There are lots of different reasons that someone may have a troubled relationship with their body. In the era of filters and photo editing, it’s become incredibly easy not just for magazines to edit every imperfection out of their glossy pages, but for anyone who uses social media to make their skin smoother, eyes brighter, lips plumper, and trim off some extra weight. Most smartphone cameras even have in-built options to make yourself more conventionally attractive before the photo is taken. Since most mirrors don’t yet come with this technology, it is no wonder that when we look at our own reflection, we notice the spots and stretchmarks even more than before.

Similarly, while it has improved a little in recent years, diet culture remains alive and well in the west. Anyone deemed to be even slightly overweight based on appearance alone, which often bears no relation to their actual weight, will find themselves subjected to degrading comments. Models with a stockier build often find it much harder to find work, and in anything fictional, the big bad is likely to be described as fat. Even in the healthcare setting, while weight is a factor often associated with certain medical conditions, there is an over-reliance on simple measurements like BMI despite their many, many flaws, allowing doctors to blame anything and everything on weight and prescribing weight loss as a universal treatment. When fat-shaming is so deeply entrenched in our culture, it is no wonder that it often plays a role in people hating their appearance.

I’ll admit that I’ve been guilty of using filters on images of myself, although I never really got the hang of photo-editing. I’ve also been subjected to some abhorrent comments about my weight, and it is perhaps only because of my knowledge of nutrition that it’s impact on me has been limited. For me, however, there are two additional reasons why my relationship with my body is often strained.

First and foremost, my body keeps trying to kill me. There were issues in utero and during my birth, and then there was a small reprieve before contracting meningitis at age 14. A few years later I had gall stones and such severe inflammation that there was a risk my gall bladder would rupture, requiring a rapid surgery. My lungs periodically decide that I no longer need oxygen. Even when my life is not at risk, recent scientific endeavours suggest that my immune system does not particularly like me, my brain doesn’t like serotonin, and my uterus refuses to keep it’s contents to itself. It is remarkably difficult to like a body that makes everything I do three times as difficult as it needs to be.

Then there is the small matter of not being cis. While I am lucky in that my experiences of gender dysphoria are limited, primarily because my gender is fluid and therefore femininity can even be euphoric for me at times, I am also less able to do anything to address the dysphoria. At the time of writing, I have yet to try out breast-binding, but chances are that I will not be able to tolerate a binder for long due to breathing and chronic pain issues; most healthy people find them incredibly unpleasant to wear. “Trans” tape, the other common breast-binding option, is also notorious for irritating and damaging skin, which can only make my eczema worse. Hormone treatments will wreak havoc with my endometriosis, and I would prefer to avoid surgery (not that I want anything quite so drastic or invasive) as I do not cope well with anaesthesia. While I have managed to achieve a lot with clothes, accessories, and hair and make-up, I do still face gender dysphoria and this, again, makes my relationship with my body difficult.

Frankly, if you combine all of the above, body positivity movements can seem stale and disingenuous. It’s natural to have aspects of ourselves that we dislike, whether that be a scar or some stretchmarks, to being stuck in a body that does not reflect your identity, or even to being in “Houston, we have a problem” medical territory. To me, it’s not so much about body positivity as body acceptance, and even then some things might not be as acceptable to you as you’d like. I have certainly had to accept the disability as something that very little can be done about, and my life is much better for that acceptance, yet I am less willing to accept something like gender dysphoria. Frankly, if you need to modify your body to feel happy then, provided it is done safely and carefully, I see no real reason not to. After all, I am at five tattoos (and counting)…