My son's BDD is spiking. He is confined to bed. He cries that he is really unwell. He touches all the time. Then that triggers a story of high testosterone or DHT levels. He pleads for blood tests to prove his recent hypothesis is true so he finally knows the cause of the loss. He draws me into an argument and I have to leave the room.
He thinks people will not go out with him because he is too dishevelled. It sounds so ridiculous and it is. He is a good looking guy but just so anxious and sick. He then says he feel like he is boiling up. He runs to the tap for a large drink of water.
It is all a behaviour pattern of obsession but to him it is all real. In this level of distress it is hard for him to see any other perspective. He can't take that step back and see himself as so ill that he must be doing something wrong. He must be prepared to change. He needs to have some physical willingness to try and do stuff that matters. He needs the perspective that you the reader has when you have the ability to question what he is doing.
With that thought in mind, I might ask him why he continues to do the things he does. So just have.
His answer was that he was helpless and hopeless and should have killed himself long ago. I think he just shocked himself with that answer. But he is living in his own hell. How much worse can this get?
The option of a long stay hospital looks more of an inevitability while he remains unwilling to do anything else.
Fortunately the mornings have an ending. A bit of akathisia but not unbearable. Upped the Prozac to 20mg. He only notices that it is harder to cry now. Watched an NBA playoff game as distraction works well. He was able to focus. Anything is a plus to grab onto.
Tomorrow is the next appointment with the Professor. He is probably a bit nervous as he is already saying he will need a hat. He called out,"mum" again from the bedroom. It is like a tourettes tic. The anxiety is so great. He just said his BDD is chronic. But he still isn't trying to really stop it. He still argues for it despite all its distorted logic. He knows he has BDD but cant seem to connect the dots and realize what he is thinking, saying and doing is wrong. Just because you think it or feel it doesn't make it true or real. Marg

The touching compulsion was off the scale. He wants the issue fixed so his mind sees that as a transplant. He will not wash his hair now. I can't remember when he last did it. He has taken to wearing a hat to go to the mail box. Even if that hat is an old Akubra sitting on his father's shelf. Two sizes too big and all wonky looking. But how ridiculous it looks is not in his mind. It is the cover up that is all important. He has taken on the toppik again so i suppose there is a hidden mirror somewhere.
Without insight he will not get over this. We can shoot his brain with magnets but if he choses all these compulsions then i don't see him having a chance.

I suppose a lot of this can be put down to the date but no excuses are going to cut it with me forever.

I couldn't stay in the house. He was crying and yelling about how bad it was. He was telling me how he looks each day for suicide stories. But he had the option to go and get help for 6 weeks and turned it down. Are we going to put that down to fear of stigma? When a stranger's opinion matters more than getting well, you have some seriously screwed up priorities. His emotions were unravelling and he couldn't control himself. He takes advantage of me.

I don't even know if i really want to go back to the house. He has got to do this for himself. Maybe my involvement is just distracting him from his own path. That might be a series of failed transplants and life time misery.

It is not about getting a date or getting work. He can do that. This is purely what he tells himself and he can't be convinced he is wrong. He has got this flaw that is hideous, people might notice. He has to hide away and give up living well. He no longer lives with us. The den of doom, the bed trap, is at the end of the passage.

We will be expecting a lot from TMS if this is going to turn around. This is very severe. Not something that can be cured with a transplant or toppik or more hair meds. The stories and the compulsions have consumed him. It is what he thinks, feels and does almost all day. That is his BDD. It is not his appearance that matters but the level of obsession. He thinks if he fixes the issue of the obsession then it will be over. But we know that is not how BDD works. He will merely move to obsessing and checking how the transplant is doing. It will not be good enough. The fear of a negative outcome will trigger even more obsessing.

Im feeling overwhelmed by the effort to just keep going and keep hoping he gets it one day.
I wish I felt more positive but it is a roller coaster. Maybe this is the trough. I hope so. Marg

My son’s date didn’t go well. Three long blacks suggests his own wise advocate didn’t do much advocating wisdom. He was anxious and it showed. She spent a long time staring out the window of the car while he drove and filled in all the silence with steady chatter. It was draining. They didn’t have anything in common. He saw a café called Voltaire and then thought…why bother. The interest wasn’t there. He is so needy for someone to be close and connected that he is still trying to make a match light when it is never going to. Another date is planned but maybe he will realise he is too unwell to keep the cover up and she is not the one.
Hopefully he might practice a bit of mindfulness today. He is too far gone to practice when he is in the grip of a panic. All he is now doing is calling out. Why does he do it? He is scared of everything. He is scared of his BDD. He is scared of what people would think of him in hospital. He is scared of the ridicule. He is in the bed trap. In bed there is little capacity for change. It is just safe and painful. But it his choice again.
I might hope he will do better today but what is the expectation when he doesn’t get up. He is going to be living in his mind all day. The thoughts will come in like a bombing raid. His physical willingness to leave the room will be absent. There is just no desire. Only dread for both of us. Another day battling BDD. I can only medicate the worst of it. But he will continue to do it. He is still agreeing with his Dute to Fin, causes loss story. It sends him into panic every time it shoots into his brain. It is just another OCD thought that needs to be acknowledged and dismissed. Like all OCD thoughts it never says anything helpful for you to do. It never solves anything.
If you ever do realise the thoughts are just OCDs then you might beat this without too much hassle. You never needed to check the lights, locks, taps, stand on cracks, arrange the pantry, keep all the receipts, clean all day. Now you have a BDD thought, it seems more personal. But it still tells you rubbish. It is not telling you what you need to do. It is just telling you that you are sick. All the stories you create to explain your concern are just an attempt by your mind to find logic in a disorder.
I am so exhausted. I can barely write. He says he doesn’t want to live with it anymore. But it is only what he says. He could be in hospital now being treated but he chose this today instead. Marg

Improving awareness.

Visiting a good psychiatrist has an added effect of improving the level of awareness of what BDD really is. It is not just about feeling ugly and thinking people are noticing. That is how it is felt by the person with the illness. It is not experienced as a mental disorder even though there is enormous disruption to life, anxiety and depression. That is what makes it so frustrating and also why plastic surgery is sort but cannot really improve the condition.

We had visited this psych ten years earlier. He had his earlier notes on hand. The concerns were just the same as they had been then. There were the appearance concerns over hair, the thinking that people would notice and the compulsions to avoid and feel safe from these feelings and thoughts. I suppose those three components need to be there if a diagnosis of BDD is to be made.

Looking at appearance concerns more closely. People with BDD seem preoccupied with the idea that some aspect of their appearance is ugly, deformed, or flawed in some way. Most do not recognize that their belief is due to a mental illness. Insight remains poor even after diagnosis and treatment. Visual judgement appears compromised. It is as though the person with BDD can’t link the knowledge of what the disorder means to what they think they see.

How does this confusion resolve? : Most individuals with BDD are convinced that their view of their appearance defects is accurate and undistorted. Everyone else is lying is the only option to resolve the conflict.
In addition, most seem to have ideas or delusions of reference, believing that other people take special notice of the supposed defects and stare at them, laugh at them, or recoil in horror because they look so bad. They never need to ask. They believe they are body language experts. This thinking too is impervious to logic. They can never modify their own thinking to incorporate a more realistic view that it is again their illness making them think this.

To be diagnosed with BDD, it is considered necessary to have some repetitive behaviours now as well. This links into the idea that BDD is a variant of OCD. (DSM V) Common behaviours include compulsively comparing the disliked body areas with the same areas on other people, camouflaging the disliked areas and mirror checking.

My son was lying in bed this morning moaning over body hair. Telling me he was so ugly.He now believes he is feeling his body hair grow. He knows the reason…High DHT. I told him it was his mental illness talking and his body was fine. He will not be convinced for long. Showers are now down to seconds because the anxiety of scoping his body becomes too much. As he terrifyingly looks over his body with the gaze of a deer in headlights, you can tell he has no idea that his brain is doing this to him. He is fully convinced of his own logic.

Zapping his brain with TMS will be welcomed. The occipital lobe, the part involved in visual perception is the target for this TMS. All his other OCDs have been visual so it makes sense. The plan is a course over 4 weeks and then a break and another couple of weeks. As my son refused the private hospital the doc has to schedule it in the public one. PET scans will be done too so we might see Christmas tree lights somewhere in his brain.

As an update. Meds are not going well. Family genetics just can’t tolerate Fluoxetine. The akathysia trembles are just as bad as the BDD. Valium and betablockers aren’t enough to stop the shakes. So it seems he can only tolerate antidepressants that target histamine.

Hope we have a better week. Something to look forward to ahead. We are going to beat this. Marg

Well the long awaited appointment with Dr Castle was so worthwhile. He made a fairly big statement that he, in his early theory of BDD, tried to prove Katherine Phillips wrong. He tried to prove it was some form of conversion disorder and not a proper distinct disorder. After finding countless cases, he verified all her work instead. He described a BDDer as some of the sickest patients he ever sees. He believed it to be a predominantly biological disorder. As my son had the form of symmetry OCD that was his particular interest at the time, he clearly was wanting to work with him. TMS will be what he offers now along with a couple of other antidepressants we hadn't even heard of. A six weeks inpatients was something my son rejected. So the doc will work around him and do what he can in the big public hospital as he is setting up a clinic to offer it to public patients. His TMS approach is to target the occipital lobe, visual perception and not the alarm system. Next appointment April 20th.
If anyone in Melbourne has BDD or in Oz really, just make an appointment even if it takes 6 months. If you say you are BDD it might be sooner. Get the private health at 1K and you will know you are getting the best.
I mentioned the problem with intrusive thoughts and he responded that I was to say. " David said, No answer." I like that. A bit less disrespectful than my Sanjeev comments that carried my contempt for the whole thing.
My son went on another date. He is very needy for love and valuing since his ex was so distant and judging. I fear he may fall too quickly without even finding out what this person is like. He needs enough self esteem to be aware first impression is often wrong. He himself is hiding enough.But he has a reason to get well and that is important at this stage.
Hope we have a better weekend. Marg