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Body dysmorphia: Improving awareness. It is in the brain.

Permanent Linkby margharris on Sun Apr 12, 2015 2:19 am

Improving awareness.

Visiting a good psychiatrist has an added effect of improving the level of awareness of what BDD really is. It is not just about feeling ugly and thinking people are noticing. That is how it is felt by the person with the illness. It is not experienced as a mental disorder even though there is enormous disruption to life, anxiety and depression. That is what makes it so frustrating and also why plastic surgery is sort but cannot really improve the condition.

We had visited this psych ten years earlier. He had his earlier notes on hand. The concerns were just the same as they had been then. There were the appearance concerns over hair, the thinking that people would notice and the compulsions to avoid and feel safe from these feelings and thoughts. I suppose those three components need to be there if a diagnosis of BDD is to be made.

Looking at appearance concerns more closely. People with BDD seem preoccupied with the idea that some aspect of their appearance is ugly, deformed, or flawed in some way. Most do not recognize that their belief is due to a mental illness. Insight remains poor even after diagnosis and treatment. Visual judgement appears compromised. It is as though the person with BDD can’t link the knowledge of what the disorder means to what they think they see.

How does this confusion resolve? : Most individuals with BDD are convinced that their view of their appearance defects is accurate and undistorted. Everyone else is lying is the only option to resolve the conflict.
In addition, most seem to have ideas or delusions of reference, believing that other people take special notice of the supposed defects and stare at them, laugh at them, or recoil in horror because they look so bad. They never need to ask. They believe they are body language experts. This thinking too is impervious to logic. They can never modify their own thinking to incorporate a more realistic view that it is again their illness making them think this.

To be diagnosed with BDD, it is considered necessary to have some repetitive behaviours now as well. This links into the idea that BDD is a variant of OCD. (DSM V) Common behaviours include compulsively comparing the disliked body areas with the same areas on other people, camouflaging the disliked areas and mirror checking.

My son was lying in bed this morning moaning over body hair. Telling me he was so ugly.He now believes he is feeling his body hair grow. He knows the reason…High DHT. I told him it was his mental illness talking and his body was fine. He will not be convinced for long. Showers are now down to seconds because the anxiety of scoping his body becomes too much. As he terrifyingly looks over his body with the gaze of a deer in headlights, you can tell he has no idea that his brain is doing this to him. He is fully convinced of his own logic.

Zapping his brain with TMS will be welcomed. The occipital lobe, the part involved in visual perception is the target for this TMS. All his other OCDs have been visual so it makes sense. The plan is a course over 4 weeks and then a break and another couple of weeks. As my son refused the private hospital the doc has to schedule it in the public one. PET scans will be done too so we might see Christmas tree lights somewhere in his brain.

As an update. Meds are not going well. Family genetics just can’t tolerate Fluoxetine. The akathysia trembles are just as bad as the BDD. Valium and betablockers aren’t enough to stop the shakes. So it seems he can only tolerate antidepressants that target histamine.

Hope we have a better week. Something to look forward to ahead. We are going to beat this. Marg

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