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HOW BDD AFFECTS LIVES – SOCIAL CONCEQUENCES: SITUATIONS IN WHICH THE PERCEIVED DEFECTS ARE LIKELY TO BE EXPOSED

admin — Wed, 27 Apr 2011 14:40:56 +0000

People with BDD feel especially uncomfortable and anxious in situations in which the perceived defects are likely to be exposed. They may avoid swimming, the beach, or events requiring shorts or short sleeves. People with facial concerns feel anxious in most social situations. Many people say that their symptoms typically worsen when they’re around other people, which makes them avoid people even more. As one young man told me, “My BDD bothers me less when I’m alone, so I stay alone.”

Relationship may be strained or avoided altogether, and intimacy is often forgone. Many people with BDD are very isolated. Spouses, boyfriends, or girlfriends usually have trouble understanding the self-consciousness and avoidance and may become irritated or even angry. “My husband is very frustrated that I don’t want to go places with him where I’ll have to dress up,” Maria told me. She avoided situations, such as parties or dances, in which she couldn’t wear bulky sweatpants that covered her thighs. “He doesn’t understand why I prefer to stay at home instead of going out or spending time with friends. He’s afraid that we’re starting to lose our friends because of it.”

BDD often stifles intimacy. “I’ve not only avoided dating because of it,” Martha told me, “I finally got a boyfriend, after 20 years of not having one, and my worries about my feet and thighs are interfering with our relationship. It interferes with sex—I’m afraid he’ll reject me because of my appearance. It’s a burden and a hindrance. I’m afraid I’ll never get married because of how I look.” Martha never told her boyfriend about her appearance concerns, even after they got engaged. “I’m much too embarrassed,” she told me. “I discuss everything else with him, but not this.” Because she was so self-conscious she tried to hide her body whenever she was around him. She undressed only in the dark, and she never allowed him to see her feet. “I wear socks at all times,” she said.

Sally was able to be intimate with her husband. “But I can’t exactly relax,” she said. “I worry about my hair the whole time—is it getting messed up? Does it look okay? I jump out of bed right after sex to check my hair. My husband thinks I’m crazy!”

Arnie, who thought his skin was too white, had never felt comfortable with his girlfriends. “It’s interfered with my love life and with any intimacy whatsoever. I wouldn’t take any clothes off. I wouldn’t even roll up the sleeves on a long-sleeved shirt!” Randy attributed his impotence to his BDD. “I’m constantly judging the size of my penis negatively. I’m probably misperceiving, but I think it anyway. The intensity of the feeling is severe. No wonder I’m impotent.”

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OBSESSIVE COMPULSIVE DISORDER: DIFFERENCES BETWEEN BDD AND OCD

admin — Fri, 24 Dec 2010 10:58:09 +0000

People with BDD also tend to have poorer insight than those with OCD. In a study Dr. Jane Eisen and I did, we compared insight into the underlying belief in 85 people with BDD and 64 with OCD. A typical belief in BDD is looking ugly or deformed; OCD beliefs vary but often consist of a belief that something bad will happen if a ritual isn’t performed (e.g., the house will burn down if the stove isn’t checked 30 times). On average, insight in BDD was poor, whereas in OCD it was good to fair. Specifically, we found that people with BDD are more convinced that their belief is true and are more likely to think that other people agree with them. They’re also less willing to be convinced by someone else that their belief isn’t true, and they try less often to convince themselves that it isn’t true. They’re also less likely to think that their belief has a psychiatric cause (for example, due to a disorder such as BDD or OCD) and more likely to think it’s actually true.

The poor insight of people with BDD is one of the reasons that cognitive approaches (cognitive restructuring and behavioral experiments; see Chapter 14) are usually emphasized when treating BDD with cognitive behavioral therapy. Cognitive approaches target the unrealistic thinking and poor insight that’s usually present in BDD. Many expert therapists think that behavioral approaches (exposure and response prevention) when used alone (that is, without cognitive approaches) tend to be less effective for BDD than for OCD. Cognitive approaches are therefore usually combined with behaviourial approaches when treating BDD.

While BDD and OCD both appear to respond preferentially to SRIs, they may respond somewhat differently to other medications. In Chapter 13 I described a study in which I added a typical neuroleptic (pimozide) or placebo to an SRI (fluoxetine). This study found that pimozide wasn’t more effective than placebo. This differs from findings in OCD, for which pimozide and other typical neuroleptics are often effective when added to an SRI. While the BDD study findings need to be confirmed, this is another way in which BDD’s treatment response may differ from OCD’s.

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OBSESSIVE COMPULSIVE DISORDER: DIFFERENCES BETWEEN BDD AND OCDPeople with BDD also tend to have poorer insight than those with OCD. In a study Dr. Jane Eisen and I did, we compared insight into the underlying belief in 85 people with BDD and 64 with OCD. A typical belief in BDD is looking ugly or deformed; OCD beliefs vary but often consist of a belief that something bad will happen if a ritual isn’t performed (e.g., the house will burn down if the stove isn’t checked 30 times). On average, insight in BDD was poor, whereas in OCD it was good to fair. Specifically, we found that people with BDD are more convinced that their belief is true and are more likely to think that other people agree with them. They’re also less willing to be convinced by someone else that their belief isn’t true, and they try less often to convince themselves that it isn’t true. They’re also less likely to think that their belief has a psychiatric cause (for example, due to a disorder such as BDD or OCD) and more likely to think it’s actually true.The poor insight of people with BDD is one of the reasons that cognitive approaches (cognitive restructuring and behavioral experiments; see Chapter 14) are usually emphasized when treating BDD with cognitive behavioral therapy. Cognitive approaches target the unrealistic thinking and poor insight that’s usually present in BDD. Many expert therapists think that behavioral approaches (exposure and response prevention) when used alone (that is, without cognitive approaches) tend to be less effective for BDD than for OCD. Cognitive approaches are therefore usually combined with behaviourial approaches when treating BDD.While BDD and OCD both appear to respond preferentially to SRIs, they may respond somewhat differently to other medications. In Chapter 13 I described a study in which I added a typical neuroleptic (pimozide) or placebo to an SRI (fluoxetine). This study found that pimozide wasn’t more effective than placebo. This differs from findings in OCD, for which pimozide and other typical neuroleptics are often effective when added to an SRI. While the BDD study findings need to be confirmed, this is another way in which BDD’s treatment response may differ from OCD’s.*364\204\8*

LEARN TO FACILITATE SLEEP ONSET

admin — Fri, 08 May 2009 09:40:45 +0000

It is interesting to observe that some people fall asleep very easily, but some find it very difficult and need sleeping pills. Even the same person may fall asleep very easily at some times in his life but find it very difficult at other times. Why is this?

There are two sets of forces acting against each other which affect sleep onset One group of forces includes good sleep hygiene, falling asleep at the right time of the biological clock, and, of course, being sleepy. The other group of forces includes poor sleep hygiene, trying to fall asleep at the wrong time of the biological clock, being unable to handle stress effectively, and, of course, having a genetic makeup that is of poor quality for sleeping. It is important to increase those forces that facilitate sleep onset and to decrease those that oppose it.

Genetic make-up. Studies of identical twins show that much of our ability to sleep is coded in our genes. Identical twins, who have the same genes, have similar sleep patterns even if they live apart in different environments for years. Some people are born good sleepers and they can sleep at any time of the day and, in fact, anywhere. My wife is a good sleeper, and she could sleep easily at any time no matter what shift duty she was on when she was working as a nurse in the general hospital. My two daughters have different abilities to fall asleep. Melissa is more like me, whereas Melinda sleeps easily, very much like her mother. But for those of us who are not so lucky and have poor quality genes for sleep, we have to improve those factors that facilitate sleep onset so as to tip the balance in favour of the forces that bring about sleep.

Sleep hygiene. This is the most important force in facilitating sleep onset As discussed in chapter 15, Sleep Hygiene, caffeine is the number one enemy; absolutely no coffee or tea. The bedroom is reserved for sleep and sex and no other activities. Leave the clock under the bed, but set the alarm to the same time every morning, even on Sundays and public holidays. A regular waking up time in the morning is an important Zeitgeber for entraining our circadian rhythm to the 24 hour clock. Daytime exercises are good, as they increase the amounts of NREM sleep.

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PAIN AND GUILT: THE EXPIATION OF GUILT BY PAIN

admin — Wed, 29 Apr 2009 10:30:14 +0000

When there is no clear cause for the condition, patients suffering from chronic pain are sometimes referred to a psychiatrist for his opinion. When these patients really unburden themselves they often disclose that they are preoccupied in thinking about some wrong they have done in the past. Over the years they have thought about it a great deal, and in thinking about it in this way, the wrong becomes greatly magnified. They have never told anyone about it. “This is something that I always thought I would bring with me to the grave.” And all the time there has been the thought, “Of course I shall be punished for it.” In the first place the pain may have arisen from some quite trivial cause; but once the pain is there, it soon becomes fixed. Only

half-consciously he thinks, “This is what I have been expecting; I knew it had to come; I am glad it has come at last and I shall get it over.” In a sense he is glad of the pain. By suffering the pain he will ease his conscience of the thing that he has done, and his mind will be at rest again.

On the one hand a patient in this situation wants to get rid of the pain because it hurts him, but on the other hand he wants to keep it, as it expiates his feeling of guilt. The pain lingers on, unrelieved by the various medicines he is given. Expiation never seems complete, so it continues until brought to light and worked through in psychotherapy.

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REASONS OF STRESS AT WORK: THE MIGRANT

admin — Thu, 23 Apr 2009 08:21:00 +0000

“I wish I were back home with my own people. People I can understand. I’m not at home here. They say nasty things. Rude things. Call me “Old bastard”. But they seem to like me. I can’t understand. I’m not a bastard. I hate it. They laugh. It spoils my life. I wish I could go back to my own country.”

Local idiom and local slang are always confusing to the newcomer. His brain cannot integrate conflicting messages. They seem to like him, but still call him a bastard. Far from being a matter of vilification, ‘old bastard’ is a term of endearment in the Australian vernacular.

I remember, some years ago, the cool reception I received when I addressed the head nurse of an American hospital as ‘sister’. In Australian hospitals the word carries strong overtones of respect, while in America it is a term of familiarity.

In matters as simple as this, the misunderstanding can be rectified by simple explanation. But without such explanation, the individual lives in an atmosphere of uncertainty which can form a background for the development of stress.

If we are secure enough in ourselves these misinterpretations lose their ill effect. We can stand by, and assume there was something in the conversation which we did not understand correctly.

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