I desperately hate how I look. From the bags under my eyes to my nose, it affects my whole life and has always held me back. I am only 34 but I look haggard with deep lines around my mouth and eyes from smoking. It would be obvious to say give up, but I'm caught in a horrible cycle of wanting to cry every time I look in the mirror, then reaching for the cigarettes. I’ve always felt jealous and inferior around other girls and although I've had a few long-term boyfriends I always feel they are looking for something better. I've spent thousands on creams, Botox, and microdermabrasion but I can't afford to keep it up. Will it always control my life? Helen

What exactly is the ‘it’ that’s controlling your life here? From what you’ve said I’d be more inclined to ban mirrors than tobacco. But most of all, I’m concerned about what’s going on inside your head, not on the outside. You’re a smoker who looks haggard and feels jealous and inferior.

Is that the worst set of accusations you can make against yourself? Because even if all that is true, then in the words of American poet Mary Oliver ‘what is it you plan to do with your one wild and precious life?’ Mother Teresa wouldn’t have won beauty contests, Angela Merkel’s choice of lipstick is not what makes her the most powerful woman in the world, and would you take fashion advice from the Dalai Llama? In other words: smoking, schmoking, of course it matters, but I don’t like to imagine you looking in the mirror and the whole world shrinks to the size of your wrinkles.

When you describe how this is affecting your whole life and holding you back, these sound like distressing thoughts. I was so concerned that I checked your description with a doctor friend. She says you need to rule out any underlying problem. I have been wrestling with myself about whether to offer a label here, so this is on the condition that you don’t believe me but check it out with your own doctor.

The type of thoughts you describe sound extreme and unrealistic, and could fit under the heading of body dysmorphic disorder.

If you don’t already have an understanding doctor, I suggest that you phone the surgery you are registered with and ask the receptionist which of the GPs might be best placed to help you if this is the case.

Bearing in mind that big if, the most likely help will be some form of mindfulness-based cognitive behavioural therapy. You can research both mindfulness and CBT yourself, and I’ll recommend a book that comes with a home practice CD. One of the key people who has led the way to incorporating Eastern traditions of meditation into clinically proven Western medicine is Dr Jon Kabat-Zinn. He talks about mindfulness as a form of ‘affectionate attention’.

You are paying your looks a lot of attention, but affection is missing. Please take it from me that you are worthy of this change of focus, and let me know how you get on.

Mary Fenwick is a business coach, journalist, fundraiser, mother, divorcée and widow. Follow Mary on Twitter @MJFenwick. Got a question for Mary? Email mary@psychologies.co.uk, with ‘MARY’ in the subject line

For more on helpful or unhelpful thoughts:

• See: rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt.aspx
• Use: franticworld.com/resources
• Read: Mindfulness: A Practical Guide To Peace In A Frantic World by Professor Mark Williams and Dr Danny Penman (Piatkus, £13.99)

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