I had a terrible shock today. I walked past a full-length mirror and I looked so fat that I didn't even recognize myself! This isn't the way I see myself from the inside. It's like I'm in a stranger's body. Am I crazy or what?

No, you're not crazy. You're experiencing a body image distortion that is common among those with eating disorders.

Most American women don't like the way they look. Recent surveys suggest that anywhere from 55 percent to an alarming 90 percent of women indicate some level of distaste for their physical appearance, regardless of whether they are objectively overweight (or underweight, for that matter). How could this be? The primary reason is that we've been trained by the media to hold women's shapes to an unrealistic standard of beauty, despite the fact that only a tiny fraction of us can ever hope to look like supermodels. Among those who are seriously overweight, body image is an even bigger problem because our society tends to view obesity with disgust.

For many overweight women, the emotional solution to bodily shame is to split off their physical selves from their identity. To survive, and to save some semblance of self-respect, they learn to avoid looking. They run from photos, videotapes, reflective glass and anything that would confront them with the "awful truth." I've had clients who've said "I don't exist from the neck down," or ",I just think of myself as a head and face, nothing more, nothing less." It's like stumbling through life wearing tunnel-vision goggles.

Body hatred and identity splitting have serious consequences for our emotional and physical well-being. For example, if we ignore our bodies, we don't take care of them. In a recent Fattitudes group, I listened to seven women ranging from age 30 to 55 speak about their negative body images. During the discussion, I asked how many had done a recent breast self-exam. Not a single one raised her hand. In fact, most of them had never done one.

Body hatred can create a vicious circle of self-defeating behavior. Take, for example, exercise. We all know that exercise is a key ingredient in permanent weight management. But if you hate your body and shun it like a communicable disease, how can you commit to working out? Ignoring one's body and exercising it just don't go together.

To make healthy decisions, we must value ourselves. We must view ourselves as being worth the time and effort to eat right and exercise. We must see the payoff of making our own needs at least as important as everyone else's. That's why, if you are "body phobic," the challenge is to turn things around and face yourself directly. Don't avoid mirrors; in fact, spend more time in front of them. Look at yourself. Really look. Can you discover some compassion for the person who resides within? Can you try to accept yourself as an imperfect human being -- just like everyone else -- who nevertheless deserves good things?

It's ironic that hating oneself for being overweight can contribute to staying that way. Lack of self-care leads to sabotaging behavior that makes everything worse. Nurturing yourself is crucial for ending this nasty cycle of self-defeat. You need to work on being your own best friend instead of your own worst enemy.