Ask Dr. Mike

By Michael Oberschneider, Psy.D.

Dr. Mike,

My 49-year-old wife and I have been married for 24 years, and we have three great kids and a great relationship. She was beautiful when I met her, and I think she’s even more beautiful today. The problem is, she doesn’t seem to think so. 

Over the past 7 years, she’s become obsessed with her appearance. She’s done cosmetic surgery on her neck because she said her “jowls hung,” and the area around her eyes and forehead because she said she “frowned and looked angry all the time.” 

She also sees someone else for fillers and Botox every month. At one point, she was taking laxatives to lose weight when she wasn’t even overweight. She got on Ozempic last summer because she said her body was “fat” and “felt gross,” and she was a size 8 then. She’s a size 4 now, and she told me that she’ll stop Ozempic when she’s a size 2 and is back to her high school weight and can fit into her high school jeans. 

Now she wants to get breast augmentation to feel “empowered as a woman,” and I guess I should be happy about that as her husband, but when is enough going to be enough? She’s also done many diets, cleanses, and has memberships to two gyms and exercises all the time, but she’s never is happy with how she looks.  

I’m worried that this will never end. Can a midlife crisis go on for 7 or more years, or is this mental illness?  I love my wife and family very much, but I don’t know what to do.  Anyone who sees her would think she’s attractive, so none of this makes sense. Even our teenager daughter thinks her mom is “obsessed” with her appearance. You help is appreciated. 

Concerned Husband

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Dear Concerned Husband,

It’s clear to me that you love your wife deeply, and your concerns are certainly valid. However, it’s important to approach your concerns with your wife with empathy and understanding. The goal isn’t to point out all the ways she is wrong or “obsessed” or all of the ways she’s gone too far. The point is to let her know why you are concerned, to then listen closely to what she has to say, and to then hopefully get to a better place together.   

Keep in mind that many men and women go through phases where their self-perception becomes more critical, and those beliefs can be amplified by societal pressures and personal insecurities.  

At 49, it’s possible that your wife is going through a midlife crisis, and yes, a midlife crisis can become protracted. As many as 10 to 20% women experience a midlife crisis, and they occur most often between ages 40 and 60.  

It’s also possible that her motivations and incessant need for bodily and facial improvements have more to do with underlying mental health struggles like depression, anxiety or Body Dysmorphic Disorder.  

I recommend that you start by opening up dialogue with your wife where you engage with her in a loving and non-judgmental way about your concerns. Share as much as you can about how much you adore her for who she is, and how much she matters to you, your children and others. 

Listen closely to what she shares with you, and hopefully you can have a productive conversation that gets you to a place of shared understanding and greater togetherness.

You could also suggest that both of you visit a mental health professional. A couple’s therapist could provide a safe space to explore underlying issues, offer strategies and help your wife and you find more agreement on the topic.  

Positive change is more of a process than a moment, so don’t expect things to improve overnight.  You’ll need to be patient and supportive with your wife as she navigates through her feelings with you. I’m hopeful that with your love and support, and professional help if needed, your wife can get to more of a balanced perspective.  

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Dr. Mike,

Our 27-year-old son is still living at home with no motivation to do anything but play videos games and to have us leave him alone. He started at NOVA after high school and dropped out, and then returned to NOVA last year and dropped out again. He told us that he didn’t like the teachers, but we saw that he didn’t do the work or make it to most classes.  

He’s had a few jobs, but those have only been for seasonal help in the winter or for short stints, and then he quits or gets fired. He’s now on some sort of social justice warrior campaign against Trump and capitalism. It’s funny that he seems to have no problem driving my Mercedes or spending our money as a self-proclaimed socialist.  

He also went through a phase where he was convinced that he was transgender but that passed.  We’ve tried to help him in so many ways, but he doesn’t want our help. My husband says we should throw him out, but I’m afraid he’s too immature to manage himself, and I think he’s depressed. 

He’s told us that he’s not happy but says he doesn’t know what would make him happy.  Thankfully he doesn’t drink or do drugs. The last couple of times we tried to talk to him about getting a job, going back to school or just getting on a normal sleep schedule, he yelled at us and then put a few holes in his bedroom wall. How do we help him? 

Concerned Parents

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Dear Concerned Parents,

Based on what you’re written, it seems your son has what is now termed, Failure to Launch Syndrome. Failure to Launch Syndrome refers to a situation where young adults face significant challenges in achieving independence and transitioning into adulthood.  

Failure to Launch Syndrome can manifest in various ways: having a lack of motivation or ambition, having social anxiety and/or social avoidance, having a reversed or off sleep schedule, having difficulty maintaining employment or staying in school, withdrawing from family, friends or social activities, just to name a few.   

While there is no single cause to Failure to Launch Syndrome, research in this area has revealed that the following factors can lead to significant problems in developing appropriate independence, autonomy and agency in young adulthood: psychiatric or psychological disorders, neurodevelopmental disorders, overprotective or enmeshed family relationships, the rise of screen culture and the gig economy, personal traits, past trauma where an unresolved traumatic experience disrupted normal development, parental divorce or frequent relocations as a family.

Based on what you’ve shared, what’s causing your son to struggle as much as he is in life isn’t clear to me. Given how long this has been going on and given that your efforts with him for several years haven’t led to improvements, I recommend that your son meet with a mental health professional.  

If he refuses to see someone, then I recommend that you and your husband start therapy as parents for support and guidance. 

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Michael Oberschneider, Psy.D. is a clinical psychologist in private practice. He can be reached at 703-723-2999, and is located at 44095 Pipeline Plaza, Suite 240, Ashburn.