Her conviction that she was basically 'not okay' came from a long history of being criticized by her parents, not just about her appearance, but also about all manner of her behaviors as a child and adolescent. In addition, peers teased her. As a result, Amy suffered not just from a negative body image, but also from a distorted body image. She could not see her physical from a realistic perspective. Shame is often at the bottom of self-consciousness, prompted by the fear that others will be judgmental and negative.
Shame is the experience of feeling 'under a microscope' with everyone watching.
It produces an intense desire to disappear or dissolve into the floor. A negative body image triggers self-consciousness and shame and the desire to hide. When Patty refused intimate relations with her spouse, she in effect was hiding from her shame and self-consciousness. All three of these women were caught in the comparison trap. They either compared themselves to others or to some internal standard about how they ought to be-always coming up short.