during adolescence, and the teen-age years are a time when our physical characteristics play a prominent part in our status. Demands are placed on us to conform in dress, behavior and speech, and teens often become hypersensitive to the verbal and nonverbal cues of others. As a result, this is often an especially stressful and vulnerable time for teens with limb differences.

Teens react to their body difference in various ways. Some withdraw from friends and social events and isolate themselves; others become aggressive and overly competitive. Girls may try to compensate for the missing body part by focusing on other areas, such as wearing more make-up, dressing more seductively, or wearing more jewelry. If not done to extreme, some of these behaviors can be healthful ways of coping. Boys often try to prove their masculinity by engaging in strenuous sports and other competitive activities, sometimes suffering unnecessary injuries as a result. Again, if not taken to the extreme, this can be a healthful coping style. Isolation and withdrawal only delay the adjustment process, often resulting in too much focus on the loss, a secondary “gain” of sympathy, and dependency.

The Hollywood ideal is impossible for most of us to achieve, young and old alike, yet our self-perceptions are shaped and driven by the media, which lead us to want to be thinner, prettier and healthier. Unfortunately, the further we see ourselves from these artificial standards of beauty, the more likely our body image will suffer.

After the loss of a limb, we become even further removed from these ideals. We are forced to deal psychologically with changes in function, sensation and body image. But the more we focus our energy on what's missing – not just the limb but also the things we could do before – the more likely we are to become depressed and angry. In fact, many studies have found that the more negative amputees feel about their body image, the less satisfied they are with their life. It doesn't have to be that way for you, however. Psychological studies have also found that the majority of amputees are well-adjusted and have full and rewarding lifestyles. You have a choice.

The way to learn to live with these altered perceptions is to recognize that you're still basically the same person inside that you were before the amputation. Successful adjustment is achieved by focusing on overcoming obstacles (with or without a prosthesis), learning to do the things you enjoyed before (which may require some realistic and creative adjustment), and seeing yourself as a whole person who just happens to have a missing body part. Don't limit yourself with the label of “disabled.” The focus should no longer be on what's gone, but on the future.

If you use a prosthesis, it will help restore your body image. You will now have the unique situation of having not one, but three body images – one with the prosthesis, one without it, and your intact, preamputation body. As you learn to use your prosthesis, your body image will begin to change to incorporate the artificial limb. You'll know this is starting to happen when you begin to feel naked without it or if you have dreams in which you are in your preamputation body.

Relationships

Altered States. Our Body Image, Relationships and SexualityRelationships come in many forms. There are those people we are intimate with, nodding acquaintances, and those in between. Regardless of the degree of closeness, the connections we have to others have a profound impact on our quality of life. People who feel lonely and isolated are far more likely to experience depression and even physical disease than those who have a sense of connection and community. When we have no one else to communicate with, we are left to focus solely on ourselves. With nothing else to distract us, we tend to dwell on our problems and pain.

Some amputees may view their body change as a mark of shame. Afraid of rejection, they may view themselves as less desirable and then project these feelings onto their friends, relatives, and even strangers. By doing this, they shut themselves off from friends and potential relationships to avoid the anticipated pain of rejection. Because social support and intimacy are so important to our physical and mental health, however, it is imperative that the new amputee recover from such a poor self-image. Fortunately, recent studies of people's social reactions to amputees indicate that a social stigma no longer exists, particularly when the amputee initiates the interaction. This is further evidenced by the marriage of former Beatle Paul McCartney to Heather Mills, an amputee.

When you initiate interactions with others, it's up to you to get them to see you as a person, not as an amputee, and to help them understand that your amputation affects only a small portion of what you can do. You are responsible for how you present yourself to others, decreasing others' anxieties about your missing limb, and demonstrating a positive self-image.

Granted, this is easier said than done, and sometimes professional help may be needed. Therapy provides a safe place to try out different social skills. Therapy sessions with amputees often consist of behavioral rehearsal, role-playing with various dating approaches, responding to peers' reactions, and learning various means of communicating a positive self-image. After all, if you don't like yourself, how can you expect anyone else to?

Love and intimacy are what make us feel whole, and relationships are one of the most powerful factors in our emotional and physical well-being. But to feel connected to others doesn't mean you have to surround yourself with a crowd. Your need for connection can be met through those with whom you already share love and affection. It can also be fulfilled by getting involved in new activities with others. In this regard, joining an amputee support group can be beneficial in many ways. When you meet with other amputees who are living full and satisfying lives, you're more likely to believe you can do the same.

Healthy relationships are based on a mutual give and take of friendship, trust and respect. You may have lost some of your independence after the amputation, however, so some of these relationships may need a discussion of how to adjust the balance of give and take. An amputee's spouse or parent may often feel overwhelmed by the new responsibilities he or she has to face, and communication is the key here. Discuss everything, “no holds barred.” The more you can openly and honestly discuss your anger, fear and frustrations, the healthier and stronger the relationship will become.

Sexuality

Many people believe the myth that if you don't have sexual intercourse, you're not a sexual person. The truth is that we're all sexual beings. Sexual interaction is, however, the physical expression of our feelings and emotions in a loving relationship. Unfortunately, sexuality (which embraces the whole self) is often used synonymously with sex (generally meaning sexual intercourse).

Touching, affection and emotion are often overlooked aspects of sexual activity, even though touching and being touched are basic human needs. In fact, studies show that babies who don't receive the comfort of a loving touch develop later than those who do.

Unfortunately, some amputees say that limb loss limits their sexuality. This feeling is often associated with a negative self-image. Because society's view of sexuality is based on youth and physical attractiveness, you may feel that you are less sexually attractive after your amputation and avoid this natural and important part of life.

For those who are not already in a sexual relationship, it's important to remember that you need to learn how to be friends before you can learn how to become lovers. You also need to learn how to make mature choices in selecting partners rather than being “needy” and waiting to be chosen by someone “willing” to be with you.

No matter who you are, the risk of rejection is a fact of life in any intimate situation. To reduce this risk, many amputees prefer to start new relationships on a painfully honest basis. They make it a point to inform their dating companions early on so that whatever their emotional response may be (positive or negative), it happens before the relationship progresses emotionally and physically. But even if you and your partner have been together for some time, it's just as important to discuss your fears and anxieties about your body and how it might now look and function somewhat differently. Without open communication, there is a lot of room for misunderstanding and hurt feelings later on.

Our sensuality and sexuality always begin with us, and we sometimes create our own barriers to expressing these components. One of these barriers is concentrating too much on the performance and not enough on the sensations. To fully experience the sensations of touch, you must let go of all thought and expectations and focus on the sensations of pleasure available at that moment. As your awareness of the sexual sensations improves, both your self-image and level of sexuality will improve.

Sex is a give and take proposition. We alternate between focusing on our partner's pleasure and our own. There are many ways to share pleasure so give yourself permission to expand your definition of sexual expression. Don't be afraid to try something new. Communicate verbally and nonverbally what feels good and where. What may have once been a comfortable position for you might, since your amputation, be uncomfortable or even painful. In addition, you may experience balance problems. Sometimes, something as simple as positioning with pillows can help with your stability. Sex is the fun part of a relationship so experiment, explore, and enjoy discovering what works best for you and your partner now. Amputees all over the world have returned to loving, sexual relationships after their amputation. You can too. 

About the Author

Sandra Houston, PhDSandra Houston, PhD, is a clinical psychologist and retired professor of psychology from the University of Central Florida. She had a private practice for 30 years, specializing in marriage and sex therapy. She has been a hip-disarticulation amputee since 1982. With over 50 professional publications and presentations, she continues lecturing and writing in the field of rehabilitation psychology.

A version of this article was printed in First Step - A Guide for Adapting to Limb Loss (Volume 4), a publication of the Amputee Coalition.

Last updated: 02/05/2009
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