We have had a couple of ghastly days. The weekend always invites wife issues to surface. Then the aftermath follows a couple of days later. The disorder itself seems to be a mask for much deeper issues of inadequacy and helplessness. A flow on of any criticism, further ignites these bedrock issues and exacerbation of BDD follows to distract the mind.
It is hard to appreciate the level of hold this illness has on my son's mind. He has been in a constant state of touching hair somewhere but still does not identify that as a problem. He continues to value his thoughts over his actions. His actions are almost trance like. His thoughts carry this yearning to know the answer so the problem can be solved. I have probably answered him thousands of times but he has no memory. The logic never adds up for him. Not all problems are his to solve but his mind can't let go of the idea that it just must solve.
His doc made a good point that his marriage might have not met anyone's needs for a long time. So he was in fact liberated. He felt better clinging to that for a little while.
I also made the point about what he needs and what he wants. He wants to have a good relationship with a caring wife. But at the moment his need for nurturing through this has him clingy and terrified of being alone. So he often sacrifices what he truly wants in his life for that short term need. A need his wife isn't fulfilling anyway. But in an ideal world he believes she could.

He certainly is living in the misery he knows. I have left for the night as he was just screaming to have his thoughts answered rather than stop asking. He needs to know how to stop this cycle without the need to bomb himself with meds. I hope we make it through this. Hope we do have. Marg

My son has been really plagued by intrusive thoughts. He feels they have escalated since reducing his compulsions. Because they are all emotionally charged thoughts, he gets unstuck often. Lying down, listening to youtube meditation music and watching NBA is all he wants to do. It is the only way he knows to stop the thoughts. I really think he needs to anticipate he will hear the thoughts and so stop the emotion that is carried with the thought. At the moment he just cant separate emotion from the thought. Just any random discussion of it will invite another fear cascade. My pet rock idea to use as a refocus aid, was too much of an opportunity to use as a missile.

I suppose when you are living in the illness, the thoughts bring the fear and the emotions then carry you away. It is really hard to use a relabel, refocus and evaluate type of strategy when in any emotional state.

I have a friend who writes to me. She has journeyed through an OCD form of illness. She has an interesting take on her intrusive thoughts. She has accepted them as her genius mind's way of managing more painful problems. A distraction that makes her responsible for solving.
I have included her words below:

I have found a "beauty" to the minds ability to give us intrusive thoughts.. we fight this ability our minds have to ask us to resolve things, that we push aside thinking that they are a nuisance, and nothing good comes from thinking about them, as we have worked relentlessly in trying to resolve them numerous times while lost in the thoughts, to no avail. the ideas to resolve them run in such speed, that most times they don't stand out to us, because they aren't new, and since the result is feeling miserable most times, we figure the best alternative is to push them aside when they come.. as they appear to be thoughts that are just haunting us with no positive outcome possible by dwelling in them.. that's the difference i guess between being within depression, where we dwell in the painful thoughts, and where a disorder is born, aka ocd, a very "genius" method the mind has developed to distract from the painful thoughts. it's all in effort to relieve depression, pain, anger.. what have you, the emotions that the thoughts induce. a quick escape from them in the best logical way we can, by distracting the mind onto another subject.

I hope we all have a better day and learn more about managing this illness together. Marg

There is nothing easy about recovery from BDD or OCD. We know the amygdala is implicated. We know the amygdala creates fear templates based on prior experiences. It creates its own roadmap for how it responds to learned threats. The trouble is that it hasn't changed since the teen years when the map was first formed. It should have been modified inline with our age but for some reason it hasn't. This leaves the BDDer thinking looks are just as important as they were when 19. This is a massive distraction from the main game of living life well. You are left feeling you are just too horrible to be able to do life. You need this fix and then you can live.

So how is my son going? His BDD is very severe. A simple trip to the shops can have him unstuck. As he recently retold his story, I saw the whole amygdala hijack play out. He was just opening the door of the car and the pang of panic hit. He said he was ugly and so embarrassed. He grabbed for his hat.
The amygdala had recognized the situation was similar in someway to a prior experience when he was exposed to ridicule for a bit of hairloss by a girlfriend. It fired and sent the panic feeling. He immediately interpreted the feeling by saying how he had felt about hairloss. The trusted hat managed the anxiety. But where really was the threat? It was a learnt fear that was well past its use by date. But my son can't seem to modify it and get it out of his mind.
At his worst he may have had over twenty panic attacks in a single day. Today he probably had three. He did try today to hold onto something and describe it as a refocus aid but he was really too wound up for it to work. As more of the compulsions have fallen off, the touching has become much worse and so has the intrusive thoughts. He screamed today that he hears them all day. Interestingly, he now can create a panic from just looking at Facebook and seeing couples. It is not BDD related but more an issue with his real life.
Maybe that is a good thing and indicating that the genius coping strategy to divert attention onto the body and away from real life is failing. Wishful thinking at this stage. Marg

I think my son is stuck in a teenage mindset. Perhaps with such an illness like BDD or OCD, there is a desire for the safety and security found in the teenage years. As a teenager, life was scheduled and mostly trouble free. You weren't worrying about finances, chores and what you needed to buy for the cupboard. You didnt think work was a sentence and recreation another chore. Personal relationships werent filed by the court system.
So when mental illness does descend it is only a normal response to retreat back to a teenager's life. A life when anticipation of the awaiting adult adventure was how we reasoned the future would be for us.

So if we enter adult life still as a teenager, we might set our amygdala to react like a teenager too.
What if the brain never receives an upgrade? 14 years later, we are still responding to some comment made about our looks that we didn't like at 13 to 19 years old.
All it takes is for our amygdala to form a template for how we should react with alarm to this comment about looks. Then anything that reminds the brain of this looks comment triggers the amygdala hijack and off we go to panic.

When in BDD, your mind's template hasnt changed to adopt more age specific software.
This leaves you craving a 19 year old look. With your mind hijacked by this teenager you still focus attention on what you look like and not what you do.

This teenager only exists in you because the adult hasn't taken charge and found that assertive adult voice that stops impulsiveness and stops abuse. Are you the people pleasing type? Wanting to be liked so you don't want to offend anyone? Do you want to own yourself? Or is the neediness to be loved so strong that almost anyone who says they love you will be OK, regardless of how hurt you are and how badly you get treated?

It is sometimes easier to find fault in yourself than look at the bigger picture and find fault in the bit of the world you have made home. It is harder to recognize the fault in the people we chose to be with. It is harder still to do something about it. So self sabotage is a much easier option.

In a way, your own body is the most precious home you will ever live in. It is a legacy bestowed on you by ancestors. It has the job of taking you on this journey called life. But how easy is it to find fault within. It can become a magnificent distraction from the main game when we become obsessed.
So BDD has a dual purpose. It traps us in a role for our impulsive teenager and it stops our adult firing up to allow us to overcome fear. That is just my negative spin really. The positives are that the adult doesn't have to turn up for work and never speaks up to defend their own abuse. Symbolically, you become stuck as a teenager with body concerns and so avoid facing adult concerns. I suppose that makes BDD, a maladaptive displacement of fear.

The goal for the adult in you, is to accept your own adult body. Surrender the teenager's impulsiveness to the adult's will and higher awareness. The adult wants and needs to be the master. You are then free from obsession and compulsion to fill your life with what you can do to make today better. The adult role. Marg

So how do you experience your amygdala hijacking?
Loads of anxiety, impulsive behaviours and the overwhelming desire to cry or punch something.
Your impulsive behaviours have for too long fragmented your inner self and the entities that it contains, the child ( emotions), the teenager ( behaviours ) and adult self ( higher reasoning) . Your teenager's bad habits were permitted because your higher adult consciousness wasn't engaged to provide the wisdom. You didn’t have access to higher logic.
All your inner hurts have remained unhealed. While you try to tame all these behaviours of your teenager, that now constitute a large part of your illness, you will experience a very significant rise in anxiety.
So you can expect the fears to come and they will be explained through the stories you tell yourself. A worry about your appearance might come and you will hear yourself say," I am ugly, I am deformed."
This is just your imagination trying to give you some context for your feelings. Remember that this imagination centre operates on quick inferences because it can’t wait for logic. This is just how your alarm defense always works in flight or fight mode. Your imagination interpreting what is happening and will always exaggerate the threat just to be cautious. There is no point to an alarm system set to idle. Unfortunately, a BDDer or OCDeer has set their defences on hair trigger. So as you start reducing your reliance on compulsions to manage your BDD/ OCD, your anxiety will spike a lot.
So to update on how we are going with our urge reduction and restriction of compulsions. It is really tough. I first divided the list into easy/ middling/and difficult to stop. I was thinking of the hierarchy list of exposure and response prevention but that is not how it worked for us at all. Nothing structured worked. Almost all the compulsions fell over at once. He has stopped the cutting for three weeks. The only mirror left in the house ended up falling off the wall in the middle of the night. It smashed on the bathroom floor. We are not replacing it for the time being. I found he was having morning panics but then realised he was web surfing on the phone overnight. New agreement, he will stop this as the panics are so bad.
So the intrusive thoughts exploded and touching has taken over as the main compulsion. The touching triggers the amygdala and he repeats a story asking. “Why?” Then he repeats a story about Dutasteride. The end of the pattern is a mad dash to drink a glass of water. So analysing what happens, it is easy to see the touching triggers the amygdala fear response. Doubt enters because he has no memory. He repeats verbatim a story created by imagination as an automatic response to give context as there is no logic working. Then he quells the anxiety by drinking.
I don’t think one can stop this once it has started but we can reduce how often the amygdala gets triggered and maybe how long it lasts.