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Body dysmorphia: Prozac improvement.

Permanent Linkby margharris on Fri May 01, 2015 11:48 pm

We have upped the dose of Prozac to 50mg. This had the effect of reducing his intrusive thought attack almost immediately this morning. He is still left terrified to do anything. He tells me the touching was unbearable this morning. This is not going to work as an excuse not to shower. This is an exposure I expect from him. He hates looking at his body hair but he is going to do it. He has relied on excuses for too long. His personal motivation might not be there yet so my enforcement will be. I just have to expect something from him for my own sanity.

As I mentioned the calling out about his stories of hair loss stopped very soon after taking the Prozac this morning. He tells me the stories are still there but they feel like they are not so intense. He was able to watch a game of basketball and hasn’t been distressed. The game of basketball finished and now he tells me his DHT is out of control. Bed rescue. The story is so useless and self-defeating. But it is part of his BDD loop in his brain. He is powerless at the moment to turn it off. As soon as the distraction is over, the BDD thoughts enter. He is not mindful of what he is thinking. He is not purposeful to direct his mental energy to some physical willingness to engage life.

What will I be doing with my mind today? Such a question never seems relevant.

As he has remained in bed all day, I haven’t given him a midday dose of Lyrica. He doesn’t seem to be needing more sedating. Lyrica is a drug for epilepsy, an anticonvulsant. It is approved for use in GAD in Europe. The doc considers GAD usually accompanies BDD in some way anyway. It works to slowly reduce glutamate and norepinephrine neurotransmitters. It dampens down reactivity. This has allowed us to up the Prozac with much less disturbing akathysia. That is the awful internal restlessness, jitters and shakes that can accompany all our attempts to take SSRIs.

We are nearing the two month mark in blogging our attempts to overcome this exacerbation. As we seem to conquer one compulsion, another one takes its place. He can now visually body scan his own leg hair and induce a panic. Too much hairiness equals too much DHT equals hairloss. You can see the deer in the headlights look on his face as he does it. I am powerless to stop it. It is very hard to live with. The only thing going for us is my son’s willingness to battle through with the medication.

On another positive note. We are going in for 3 MRIs this will be part of a study on oxytocin. These MRIs will then be used diagnostically to target the transcranial magnetic stimulation. We are booked in towards the end of May. It will be interesting to see how his brain looks and if anything odd shows up. From the readings I have done, the amygdala is more illuminated than normal.

BDD is thought to be a biological disorder of the primitive alarm system. The alarm system is built around the amygdala. Just waking up can trigger the amygdala to fire. This then trips fear stories to arrive in the brain to provide context for what is alarming. So my son fears going bald. This is his learnt fear. Why he can’t diffuse this fear like other people can is because it is linked to this alarm. If he even thinks of it, he causes alarm sensations. So trying to avoid any thought of balding seems the only option. If the fear doesn’t eventuate then the alarm subsides. This is why plastic surgery is sort. It provides a short term fix for a fear that seems so consuming. But the alarm system is still faulty. Another story soon is born out of feeling the fear and thinking what is the worst thing I can be fearing. Give that feeling context and your new BDD has arrived to torment you. The surgery will not work and can never work because the content of the fear is not the problem. It is the generating of fear in the brain coming out of the amygdala.
If you can ever get your head around this understanding and realise your amygdala is sending fear stories you might be able to think yourself out of this disorder. This is so not easy to do when you are so prone to anxiety. I know I have nothing to fear going up a high building but I can still experience vertigo if I look down. It is the same with BDD. You might still get a fear response despite all the exposures you do. Ploughing through the fear is not always an option even if you really understand your brain is misfiring. If you can tell yourself it makes no sense then you might be able to feel the fear and be able to dismiss it. I doubt my son would ever get to that point though as the fear is just too intense.

Medication for us seems the only option. But do hope TMS will work as well. The problem at the moment is that the amygdala is too deep in the primitive brain structure for magnets to reach. So the storytelling context or the visual perception parts of the brain is to be targeted. They are really secondary targets that feed from the amygdala. How the fear is being fueled by other parts of the more superficial structures in the brain lobes is what can be targeted by magnets. The science makes sense. Do hope it translates to results.

We all need more than luck. it is just so traumatic to live with this. Marg

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