I hadnt looked at specific structures of the brain as the cause of BDD or OCD because the illness itself took all my attention. I was blown away when reading about the amygdala hijack. It was easy to recognize our experience with BDD panics. Below is a working definition of the amygdala I found. It is all about that emotional reaction in flight fight or freeze mode:

The amygdala is a very small almond shaped mass of nuclei located deep within the temporal lobe of the brain. It is involved in many of our emotions and motivations, and most significantly, those that are related to survival. The amygdala is involved in the processing of emotions such as fear, anger and pleasure. The amygdala is also responsible for determining what and where memories are stored.
So the amygdala must be involved in a BDD or OCD panic cycle. This would explains the level of emotional intensity, the lack of aversion to the pain caused and the inability to recall reassurance. Memories aren't being processed and stored to moderate and create that learned conditioned response. It is like having holes in your memory. So the person with BDD or OCD continues to repeat behaviours and panic.

Many of us will have heard the term emotional intelligence. Well this also describes the amygdala being hijacked” so to speak, and wreaking havoc on our ability to tap into our rational brain to make good decisions. When an event happens that triggers an intense emotional response the amygdala gets activated and starts the whole fight or flight response in your mind/body system. The body and mind gets caught up in various neuro-chemical processes that make it extremely difficult to think through the situation with a calm and logical approach so you panic. It can take anywhere from three to four hours for your mind/body system to begin to calm down after the amygdala is hijacked.
So this is what the experts on emotional intelligence say to do. It looks similar to a Jeffery Schwartz approach in 4 steps.

1. Realize! Stop yourself and notice that your amygdala is being hijacked into a fight or flight response. Recognize the emotions that are flooding you and name them. There really is no terrifying event happening.
2. Breathe! Taking 4 or 5 deep, cleansing breaths will oxygenate the brain, supposedly helps anxiety.
3. Give thanks or refocus. This one will be hard to do, but just DO IT – say to yourself what you are grateful about related to the situation you are experiencing. The act of moving toward gratitude is helping shift the neuro-chemical landscape in your brain. I think some form of nature would be easier to focus on so I added refocus. Even carrying a pet rock you can start describing might work.
4. Re-think! Once your emotions have calmed and you can think rationally, re-evaluate the situation and pinpoint the triggers. Becoming aware of your triggers helps your brain to shift into the neocortex logic brain again and activate rational thinking about this event and how your mind/body responded to it.

To avoid future amygdala-hijacking, use mindfulness to train your brain ahead of time. Mindfulness is the act of bringing your attention to the present moment in a way that allows you to act as a compassionate observer about what is happening on a moment-to-moment basis.

It sounds good but I know that the BDD cascade of fear happens in an instant and is very hard to get a hold of any perspective other than sheer terror.

So with this information we have another key to overcoming BDD. We have to tame this amygdala. It is over-reactive. By reducing compulsions and talking about our concerns openly, we might be able to reduce triggers. Marg

Understanding more about one's compulsions often helps to get perspective and step away from performing these acts. From that vantage, you start to question why you are doing the stuff and more importantly if there really is a benefit to you. And you already know you never do find the answer with another check. All your action end up in more repetition. In fact, these urges often trigger even more panic. The fear floods in when you know you should try to stop but that trance like state can have you fixed to the floor unable to move away. Your urge, as though, in the hands of a teenager, becomes out of control.
Storytelling, through enlisting the imagination, is that vital component in developing all our impulsive urges. Stories are our brains attempt to explain the fear and give it context. This is because the logic mind doesn’t work well in a highly emotional state. We are in the freeze, flee or fight mode so no time to think. Storytelling provides the link between the sensation of fear and the need for the compulsion. Feeling nervous.... you must have that drink...and in my case, chocolate.
So to bring a bit more clarity and understanding to this cause and response, we need to know about the amygdala. Google does well here. You will find it is all about emotional memory and motivation. Looks like we found the culprit. Marg

Our urges are our compulsive behaviours. These behaviours provide comfort or an escape from discomfort. That is how they start. We feel compelled by relentless thoughts to submit to our urges. It feels safer to do them rather than resist.
Now we may not be able to manage our fears. Our thoughts or stories, often come in the form of questions, arriving too fast for us to stop...But we can detach from our behaviours. We can separate our feelings from our behaviours and chose not to do our bad habits. So this is where we can start.
There is though one hesitation before any such commencement...We have to admit we have a problem and that is the difficult part for some of us. Some of us still want to blame and find reasons to deny our own responsibility to ourselves and our families. The responsibility for getting over BDD or OCD is in the hands of the person with the disorder. No one else can do it for you. So if you have been diagnosed, the denial and deception is only a symptom of that teenager not being up to the task. And they aren't. It will take an adult. The genius inside to take control away from the teenager.

So knowing what actions constitute your compulsions is the first list to make.

Here is the list I made with my son. It was only a beginning and needed adding to along the way. Many of you will find the actions he does familiar. Making a list for yourself provides you with that road map for where you want to go.

1. The shower inspection
2. Touching the defect.
3. Hate the mirror but buy a comfort mirror to hide in the bedroom.
4. Clothes. Important or couldn't care and living in underwear.
5. Fear of crowds due to constant comparison
6. Camouflage. Wear hat, wig, make up,also shaving and hair-cutting to conceal or even-out a look
7. Inner critic/outer critic. I'm helpless hopeless and unlovable. People, genetics are to blame.
8. Faith in cosmetic surgery. The miracle fix despite the mountain of evidence.
9. Self medication. Miracle vitamins, beauty aids, toxic drugs, alcohol and other rec drugs.
10.Food and water. Eating or drinking in excess or starving to achieve a look.
11. Express your depression but have no desire to exercise
12. Suicidal thoughts encouraged by online browsing stories.
13. Storytelling to explain the fear. ie. the schoolyard bully, the failed relationship, the doctor's opinion, the families' lies.
14. Passive aggressive tendencies. The teenager cant get out of bed because the problem can't be fixed. Lets scream about that. WHY I NEED SURGERY ???
15. Online browsing for fixes or similar stories to your own.
16. Photographs. Another way of checking.

Now the usual therapy has been called exposure and response prevention. But I have no need to create artificial situations. The task for you is to not do any of the above. When you get the urge, you are simply going to try and resist. That is why I call it urge restriction and reduction. These urges often act like triggers that keep the beliefs in your fears fueled up. They do not act to reduce your anxiety but rather encourage you to believe in your own defective thinking patterns.
Remember there is nothing wrong with you or your performance. There is something wrong with your brain's defense mechanism. It just needs a bit of recalibrating.

So start writing your own list of actions you do and try to build up a resistance. If you have had to overcome alcoholism or smoking, you already know a path to follow. That is a big advantage. Your self esteem will build with each behaviour you conquer.
Like alcohol withdrawal, you might like to enlist the aid of a partner. Praise yourself every time you resist. It all helps build confidence in your own adult capacity. Marg

I first heard about taming the outer child through the work of Susan Anderson. She was the person who connected our self defeating patterns to an entity that exists in each of us. I like to refer to this as my teenager within. My teenager can take control of me at any time in the most self destructive of ways. The teenager acts out with all that emotion left unexpressed, in the care of the inner child. The teenager wants a quick fix without doing the work. The teenager is the outer expression of all the emotion you have trapped inside. The teenager is irresponsible, loves impulsive acts, loves excess, loves drama. loves blaming others, loves procrastinating. The teenager has a story to explain away every poor decision. And you can't confront the teenager as the power play that ensues will tear up the house. It is like living with the Kraken.

How does this teenager impact the very sensitive OCD/BDDer, who just wants to get it right and do the right thing. The BDDer has felt blamed and inadequate for a long time. There is a lot of trapped emotion to release. Anxiety is felt urgently and there are plenty of urges to fulfil. Feeling broken inside while being so exposed to the whole world. How can one live in such a torn state. Fears are felt intensely, stories become the narrative you hear describing the terror and no assurance can be given. The imagination takes over and the urges become all consuming. The anxiety is so intense the urges take over. The teenager is out of control.

You might have the fear. You might have that story that you have some defect or have done the wrong thing. You might call yourself inadequate and ugly. In doing so, you abandon your true self. The teenager has no sense of direction. There is no motivation to lead a better life when teenager runs the show. Teenager just wants it now and screams when denied. The teenager is just after that quick fix.

So this is the dynamic that needs addressing. The fears, the stories to explain the feelings, the reassurance that never sticks and the horrible urges. The urges were first used to manage the anxiety but soon took over as the main problem. So lets tackle our OCDs/BDDs by managing our urges.

So lets start with...Urge reduction and urge restriction. If you stop doing the actions the urges demand, you stop some of the triggering. You might not be able to stop the fear or the story because they enter the brain with alarm but you can stop acting on them. So lets try stopping all the stuff you do that is supposed to help but really never did. Lets tame that teenager and find our own adult prepared to look after our inner child. In so doing, I believe the fear will subside. We will be capable of living an adult, problem solving, purpose filled life. Marg

Now the child within us contains our feelings, wants and needs. In reality that want may be as simple as a warm hug of approval. But imagine you have a BDD/ OCD brain working to alert you to the need to get it right. Each day you might get a fear and then a story follows quickly to try and explain it. You are never quite sure of the context for your feelings. Only the story seems to make it sound really important. But the story has been created from your imagination. So logically you know to doubt it. You ask for reassurance to explain all you feel. Oddly, the answer never sticks and so the sensation returns that you must have got it wrong. Over the course of a lifetime how inadequate must this experience make one feel. So we need to know why it happens.

Our feelings, thoughts and actions are designed to keep us safe. But an OCD type of brain contains an overactive amygdala. The amygdala is responsible for emotions like fear and motivation. The amygdala is always on the lookout for a threat. When you are living in constant fear that something is wrong and you didnt get it right, you can easily translate that to a state of paralyzing self doubt and terror.
There is something wrong with me becomes the mindset of the BDDer. I did something wrong, the mindset of the OCDer. But the truth is that there is nothing wrong with one's look or performance. It is merely the brain over reacting.

So we now know a lot more about how the brain works than 14 years ago when this story began. We know that fear is felt first as a strong sensation. It comes to us before thought and context because we need to be ready to react to alarm. Fear from the amygdala is our early warning system. We also know context for strong feelings is often obtained through imagination. Most of us have runaway from a big dog only because we were conditioned to fear from stories told to us or from a earlier experience. The big dog didn't threaten us at all. We just told ourselves it did.
So all that is experienced in the sequence of an OCD/BDD cascade of alarm, story telling, seeking reassurance and action to relieve anxiety can now be explained.
The feelings, thoughts and actions are all a result of how our brain work in defence mode. Our brain contains emotional memories and logical memories. When we store an emotional memory it often contains no context. We can have an argument yesterday and remember how angry we were but completely forget what we were arguing about. Similarly we can have a vivid memory of someone dying and yet there is no emotion recalled for how we felt at the time. This is because we store emotion and logical context in the brain separately. Most of us dont have the wiring in place that connects the two. So when we have a strong fear, we have to interpret the fear through imagination rather than wait for the slow wiring of logic to tell us the what really is happening.
So for a BDDer/OCDer who has superfast broadband wiring for fear, the imagination has to work overtime to try and make sense of the input into the brain. The story is inevitably doubted because at a subconscious level we do know how our brain is working. We know our brain never had time to wait for logic, so we ask. This action of asking is universal to OCD/BDD. However the answer never sticks because the question was asked from the imagination centre of the brain. It cant store the logic it hears there. It just cant connect with the answer. So the answer is forgotten or rejected.
The only way left to allay the fears and anxiety created is by doing a ritual. The imagination makes up something it tells you to do to calm the fear. You do it as you feel compelled to reduce the awful feeling of fear.
In this way the feelings, thoughts and actions of a disorder become manifest in a cycle of chronic repetition. Our own defense mechanism becoming a tyrant living within us. The person with BDD or OCD entering a living hell of fear and torture. But there is a way out. I hope we find it...

[ Continued ]