There is nothing like a date to pick someone up. The anticipation anxiety was a bit hellish but he managed. The bedroom texting had been going on for weeks but he looked too unwell to actually ever get to the dating stage. The day before preparation had begun with a hairwash. He got through that, then wanted a cut the next morning. I was a bit terrified to be honest. He just didn't seem ready.
I think he took an extra dose of Lyrica in the morning but was still able to function at lot better than he had all week. He managed a salon cut of the sides and back and we were able to sit in a bright coffee lounge. He was out of the house finally and actually enjoying himself. Distraction was working again to reduce his BDD symptoms.
The dose of Prozac is now 60mg. It is about 6 weeks since we started the therapeutic dose of 40mg on April 11th. I actually had to force the issue for him to take it at 10am but he seems to be tolerating it now much better than I would have expected. I didn't notice the akathisia shakes all day. This medication cocktail seems to be working for him. There is no head in the fridge side effect. He is not interested in food unless i am not around. Then he might raid the fridge of anything sweet. He tells me he has lost weight. I think he has too.
On his return from his date he was able to tell me all his conversations. It seemed to go really well. He has a marvellous personality but I was expecting the anxiety to kick in as it had done in the past. But there was no repeating of sentences.
The BDD is still there. This is just a distraction that is working on a functional part of his brain. But he hasn't been sounding this positive since before Christmas.
He did wake with a morning panic but was able to tame it down. He only repeated sentences of alarm a couple of times. Whether he now can put his functional mind to do something else will be today's test. His body hair seems to be more of an issue. He believes he feels it grow. Most likely does with the level of close attention he gives it.
I think we need a return to a more functional self before we tackle any of his BDD symptoms. Just pleased and hopeful that the worst is behind us. But with hair as the issue, no day is a certainty.

So I am now thinking this illness is something more like epilepsy. In epilepsy the physical body is hijacked by an electrical storm in the brain. Once this was seen as a sign of demonic possession. it was completely misunderstood as it could not be controlled by logic. So sinister explanations persisted. Some form of karmic justice.
In a similar way BDD is a hijack of the emotional reasoning part of the brain. A brain triggering causing immense panic that cannot be tamed by logic. Because it is deep in the brain, it is more primal. It is an arousal fear that is constantly looking for context to attach to. Hopefully our functional MRIs will be able to clarify the picture. We are booked in for mid June.
Wish you well. So yes, we will find a functional cure for BDD. It will be like epilepsy or asthma. You learn what it really is and what you need to do to stop an exacerbation. You just can't ever forget that it is there dormant. Marg.

Body dysmorphia: Habit refusal and storytelling.
I think a lot of my son’s behaviours need modification through some intervention to reverse habits. The touching habit is so destructive. I almost feel his hand should be stuck to his head to show him how often he does it. I can get so distressed by it as it so often triggers a sizeable panic but he still never learns from experience to stop it. The urge to check is stronger than the subsequent panic that needs avoiding. I liken it to an instinct pattern beyond logic.
Habit reversal usually requires mindfulness. Writing down your own triggers to touch and building on awareness. Then substituting another behaviour you can do with your hands. It is sort of like chewing gum for a smoker.
Having the list of compulsions is also a must. It allows you to see really what has to be worked on. It sets up the goals to be symptom free.
This gets me to the very well experienced but rarely mentioned in the literature: Storytelling. Once my son’s circuit is triggered he will recite sentences that are attempts to explain his distress. Most often they are verbatim replicas of what he has said the day before. He has no ability to dissolve these sentences. Regardless of who has discussed them or how deep into the burrow I have gone with him to internet search their murky origins, they still are repeated as though they are illuminating. I now try not to buy into any discussion of them. He will still try to repeat at least one each day. It is a habit now that I probably realise can only be sorted with medication.
Now many of you might think this is all only a learnt fear. But regardless of how well his hair is regrowing since he has finally stopped cutting and shaving it, he only assesses it in terms of loss.
This value and assessing of hair then is encoded in his brain. It is likely to have arrived there at most likely the age of 8. He would have seen the back of his father’s head and he indeed has reported to me that he recalls loathing it from the viewpoint of the backseat being driven to school in primary school. So he was visually fine tuning his values as soon as he was able to personally assign his own emotion to the things he saw.
His father was the detached type. Born in a work camp in Germany to a Polish mother who had suffered the most unspeakable. She had been a gorgeous looking tall blonde 18 year old at the start of the war. Her emotional shutdown lasted all her life. So as a result, my son didn’t know his own father emotionally either. A legacy handed down from a heinous war experience of what men can do to each other.
So maybe valuing his father negatively was a reflection of a love bond that was strained by distancing. He was too young to understand. He reflexly made a stronger bond with me to fill the void. Perhaps most boys do make stronger bonds with their mothers. But at some stage they do have to own their own skin and become the man that is their destiny. But he had already set himself up to rejecting a part of himself that would remind him of his own father.
Integrating himself with his own body image might need a revisit of childhood and the value he placed on his own father. By resolving the discontent with your own parent’s looks, all of you might be comfortable to own your own.
So he needs a new story to tell. One that integrates and understands how he saw his father and how that might have translated to an overvaluing. This still might not be able to reach and integrate into a circuit that was laid down as an 8 year old so diffusing in this way might not help his BDD. It may help with his ongoing relationship with his father. There is no evidence for talk therapy in this kind of psychoanalytical way as a treatment for BDD. This is the opinion of Katherine Phillips in her book based on her research work. However mental illness has a way of spotlighting lots of other problems that need a bit of work. So a repair of my son’s relationship with his father is now part...

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Havent forgotten this blog. Just had trouble losing posts with some issues on Mozilla.

Exposure and response prevention was mentioned in the forum and as it is relevant to us today I thought I might make a reply with my two cents.
Historically ERP was designed for OCDer. It was the variety of contamination fears that had people put their hands in garbage. Not all that relevant to everyday living.
It was hard to find any therapist who had any knowledge of what to do. No one was immersed in the disorder enough to really know much more than the theory. Practice had a lot of shortfalls.
I can remember during one hospital stay, simply demanding that the psychs just try ERP on my son as handing out sheets on what anxiety was, was truly pointless.
Well the ERP didn't go well. They had no experience. After a half hour session standing in front of the mirror. He was supposedly practiced with control so they handed him scissors to place in his back pocket. A very panicky nurse rang me up later in the day to take him to a hairdresser. He had attacked his hair. Even with my limited knowledge I likened what they had done to giving an alcoholic a flask in a back pocket.
So from our experience set up exposures are more miss than hit. But there is a place for them when avoidance gets out of hand. My son now can give himself panic attacks over having a shower. This is no primal circuit operating but a learnt fear. If I change the cost benefit analysis and say he gets a Propecia tablet after a shower, I can get a shower. His thinking I believe is just being distracted by the expected reward so the anticipating fear is reduced. You just can't really think of two things at once. So this is more a distraction approach.
It works in the short term but doesn't do much at all for his own executive functioning. He is not doing the thinking himself to get him in the shower and that should be the goal.
A pressing problem also is his refusal to wash his hair. Not sure really if it has been really washed this year. The longer it goes the harder it is. I suggested a little drizzle of water as a starting step. But even this is felt as a strong anticipatory fear. When your BDD is this bad, the avoidance is so strongly felt that you really cant force it. Forcing is just met with counter resistance. I have allowed this to go on maybe too long. Really hoping the meds might make a more confident person to deal with. So I know he needs an exposure to deal with this but not sure he is medically ready. The willingness should be coming from him. I feel I need to wait for that to arrive.
Avoidance issues are also only the negatives he does. There are a host of compulsions that need what I call urge restriction and reduction. This is all the stuff he does but shouldn't do.
I made a list of all his compulsions early on in this blog. Haven't checked in with him to see how that is fairing. He has been too bedridden to be doing them. There are no mirrors for checking and no scissors. Online browsing and checking others for hairdos seem to be a bit less. He has mentioned friends who he described as ugly who had great partners. He explained that he knew his BDD thinking was all wrong. That is a perspective change that wasn't there a couple of months ago.
Still we are no more functional. Postponing or opting out is frequently preferred over doing. The battle lines shift but the battle just moves to another front. Yesterday he did go and do a small shopping list. He came back mentioning how many children were at the shops. I take from that that he wasn't looking at hair. I am probably too tired of this to register how much progress that might indicate but I have got to face up to tomorrow.
So in summary, I have been stuck in this exacerbation now for 16 months. If ERP was easy enough to do we would have found a way. My son is just too unwell and too unwilling. The hero who really wants to be a conqueror has to self initiate. He is a hero to live with this but still...

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Other issues are constantly coming to the surface as we deal with body dysmorphia. The mind is creating FUD all the time. Fear uncertainty and doubt. It seems as though uncertainty is something most of us find very difficult to manage. We just want to be certain even though we know it is so illusive. Can we ever be certain of anything happening tomorrow? We know we can't but we still seem to need to know. Is it really that we don't know how to find pleasure and happiness for ourselves? Do you know what will make you happy...really happy? Can you really be certain?
All failed attempts at surgery seem like evidence that we can't find our own certainty. All that is certain is that we have to deal with a degree of uncertainty..If we try and fight and control rather than allow, we use up energy and create anxiety.
We need outlets for our energy. We need to know what can make us happy. Isolation isn't likely to make us happy. Imagining how people might treat us when we go out just takes us down that path of negative assessing. Nothing healthful in doing that. We can get trapped by predicting the worst rather than expecting the best. But that is really happening in the future. What are we all doing now? Can we list 5 things around us that we like. Maybe we can only name one but we can focus on something positive.
If we create what we think then we need to have a way of thinking more positively and diffusing our bad thoughts. I mentioned to my son that he might be able to write out all his horrible thoughts about himself and get out all the swearing and anger he has towards his illness, and those who let him down, including himself. Even writing, 'This is bloody s##t.'might be a way to diffuse pent up feelings.
He has been lying in bed watching NBA all day. He has little appetite. He is only taking 40mg of Prozac. Anymore and the akathisia is intolerable. We have to get the Lyrica working better to increase the dose.
The outreach worker came yesterday. It was a nice talk but a lot more intensive things need to happen for this to be of value. Maybe someone caring builds confidence and connection to the outside world. She said the Lyrica and Prozac was the best combination for our profile. 60mg of Prozac was considered the therapeutic dose for BDD. A bit of a worry there..so high.
This woman is working with the team who will be doing the TMS. A special medical guy from the US is out here to help read the MRIs and suggest targets. It is still in the experimental stage here particularly for BDD. We are going to be getting the best medical help. But she told us it can take 4 months for improvement in BDD as the neurotransmitters take time to level out. We only started a therapeutic dose for depression on April 11th so still very early to see improvement.
Wish you all well. Marg

Our family doesn't really cope well with BDD. It is hard for siblings to understand a disorder that still hasn't had the air time to make it accessible to them. Perhaps Michael Jackson provided us all with a most heroic example of how this can play out in real life. We should never lose sight of the horrendous suffering and toll on life it takes. No one would want to change places with someone stuck to the bed with fear or staring down the path of revolving door plastic surgery.
It has been suggested that I should be able to cure this problem just with the knowledge I have. But that is a nonsense. I can't even cure someone's cold. I can't cure someone of their alcoholism or anorexia. I can only work on myself. All I can do is provide some signposts and insights that might be of help for the person with the illness navigating through this themselves. I have an intellect I can use to help and that is about all I can do.
I suppose what makes this illness so annoying is that when living on the other side of this illness, one can see how the misperceptions are occurring. Something like hair is impermanent. It is like all impermanent things on the body, the skin, nails, teeth, body hair will all end in the bin. We could save a strand of hair today but like the skilled surgeon who does the transplant. His hair will end in the bin too. It will all end in the bin in the end. Our whole body will be binned. That is the nature of this thing called body. It is forever changing and generally not for the better. We can cry about what nature intended for us or just accept that this is the way. So what can we rely on. The mind and the heart have a lot more going for them. They can direct our path for the good. A good kind heart can provide a smile to many. A fine mind can bring the clarity of thought to any problem.
But within BDD, thinking has been hijacked by emotions of fear. The illness is attributed to the body and a concept called, FLAW. But seldom does the BDDer look on others with the same judgement. The fear of a flaw only serves to trap them in their own negative judgement. The BDDer rarely realizes the problem is really stemming from their own mind and their body is in fact fine. That completely right feeling of being perfect is an illusion that cannot be attained. It is a desire that cannot be quenched.
Tears never finish when you try to apply your logic to something that is simply not logical. So the misperception continues and is misattributed to the body and is felt in terms called, "ugly". This is the BDDers experience of their illness and seems completely resistant to alteration. I can't change that personal experience. All I can see is a different perspective.
If you put your hand in front of your face up close then that is all you see. This enormous big hand. You might even find your hand ugly at this close range. If you move the hand away from your face, you still see the hand but it is in context of the whole and all that is around it. You see relationships. You see where the hand could be used. That is how the BDDer distorts their own focus. It is just too intense to grasp the full picture and what is truly important in the relationships between people. There can be no satisfaction in a devotion to that which, in essence, is impermanent and destined to disintegrate into the fire, wind, water and earth of compounded existence.
Instead we can think of ways to be a better nicer person. That is what we remember about a person, what they did and how they made us feel. What they look like fades from memory. But if we felt the love, we store that memory in our heart.
If we have BDD, we may fear we don't look good enough unless we have checked many times in the mirror but nothing really changes how we look. Fear just creates and justifies the obsessing.It is OK to look like we do. It is not a mistake even if we call it a flaw. Sometimes we need to stay with the fear a bit longer and let it subside. We can then wonder...

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