Well yesterday he seemed back to normal. He never mentioned hair really. We were able to watch Fast and Furious 7 which went for a couple of hours. There was that ongoing adrenalin rush but it didn’t phase him. He also spent quite a lot of time texting a girl on Line. The concentration was there and there was none of the looping thoughts. He used to forget what he had just asked and ask again.
He helped me out. Did a spot of vacuuming.

Only a week ago, I was dimming the lights at 5 pm and he was complaining of heater fan noise. All he wanted to do was calm down and try to relax in bed as the panics took over his life. I had bunkered down in a back bedroom and played Candy Crush or watched a download of Revenge played with earphones to minimize the noise.

So really the change is remarkable. Literally overnight, because I really didn’t see anything major as I would have reported it on Friday during our visit. At that visit I was still in attack mode myself. I had caught on to him browsing suicide sites. It came up in history as his second most popular. I was livid at how less than optimal that was to our well being. I was in this with him and he had to be at least trying.
The dates are going well too. He is well enough to go and doesn’t exhibit the anxiety that other dates have noticed.

So this must be attributed substantially to the med regime. Prozac and Lyrica. Prozac is at 60mg. Lyrica is 300mg and 150mg prn if needed for outbreaks of anxiety. Plus one Valium 5mg to be taken prn as well. I make up the daily med regime and hand it to him and he manages it himself in a dosette box. That has stopped him running to me on and off all day for meds. It is his responsibility to take them. But if he takes them all then I am not to give him any more. It has worked so far since Friday when this method was adopted.

The shaky leg side effect is still a bit of a concern. Still the doc seems to believe in habituation to this. Not convinced that is true. But time will tell. We are to stay on this probably till September.

The doc usually goes for Prozac and Luvox but did mention that he has been impressed by some new results coming in for Vortioxetine. He seems to consider anything doing for GAD is highly likely to be good for BDD too. So if you have been on high dose trials of Prozac or Luvox but didn’t get the results you were after, then Vortioxetine is a possibility to consider asking your doctor about. The adjunct of Lyrica is most likely really important too. My son’s side effect profile is truly hideous.

So just to recap our medical adventure so far:
Lexapro couldn’t get started due to chronic akathisia even at half a tablet.
Seroquel caused psychotic behaviour which was eventually diagnosed as NMS.
Doxepin did nothing for thoughts and he only was up for half the day. We only saw him after lunch.
Prothedin gave him the jitters and our new doc saw no benefit in it.
Mirtazepine. Kept him in bed. No energy and not much change in thoughts either.
Luvox. You might need more than Viagra with this one but was functional.

Well it is after 9am and I haven’t heard from him. He might have crashed after yesterday. I can’t expect it will be all over.

The theory that the mindfilter in the brain that screens out unwanted trivia worries doesn’t work in BDD seems to have some substance. The mindfilter lets some unwanted thoughts through like it has holes in it. Meds flood the synapses with more serotonin and the holes get shut off so the thoughts stop.
Hope you are finding the help you need. Thanks for the support. Marg.
Tip for the day. We can beat this fear. It is all False Evidence Appearing Real.

We have been trying to do some modest exposures. It is just so difficult to work out what someone is really ready to do.
Trying to overcome the fear of…..might have to be tackled in a stepwise fashion. It is not as simple as exposing yourself to the situation and not running from it. You have to be doing cognitive restructuring at the same time. Going to the shops while still telling yourself everyone is judging you and that the woman with her head down turned away because of your looks is merely reinforcing your thinking that contributes to more worry. You will have your head down running for the shadows.
It is vital to do some mental reframing of how you think before you start any assignment. That step is to take the chance that your interpretations are wrong. People are not interested in you and have busy lives. They are going places. “I wonder where they are going and what they are doing?’ replaces: ”Are they looking at me? Do they think I am ugly?” That is paranoia.
My son has been becoming more scared of showers as his illness has progressed. His scoping of body hair could induce a sizeable panic. He linked the hair to an overload of DHT story, and that then to hairloss. The story terrified him so avoiding the shower became the safe option.
I wanted to catch this before it became any worse but I didn’t really know all that he was thinking and why he was doing this avoiding. I wanted to increase his tolerance for having a shower by just doing it and the only leverage I had was to give a Propecia tablet after the shower. Of course, the incentive worked but the showering got worse. I think he even showered at 4 am for 10 seconds. It just had to be over. The exposures weren’t working. He was using the wrong mindset and only further avoiding by doing the shower for the shortest time possible and preferable in the dark. This then didn’t represent any exposure at all. He was avoiding even though he could report that he was having a shower.
Mindfulness is the key here. He needed to be thinking of the water on his skin. The temperature of the water. The smell of it. He needed to keep his focus on the now experience of what he was doing and not shock himself with hair scoping. He has yet to tackle this well. He has to perhaps play this out in his head quite a few times before any real exposure is taking place. This is what is called cognitive restructuring.
There are 4 steps in cognitive restructuring.
1. Identifying your negative problematic thinking during an exposure. So you need to write down really what you are thinking here.
2. Identifying thinking errors. After writing out the thoughts, you need to identify if they match with any cognitive distortion forms. There are many lists you can find for these online. Mind reading, story-telling, catastrophizing, idealising and over generalizing are the usual suspects.
3. Challenging the thoughts. Identifying that we might be exaggerating or our stress level is tampering with our judgement is important but you have to go that further step and begin to challenge thoughts for accuracy. I can hear all the screams that this can’t be done. If you find thinking errors or are told about them then you have to allow yourself the risk that your thoughts are inaccurate. This level has to be mastered before you put yourself up for exposure. You have to be cognitively ready to let go of the stories of fear. They are just holding you back from the safety and freedom of life without BDD.
Is my son’s hair really so important that his whole life depends on it? What a chronic exaggeration and distortion of reality.
4. Replacing the thoughts with more realistic thoughts. I have a lot more going for me. I have been accepted for who I am in the past and can do that again.
Once you reach that mindset then you are more available to healthy exposure work. It might also be necessary to go to events with someone with you. This person can assist in showing you how they notice the environment. They c...

[ Continued ]

People often don’t really know what BDD is. They know they have BDD but they believe the symptoms listed in the diagnosis is the problem. This makes BDD very hard to treat.

We all know that someone falling down with epilepsy doesn’t need a straight-jacket. We know that it is the brain misfiring that is the cause and the agitation state is the symptom.

BDD is very much like this. The obsessional worry starts interfering with everyday life. But you have to get the right treatment by understanding really what is wrong. You have to be clear what the problem is or else you will be going to buy straight jackets. BDD hijacks your logic and makes you think the problem is something else. You don’t think the problem is in your brain.

It is very similar to OCD. If you become a washer, your problem isn’t dirt. If you check, the problem isn’t uncertainty. The problem is always the worry. The person with the illness worries so much because they care so much about getting it right. They are just conscientious, so try hard to solve the problem of worry. They try to deal with the worry about slight risks in ways which are counter-productive and damaging. They increase and exaggerate their perception of the risk. The fears trigger the sufferer to try too hard to be clean or to be sure. They want to be in control.

BDD is just the same. The person seems unable to ignore their own thoughts and doubts because they seem protective and the risks too great. So the paradox is that the more sensitive and caring types are more at risk of BDD. The person who values looks because they have been told they are goodlooking is tortured by the idea that they might not be. And the more they try to deal with these obsessional thoughts the more distressed they become. So obsessional thinking and behaving becomes the solution to the first worry. Then this solution becomes the problem.

How can the solution be the problem? It happened gradually. “If only I can do a little more it will help me relax.” I can do this and it helps me stop worrying…..I will camouflage.I will avoid. The promise is the worry will stop. The liar’s lair, the trap is playing you. You haven’t a clue.

But the thoughts keep coming, progressively more demanding, taking more from you, leaving you feeling more worthless. More out of control. You have to obey. The risk you think is too great. Whatever the risk was has now taken on the size of a Behemyth.

So you buy the straight jacket from the plastic surgeon multiple times. You tell everyone who will listen that they need to fear everyone because of put downs. You complain that you are ugly and others are lying.

But all of it is worry. Worry that someone might find you ugly. Worry that you might not be as beautiful as they said. Worry that someone might not like your looks. Worry about a nose, skin or hair that is not perfect. Unnecessary worry.

I call that worry, FUD. That is what enters your brain. The fear, uncertainty and doubt is felt as worry. It wears you out with its persistence. It is hard to tame once you have given it so much value over your life. The fear that something is wrong, creates the thought of uncertainty. Something needs fixing. The emotion of doubt enters trying to force you to own the FUD and translate it into something tangible you can focus on. Is it your body? Is something wrong there? Is it the people walking past...will they ridicule you? So you worry....

My son's worry is his hair. It is the worry of... that is the problem. That is his BDD. His hair is normal. But his stories he repeats daily. This worry has no logical path to resolve. He just has to accept the uncertainty at the moment. Perhaps that uncertainty will recede a bit with the meds but ultimately we all have to live with a mind that can filter out the trivia so we can concentrate on living well.

Another doc visit this afternoon. Meds have made not much difference at this stage. He has to try and live at his optimal best. Marg
,

Our outreach worker came today. She said that my son had been on the wrong meds for BDD for a long time. It was just unfortunate that not many people knew how to treat it. We all know that is true!

With this new regime of Prozac and Lyrica, we would expect to see improvements in the next month but it might take three more months to really make a difference. The therapeutic dose for Prozac being 60mg to 80mg. We have only been on 60mg for a bit over a week. The ultimate goal was to get my son back to work a couple of days a week by the end of the year.

She was able to narrow the focus of concerns back to his functional level and address the bedroom rescue. The den of doom is where he lies all day. She made up a timetable he was to follow. I was present at the table while all this was decided and felt quite helpless that I wasn’t able to achieve this myself over all these months. The woman recognized how I was feeling and mentioned that she had never met a mother able to redirect a behavioural problem like this.

It is hard to understand how it started and why he has never really tried to stop it. Perhaps it is depression and all that has happened to him with his relationship on top of his BDD. It just became an overload.

So this woman is connected to the professor. She feeds back to him and can tell him of my son’s functional level and how medications are truly going. She repeated that the condition was biological. My son was too unwell to work on BDD until his depression had lifted and the medications had had time to have an effect. By then, the intrusive thoughts will expect to have lessened in intensity making it possible to challenge them. Until then there was no point in doing much BDD work. It would just be too hard and liable to easily relapse.

So now the new day starts. Get up at 8.30, Have a shower and dress. Then don’t go back to bed. A bedtime of 8.30 has been set as well.
I can report one and two got done. But he is back in bed again. He was at least calm until just after 9am. FUD arrived. He had touched and the story kicked in with a panic session. It only went for a few seconds on the surface. He tells me now he hasn’t promised anything for today. So great to hear his resolve is so strong!!!!!!!! I want to slap him. Got to go TLC shopping ASAP.

It is now 11 am and he is not up. Still dozing. Looks like the outreach worker really doesn’t have any more sway with him than I do. I don’t really know what anyone can do for him.

The professor’s office rang. The doc wants our MRI brought forward. First available slot in the MRI machine is June 5th. I think they do need to see what my son’s brain really looks like before the meds kick in to change the picture.
We are at a research establishment so they do all the heavy stuff like deep brain stimulation for OCD. They implant electrodes to knock out the OC circuit. The intrusive thought gets fired back on itself so the ritual can’t be completed. This procedure is for people trapped in their home by ritual OCDs for 15 years. So I have got to realize it can be worse. Marg.

Well that recovery was short lived. Back to bed all day fudding himself with the stories he has dredged from online hairsites. It is all true he screams as another FUD attack hits his brain.
He has FUD occurring in the brain, fear, uncertainty and doubt, so what context can he find to give it life and become a symptom for his BDD. What is the context for the FUD? The screaming he is now doing is context for FUD. What context can he find to explain the fear in his brain? He tells me it is his story. The Dute story. He has connected to it and he instantly becomes terrified. So he has connected FUD to the story. I ask him what the story is? He replies it is his favorite.

This is his story that he has one hundred percent faith in even though no one else really does. So he is fearful due to a couple of online posters who scam for a website. This website I can't even post on because they don't want anyone honest on there. They just want to sell drugs and other products by insighting fear in anyone who browses out of concern over hairloss.

So why does my son think he knows more than all of us....In his mind, his stories are true and are not symptoms of BDD. So I ask what are his symptoms of BDD? He replies that touching the defect is his only symptom.
I ask if he thinks FUD in the brain is not a symptom of BDD? But he tells me that he knows it is a symptom of BDD.

I again try to explain that he is needing to connect and make sense of the FUD. So his storytelling is his brains attempt to reason what the FUD is about. Otherwise he wouldn't have a subject to fear. So his experience of life must conceptualize what FUD must be connecting to in order to give it meaning. At the moment he is connecting to some story online and believes this is the story that is now making him bedbound with terror. Not because this story now has anymore potency than when he first read it. So the potency factor of this story is not evident to anyone else. it was never banned from being posted. It was never a fear story but only an opinion. It was never an alert in the newspapers but my son alone gave it so much importance. But it only has importance in his brain because he attached it to his BDD FUD.
Our conversation went something like this..." Here now in this room where is the fear? There isn't any. You are making it up because you are connecting something you read long ago to FUD. The FUD is now being produced in your brain. Something you read long ago you are connecting to FUD.So you have to remember when you read it and disconnect from it and try to stop connecting it to the FUD of NOW. So you need to make an effort to mindfully relax and not let FUD connect to anything. You can feel the fear but not connect to something you did long ago. If you now really remember the first read of the story you might have thought maybe that is true, maybe I am doing something wrong and now I am reliving that by connecting the recall to FUD. I have such a safe life that I almost have nothing to fear so I have to go back in the past to dredge up something to fear. So I have this story from an online post from an anonymous poster, who possibly might have gone to a "hair doctor" but probably not and is most likely selling drugs because the whole site is bogus. But I will overlook all that because I need to assign FUD to something. To get relief from FUD I need to assign it to something and that is my symptom of BDD. Having FUD and assigning it to something that made me fear in the past.
I hope some of you get this because really this is what BDD is doing to all of you in some way. The fear needs context and you supply it with recall of something that was never diffused from the past. Imagination and exaggeration take over to catastrophize the experience and make it retell worthy for the level of FUD you now experience. Some of you retell the same thing over and over without ever acknowledging what you are doing. The fear needs to be expressed...

[ Continued ]