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Body dysmorphia: update. Ideas are left

Permanent Linkby margharris on Sat Aug 29, 2015 11:31 pm

It is a little over 4 months since starting with the professor. The professor’s approach is to medicate the biology that underpins the disorder. The amygdala in the brain has been hijacked by anxiety. The amygdala usually has two functional circuits to create alarm. A fast circuit tells us that alarm exists and we should run. The second circuit goes to higher areas of the brain and is aimed to provide feedback about what is actually wrong. This second circuit allows the alarm system to subside once the danger passes. These circuits are not functioning correctly in BDD. Medication attempts to reset this alarm system.

My son has been on a cocktail of meds to manage a very severe, stage 4, bed rescue of his BDD. After being house bound and psychotic for most of the year, the health professionals thought he would never recover. There had been talk of him going to community housing as few people thought I could manage him long term. That was before we met the professor. That was also before we realised the psychosis had been brought on by the use of Seroquel. The off label use of antipsychotics for BDD now seems questionable. Any exacerbation of symptoms on such meds needs to prompt an immediate review. In our case the more psychotic he became the more antipsychotics he was prescribed. I doggedly approached a higher echelon of medicos after exhausting the lower ranks. Ultimately, I reached the research professor who lives and breathes this. He could live in his rooms. He is that dedicated. He even returns emails about meds on Sunday. After 4 months my son’s life has returned.

I asked my son how much he has improved and he answered 90%. Now that isn’t a miracle but it seems near enough for us to state that meds work. My son’s regime is now: Lyrica 75mg twice daily for GAD. Prozac 50mg in the morning. Minipress 1mg for sleep ( used in PTSD). The doc has been quite adamant that he is not to reduce the dose as he might bring on a return of symptoms.

At the same time, an outreach worker has come to the house. Her approach is to help him reconnect to life. This treats the behaviours of BDD as an addiction. My son must remain active throughout the day. He now cooks most days. This gives him something to do in the house. Reading the recipes and getting ingredients helps keep him in active focus. He has to plan concerts and do catch up with friends. He now has a novel he is reading and a new membership of the local library. An old pinball obsession has also been revived. He has had a new girlfriend for about 4 months who is keen to have him move in full time.

It was only last session with the professor that hair was really mentioned. The BDD seems to be falling away without doing anything directed towards it. His self care of hair remains atrocious as he still has ideas that hair is like candy floss. He doesn’t wash but cuts it to barely pinchable length. I don’t know when he does this but he knows he shouldn’t be doing it in response to stress. If one does start talking about anything BDD, he does start to become noticeably more anxious as he defends it still. So I can see that at this stage CBT might be counterproductive. The professor talked about him being in the consolidation stage of his recovery. He is to have medical clearance from work for another three months.

So there is no touching, checking, online browsing, talking it up and comparing going on. Most of the behaviours from his compulsion list have gone. But there is still the ideas. My son now recalls times past when someone mentioned hair and a celeb losing his looks and he would feel that pang of anxiety. He felt the anxiety even when it related to someone else. The notion of genetics made him connect his future to his own father and he then pronounced by prediction a future calamity. He was doomed by his own mind. These ideas that he values have formed circuitry around the amygdala in his brain. Whether he can be ever free of these ideas, I am not sure. We all age and we all have flaws. Why he felt anxiety over that traces back to why he was so heavily invested in looks. Was that a heightened visual acuity or was that because he had good looks that people noticed and commented on? Or was it all because he had the biology that caused the alarm system to malfunction. The alarm system had to find a reason for the worry. It connected to what he valued.

I see on the forum the idea that looks equals success and that some flaw equals loser. It only becomes a loser card if you decide it shames you. Someone’s big bum becomes an asset when you are prepared to show it off to millions. But most of us are private people. We don’t want a life of celeb scrutiny. We just want a life with someone to give to. So learning how to give works through learning what you can do.

Spend time in the kitchen rather than the mirror. Marg

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