My son was very present during our visit and spoke with confidence. He didn't need any prodding to explain how things had been going. The doc was pleased he had started at AA and felt he was the best he had ever seen him. He felt the new girlfriend was a good addition to help him reflect on how he behaved himself. My son mentioned how concerned she was about appearance and how that bothered him. He would be talking to her across a table and see her eyes gaze over to someone coming in. He felt she was checking them out for how they looked. The doc mentioned that it was important for him to realise he did the same thing. He needed to live in the moment and work on cultivating mindfulness. It is really about focusing on what is important. Being present for the person talking was important in nurturing your own sense of self and the connection you made to that other person.
The medication of Prozac 60mg and Lyrica 150mg twice a day was to stay unchanged. He could take another 150mg Lyrica at bedtime if he felt really stressed. As he has developed some insomnia with the meds, the doc prescribed the addition of 2mg Melatonin one hour before bedtime. The MRIs havent been read yet but he spoke to the guy who does the TMS while we were there. So I gather TMS is definitely an option he thinks is worth doing.
I didn't really think it was appropriate to mention my own concerns. It is important for him to own this illness himself. I would have liked to see about CBT but it doesn't even get mentioned at this stage. I feel they are waiting to see how the meds go for at least 4 months at the therapeutic dose suggested by Katherine Phillips and maybe do some TMS. They are after him developing insight himself. Mindfulness was mentioned though. The outreach worker will do some techniques on this to help him stay in control and sleep better.
He has been a lot better, despite the last hiccup so I have to be pleased for him. Meds do work a lot. Marg

Things had been going quite well. He was heavily invested with the new girlfriend and a mate was to stay over. No time for an all day bed rescue but he could cope we thought. The AA was to help stop the desire to implode with drink.
But it all became too much. He had visited beer pubs as this was the scene they once were into together. He was able to refrain and make an exit home early. The guy made his own way home.
In the safety of his own home. The explosion happened. A BDD session commenced. The stories poured out of how bad it was. He couldn't stop hairloss. He drew trajectories of future loss and demanded further treatment even at the expense of his overall health. He crossed the line into insanity. I tried to escape as I was the target for the tirade. At one point I thought of leaping from the back bedroom window. He blocked the bedroom door and in my panic I beat at his chest to try and get him away from me. Then I felt the blow. It hit hard and it was over. An immediate bruise blew up the size of a tennis ball on my arm. I took off out the door and stayed in the car for an hour. It was too late for a motel on Saturday night and too cold to stay in the car all night. My biggest fear is that my husband and I are always at risk of violence at his hand. Either of us could become the victim once he loses touch with reality. A criminal charge would finish all of us in a completely different way. His job prospects would be over and we would then enter a new phase of the criminal justice system.

We are to visit the psych tomorrow. The obvious move is a ramping up of the dose. But i still think the behaviours need addressing now through CBT. He has been deemed too sick to confront anything so far. No psychologist will see him. There is no point really second guessing what the psych will say. It is wishful thinking to imagine a psychologist could do better than I have done. But we have to get to the bottom of what keeps driving the disordered behaviours and thinking. He has to account for that himself.

His identity has merged with this conviction that hair matters second only to breathing. Why only hair and not skin or teeth or wrinkles demonstrates the bizarre nature of the illness. It is only hair that he abhors. His life has been hijacked by an intention to have perfect hair and prevent loss.
Interpersonal costs come a distant third in the drive for maintaining a perfect hairdo for life.
The worry about hairloss drives it, I suppose and the intention then becomes to prevent hairloss regardless of the cost to himself and others.

If he went to CBT he would have to be able to submit to this three pronged approach. Reducing avoidance, engaging in response prevention and practicing full on exposures to eliminate any situational phobic triggers occurring in the future.

How this works out is that Avoidance is usually tackled first. What things are you not doing out of fear? The thinking and behaving links would be explored to highlight the lack of wisdom and fear, avoidance, generates. My son is not washing his hair. He is not combing his hair. He is not looking in the mirror. So these very normal things that he once could do would be requested of him.
In response prevention work. You list all the things he now does that he shouldn't. Online browsing, comparing, checking, thinking about it and talking out his stories are things that keep the problem fueled up in his mind. The concern is kept alive and given breath by these sorts of behaviours that are a response to fear.

So once the things he avoids and things he does that are not safe are worked through, then exposure is artificially set up. You go under bright lights and take a look at yourself. You set this up yourself so you are more in control.

You keep practicing recovery language.too.... My worry is just a brain circuit problem. My hair is normal. I don't need to be worried. I need to have the courage to let my hair take care of itself. I am not in control of everything....

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His life has returned for him. Out and about almost as much time as he is here with me. He reported his BDD was 70% improved. He has been to two AA meeting and I bought an excellent key ring with the inscription of the Serenity prayer and the other side had UNITY, RECOVERY and SERVICE on the other. The centre contains a circle that can be etched with the months of sobriety. He has got to be holding those keys when he buys the bottle. I hope he feels my presence at that moment. It is just another thing I could do to stop the cycle of pain. You can't anaesthetise BDD from your brain.
A friend of his is now staying here for a week. He was so anxious that he would need to control his BDD all this time. So his BDD spiked yesterday. Touching started it off and then he repeated all the stories as though he had to endorse all he thought and give it air time to let it out. More attention he gave it the worse it got. I had to leave the house and was thinking the motel was a likely outcome for the night. But the friend was coming so i knew he would be distracted and pull himself out of it. I stayed at the table with them and talked to take the pressure away from him to do all the entertaining. This allowed him to eat his way through everything he had bought to share.
I suppose this highlights the need for him to monitor and be in control of what he thinks. We all have to be accountable for what we do with our bodies and with our minds. He just can't let himself touch and he can't let himself repeat hurtful, unhelpful, sick stories to try and legitimize his own illness. It is an illness after all. I think this is where mindfulness has its much needed place in recovery. He has got to retrain his brain not to go to this behaviour pattern.
It is NOT SAFE to repeat your BDD story.
Once you really understand your brain is creating FUD and you are assigning it to something on your person as a secondary consequence only to explain it, then you realise how you are contributing to why it always gets worse.
You can't live well relying on excuses and explanations to pardon you from adult accountability and responsibility for why your illness doesn't get better. It is not the progressive nature of your flaw or your genetic load. It is what you keep telling yourself. That attention and value you give your thoughts. We would all be sick if we told ourselves our flaw was so horrible and we were ugly as sin. We all have flaws that could self sabotage our lives. We just dont have the brain constantly firing FUD at us that we need to interpret and look to explain.

Think of it as the doorbell going off when no one is there. You stop giving the alarm attention.
No story of who might be at the door. Just recognition that the doorbell is faulty. In the same way your brain is faulty too. You have got to stop responding as though it says anything helpful about looks. It is MINDFULNESS training to make another brain circuit that explains the fear by assigning it to the brain.

So all of you who keep repeating your worry story of how bad you look and who you can compare too and how bad the trajectory is in the future...Well how can you ever improve if you aren't mindful of how such negative attention is fueling the concern. You can't give these thoughts any attention...

But I know after years of doing this, the personality is affected. It is your identity and you defend against the knowledge that makes you feel you know youre right and I must be wrong. A part of you doesn't want to stop. You just want to get it out now and so you let it. It is part of recovery to unload but at some point it must stop so the story gets left behind.

You need a new story that really knows you don't have to think this way. There is no trauma you have experienced as bad as what you are doing to yourself through storytelling.

Monday is our next appointment. Marg

Six days sober. I suppose with each quit/break you learn something more about why you use alcohol and how much better it is to know what you did all of yesterday. You must be getting better at quitting. Well that is the thinking I am clinging to. Most likely you get complacent over time and at that six month mark you forget the awful horror you were and think you can manage a glass. And the genie is loose again.
He had his final MRI yesterday. Really sure he had no oxytocin as he was not bubbly at all unlike the first session. We also learnt that the professor is funding much of this research himself. He works on the weekends and on holidays with private patients and uses this money to fund the research. I think this made my son feel quite a bit worse as he had been too drunk and in mind fog to remember his last appointment with him. This professor was to see him on the Queens birthday holiday.
Anyway they will be putting the film through a computerised machine to analyse it for abnormal functioning. So the doc will be getting our results personally before any findings. He will then receive TMS targeted to his personal results.
He is finding the med regime a bit difficult. The sexual side effects would make this untenable for most men. Viagra and faking, but how long can you pull that off. Perhaps not the right choice of words there. His hope is that as he gets his BDD under better care with tailored CBT and TMS for his brain then he can reduce the dose. So I will keep this blog going so we all can track progress to this complete cure. If it is possible.
He is at "workable day" at the moment. He got up at 9 and is making plans about what he will do. When you consider he was bedridden and delirious for over a year on Seroquel, he has come along way. Still his case worker expected it would take another 6 months before a complete return to work and full functioning. He was gutted to hear that.
But my perspective on that is that she and I want him to really get over his BDD and not let it rest on the backburner with distraction working so well that he doesn't feel the anxiety and fear of it so doesn't bother dealing with it. He did that last time with Luvox. Keeping residual compulsions going is like not killing off all the cancer. It is a guarantee for a relapse. But i don't really know whether you can kill off this circuit in the brain that keeps the habits and thoughts alive.
It is about 3 weeks since the last anxiety cut and probably half a year since it was washed. My harping is not likely to be a strong motivation. I have written a postit for his to do list. It is up to him to face his fears.
Fear and running away from fear through the need for safety and avoidance keeps this going. He doesn't know what is real or unreal. He has this unreal story that washing is dangerous and clings to that. He actual can tell me that he cant fathom how people can wash their hair and blow dry it. This part of his brain is impervious to logic. This is where I imagine CBT is needed to tease away at the absence of logic in what he is doing. The brain is running at the level of automatic compulsion driven by fear.
An interesting poster on the forum claimed they didn't have anxiety with their BDD. The need to avoid has to be driven by fear. You need now to have some form of compulsive urge to check or compare to be diagnosed with BDD. My son still reports that he is comparing when he is out all the time. At the traffic lights you can see where his gaze is going. It is distressing. So all this has to subside for him to overcome this. Still he says he has better perspective.
I asked him now what percentage improvement he gives his BDD. He said 70%. At this stage that is how well the meds have worked. He then went on to say he now knows personality can get you a long way. He used to think that but really didn't believe it when he was in the grips of his BDD mindset. He concern is that he is now dating someone who is as shallow as the...

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Well he went to his first AA meeting. That is actually a big step. About twelve people, all of whom he described as similar to himself meet at the local church at 7.30 in the evening. They were not the street vagabond types but intellectuals, mostly well spoken. They all told their story as he was a newbie. It was not religious. They only repeated the Serenity prayer at the end of the meeting. He tells me he needs to go to these meetings each week. He has crashed today. Bed rescue. Hopefully this is not just a prequel to going out tonight to see the new girlfriend.
His case worker also came yesterday. She recognized he needed more support so will come next week again. She was able to see the scrap along his nose and the skin off his chest from the fall over the fence. She, along with the police the night before have tried to ram it home to him that this is serious and he cant dismiss it. He is an alcoholic and needs to address it. This is very much a symptom of BDD too.
He was trying to self medicate the thoughts away. It might work at some level like a miracle pill but you can't get the genie back in the bottle. It becomes an vile evil devil. You can't remember what you did or what conversation you had. You can't recall what you are to do today. It is an anaesthetic for your pain while insidiously making sure you get even more. You went through the door to the darkside.
What is the excuse today. Lie, just another lie. Suspend judgement about what you are doing. Who you are deceiving? Who is the victim?
Hopefully this AA works and he does start his own journey on a road of recovery with the passion and mindset to overcome this demon.
Marg