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Body dysmorphia: Containing the monster.

Permanent Linkby margharris on Mon Jul 20, 2015 6:38 am

It has been three months since we started on Prozac and Lyrica. My son’s progress to reclaim his life has been just short of a miracle. When he is focused on his life he seems back to normal. He is able to carry out responsibilities, meet up with friends and handle the little frustrations of life. A few months ago any trifle would have meant another neck wrung.
He has asked about starting work again but there is just a hurdle standing in the way…… His BDD and how he handles a build up of stressors. The outreach worker mentioned that it wasn’t whether he could do a shift but what he did when he returned after a shift. What could trigger his BDD? And what he could do to handle stress now that alcohol wasn’t the option of choice.
So those concerns now need to be addressed. How does he unwind and manage anxiety. BDD at some level is a coping strategy that focuses attention by placing the focus on appearance. Mindfulness of what he is doing is essential. Meditation has been mentioned in the past. It is something he needs to develop to handle anxiety. Anxiety just can’t be avoided. He needs to plan how he will tackle it when he starts to feel it creep up. He hasn’t got alcohol as his go to. So I think he isn’t ready for work just yet. He needs to know what he can do and have a list of relaxation tools. Whether that list contains reading, exercise, daily walks, meditating or doing something he enjoys like cooking, he needs to develop that list of things he can connect with.
I realise now how destructive alcoholism is to the whole equation of getting well. Alcohol stops you developing connections. The addiction takes away all chance or choice of connection. You don’t go to do any of those healthy things. There is an absence of connection. So sobriety isn’t really the opposite of addiction. I rather think it is connection.
I could ring a friend or go shopping or start cleaning or get my hair done. An alcoholic loses all of that. Isolation and aloneness accompanies the love affair with the bottle.

The doc for the first time asked about his BDD symptoms. He is obviously thinking he is well enough to address this monster. He called it a monster, like it was some alien creature sitting on his shoulder.

" Did you open the box and let it out or shut the box up? "

He wants him to be mindfully aware of what his triggers are. Taking control of his thoughts requires him to focusing on these thoughts and the behaviours that allow the monster out. Once the monster has control, the doc described it like a vortex that sucks him in. He will lose perspective.

So that gets us back to all the compulsions I listed at the start of this blog adventure….
the shower inspection, touching, comparing to others, online browsing at celebs or fixes, camouflaging, and talking it up, are just a few that come to mind.

Story telling is a major problem for most BDDers. It certainly is with my son. He never tells his whole story of all that he does and all the devastation he creates from his BDD behaviours. He focuses on part of a story. What he says in his mind is the same story all of you say. “It is embarrassing and makes me feel hideous and deformed. I have unlucky genetics. If only I could get it fixed. If I looked different all would be well. My brother got it right.”

That would be how he described his BDD but that story doesn’t mention the shower, the touching, browsing, comparing, or the frustration and anger or what he avoids. That would be the whole story that he seldom tells.

Touching is a despicable problem still. He just starts with the hand on his face and moves around his neck or down his back, ultimately it will end up on his head for a check. I know too what he is thinking when he trolls the celeb pages. It will be all about what hairdo they are pulling off. It just a real shame that the media has this focus on air brushing anything that isn’t perfect. This makes everyone self conscious of flaws. But all this that he does has to be the story he tells to describe his BDD. ALL of IT.

On a positive note he washed his hair. It was scary for him. That is what avoidance does over time. It just builds the fear each time you reinforce it by avoiding what you know is the right thing to do. That is why exposures are important to do as soon as you recognize you are fearing something you once could do easily.

On a less encouraging note the TMS hasn’t proven so successful in our docs research. He has had patients come back with a relapse to baseline symptoms after only 8 weeks. He seems to be suggesting you need to do the work to know your triggers. You are treating your BDD more like an alcohol addiction. You can’t do anything that lets the monster out.

So it seems that for BDD you need to work from the inside out to heal yourself. That underlying biology responds well to medication but the dosage is important. Meds are taken at a higher dose than for anxiety or depression. Once your biology has improved you are still left with the thoughts, behaviours and stories. They are not going away if you still chose to do them. So this becomes the whole story of your BDD. BDD never was, “ I feel ugly or I fear being ugly.” The whole story is so rarely told. The whole story is all about your anxiety level, and what you do to feel safe and to avoid so you feel less fearful. It is all you give up to keep the obsession going. There is so much to it. It makes it hard to fight.

Wish you all well. Marg

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