My son at some level does recognize BDD as a thought disorder. The fear the thoughts invite sends him into shock. This is the hell of an OCD visit to the brain. It always sends thoughts that are linked to what we fear the most. I suppose that knowledge might help in recognizing the BDD/OCD thought circuit from a normal thought. Normal thoughts don't carry the punch of fear every time. We can diffuse a normal thought and reason it away. That is not the case with a BDD/OCD thought. The thoughts keep coming making it really difficult for us to focus on anything else. As we know this is how any alarm system works. It makes a very loud noise to make us acknowledge something is wrong so we can take a look. But when this happens in your own brain it is very hard to deal with. You don't know the code to turn it off. So your alarm system can be firing on and off all day sending you into panics. You don't realize your thought system is faulty and firing thoughts that are wrong. You can remain convinced that the content of the thought must be important for years. You have linked alarm with something important to find. So you find the fault. It is really hard to give up on this perspective. It might take a leap of faith to acknowledge that your brain could be getting it wrong. The alarm system is stuffed.
My son processes his thoughts into stories that serve to vent his concerns. At the moment he has a Dute to Fin story that now links to increased androgenicity and increased DHT receptors. All it took was a bit of online browsing and his mind was awash with the hypothesis that he at last knew why he lost hair. But this certainty was short lived. Moments later he was asking whether the story was true. And that is the line drawn between facts and stories. If it was a verifiable fact, he wouldn't be asking. I have tried to dismiss his attempts to find a doctor who will confirm this because in reality no one knows any of this as a certainty. That is what he searches for..certain answers.
If he ever found a certain answer, he would probably start doubting it anyway. That is the nature of BDD and OCD. There is always an over riding doubt that creates a fear. The not knowing is processed as a reason for alarm. It is a catastrophe. The worst is going to happen and so the person with the illness responds as though it did happen. It is all driven by thoughts.
My son is into managing his thought attack negatively. He just tries to reduce them by bombing with meds, or going to bed to remain trance like, arms under the blankets to stop touching. He is reducing his life back to corpse like nothingness. In this state he doesn't hear the thoughts as much. If he calls out in alarm, I know he has just got another intrusive thought attack. Even in bed he cant turn off his brain. He is just scared. More thoughts and stories flood in. It is not easy to stay with him. Marg

Can't stop the compulsive touching. He doesn't want to try a physical restraint so I learnt up on other methods. The most promising was a habit reversal training that started with awareness of the triggers.
I had noticed he touched his facial or neck hair and then moved to his head. I wrote both habits down on a piece of paper and asked him to put a cross against them if he did the habit. Within minutes I returned to see four crosses next to each. He told me he touched his body hair and that triggered his DHT hairloss story so he followed on to touch his hair. I suppose it serves as a form of reassurance or checking. So the awareness training helped him build some understanding of the pattern to his behaviours. If he touches his body hair, he is likely to go on to touch further and continue to do it. It is like he can't stop once it starts.
I asked him to try and work out why he touched in the first place and he believed he felt his hair tingle. More likely he is somatizing with the extreme focus.
So this exercise in awareness did build up better understanding. Of course it didnt address the problem of touching in the short term. So I asked him to move the mouse to his touching hand. He did it for awhile. I have to find more things he can do with the hand so he might like one and take it up. This touching is a hard habit to break but a must do if he is to break free of his BDD.
Marg

Just because you feel something doesn't make it true. Having a conversation with my son trapped in feelings thinking is a battle I often find myself drawn into. He defends his feelings as though the depth of intuition they must connect with provides a certain type of truth. But my experience is that feelings are the prime reason for all the distortion. Feeling what you think leads to impulsive decisions.
So when you think whatever you feel is true regardless of other people's logical argument and what is known to have been said on the matter, you must be distorting and moving away from the truth.
"I feel ugly, so I must be ugly even though others tell me I am not." " I feel it is my fault, so I must have done something wrong." I feel overwhelmed and hopeless, so I must be a worthless." "I feel everyone is looking at me, so I must be repulsive." "I feel anxious, so something bad is happening." My son's in a "I'm not in the mood to do anything, therefore I might as well just lie in bed"
I don't know really what advice you can give someone who believes they can judge reality through their emotions. Your emotions are just too volatile and your judgement is likely to swing wildly. Are you discounting positives, personalising, mind reading, fortune telling, catastrophising, using negative filters? These are all means of preventing the true knowing of the facts, disguising emotional reasoning from facts. Dismissing facts as lies or half truths maintains the illness.
The emotional reasoning in BDD is very strong and defended as truth. I think because different areas of the brain are employed in emotional reasoning and fact, the logic just can't modify the emotions to make change. So things become fixed into rigid patterns.
My son now lies in bed screaming about androgen receptors and the blood that comes out. He has been able to ferment his feelings of terror into stories that fall over the fence into psychosis. " What if it is true?"
I go in and scream back," I don't care about your story." Another example of faultless emotional logic.
I think emotional reasoning is also behind a lot of procrastination. " I feel anxious so I won't do it today." Maybe you think your emotions are protecting you. My son feels his emotional reasoning is just about him trying to find the truth. But there is no truth found in emotions. They change from day to day. How he can stop this and accept that all is not known and what is not known needed be a worry. I suppose that is the answer to why he still wants this disorder in his life.
He is a long way from just getting up and telling himself he has to do the opposite of what he feels. But in the end he has to do what is right. Not what he feels.
Hope we get through this day. It is a struggle with a new med just begun overnight. Marg

Mornings are particularly awful. Through every exacerbation this has been so. He wakes up in a panic. He calls out and cries in the pain of it. Some doctors have thought the behaviours have some resemblance to Tourettes. I rather think he has just a flood of fear that his brain simply operates at a very primitive survival level. Calling out is that alarm response to peak distress.
He ran for the shower early, but not for any mindfulness of his daily needs. He believed our agreement was he could take the Propecia tablet after a shower. So the urge to take the tablet to halt hairloss and kill off DHT was so great, he was busy with a compulsion as soon as he woke.
The tablet is something he knows at some level is something he should stop, so I think it is highly likely that just taking the tablet spikes his anxiety and sets him off.
To get through the panic we have tried the 4 staged approach like Jeffery Schwartz suggested. It is a basic label and attribute approach with refocusing the big hurdle for us. It is so hard to focus in a panic on anything but how you feel. The distress gets to me too and all I want to do is scream back. Staying calm can be hard if it goes on for hours. Sarcasm starts up fairly easily now a days.

I decided a new tack was needed. A clench fists moved strongly downwards while saying, 'False thoughts." This is like throwing down an anchor. The physical movement linked to the dismissing label might be more powerful in taming the panic and recognizing the thought attack is merely the amygdala hijack showing up in his brain. It gives a bit of space and time for perspective to enter.

I have tried to introduce a mindfulness chores list as this is part of a mindfulness training to stay present and connected to what you can do now. I wrote down about three thing you could do on entering a room of the house. Not at all successful. He will have to initiate this somehow himself to own what he does. There is little reward in doing a job well if you haven't been the one wanting it done. Improving motivation to stay present and commit to an adult role still seems a way off really. I spoke this morning of the idea to just enter a room at any time and scan to see one job to be done and then try to do it as a form of meditation. It is like an exercise in self control and discipline. Will he take up suggestions like that? It is a leap of faith but perhaps it suggests I have more hope than experience.
I have put on a youtube meditation to echo through the house. He finds this soothing.
On a positive note, he said yesterday he would try to stop wearing a hat. Now today that might have been forgotten, only time will tell. Just pleased to hear him say that. It means it is on his to do list. There is some forward planning.
Also on a positive, he is more resolved in his understanding of his problems with his wife. She never saw herself as being beneficial and really connected to his recovery. He had to do it for himself and she would ignore anything that did not conform to what she wanted. This rejecting of illness and need to conform or control or ignore is most likely a cultural thing. But it can't work. The resentment list is held tightly on both sides. The criticism and lack of approval or appreciation for how hard a road this illness is will never be understood. I suppose any huge upheaval tests a marriage. You go along smoothly only because nothing major is happening to test whether needs in the relationship are being met. The problems surfacing is like pulling off a bandaid to see the woundings below. The bottom line is you need to be able to trust the person with your dreams, fears, secrets and your heart. To get over BDD, you truly need to find yourself as valued, loved, balanced and supported. While he battles this without her, she has gone on her own journey to find herself. She had work to do as well. Maybe in time he will understand that she just didn't have it in her to respond well.
The Prozac is giving...

[ Continued ]

There are not many meds we haven't tried. Most SSRIs are intolerable. Mirtazepine has left him unmotivated and teary. Started Prozac yesterday. This morning he felt that internal panic that made him feel he would never get up. He had an appointment so it forced him out of bed. He was much better all day. Decided he needed to reduce the dose to manage the side effects. Not so easy with capsules. He can ask for the syrup tomorrow.
The hair is looking a lot better as he hasn't cut for over a month. That positive spin is likely to relax his brain for a few days. He has mentioned the stories a couple of times today but I have just answered," Cant be debated." Maybe we are just rehearsing this as a way of diffusing them.
Hope this works.
He is listening to the Hollies on Youtube most of the day. It helps to focus his brain on something.
He has spoken to some friends today on the phone. They don't really understand it all. He keeps a lot from them no doubt. Keeping up a front to stop feeling shame. We have a long way to go to stop the stigma of mental illness. Do we need a front with cancer or arthritis or diabetes? But mental illness, we see as weakness. Actually takes a darn lot of strength to handle an mental illness. Only the strongest can manage to take it on as a life lesson. Nothing like a mental illness to bring us to our knees. Hope you all are finding something to own for yourself in your journey out. Marg