GENDER AND BDD ACROSS THE LIFE SPAN BDD AND GENDER

July 17th, 2011

Is BDD more common in women or men? Is it different in the two sexes? We don’t have definite answers to these questions, but what we do know is intriguing.It’s often assumed that BDD is much more common in women. Aren’t women more focused on their looks than men are? And doesn’t society place a particularly high premium on attractiveness in women? Indeed, research findings from the general population indicate that more women than men are unhappy with how they look.Several studies of BDD have contained more women than men. Several others, however, have had as many men as women or even more men than women. Somewhat more women than men (60% vs 40%) have participated in my BDD studies. It’s unclear to what extent this ratio reflects the true gender ratio of BDD in the community. It may be harder for men to acknowledge that they have BDD, and men seem less likely than women to participate in BDD studies, especially treatment studies. Thus, the gender ratio may be more equal than these percentages suggest.In a study done in France of more than 600 patients with obsessive compulsive disorder and similar disorders (e.g., trichotillomania), men and women were nearly equally represented among the 151 patients with BDD. A number of years ago, I reviewed all the published cases of BDD that I could find in the English-language literature as well as a large number published in other languages. In these published cases, the sex ratio was approximately 1.25 female to 1.0 male.These research findings can’t give us as valid an estimate of BDD’s sex ratio as we’d like. What’s needed to determine it with greater certainty are large-scale surveys, in which the prevalence and sex ratio of BDD are determined in thousands of people in various settings, including the community. The studies I just noted were relatively small and could have various biases. In the meantime, until such surveys are done, we can be certain that BDD affects both women and men.*147\204\8*


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BDD BEHAVIOURS – REASSURANCE SEEKING: “DO I LOOK OKAY?” THE REASSURANCE GIVER

May 15th, 2011
If the person with BDD does believe you, the relief is usually only temporary. The doubts soon return. Maybe the reassurance giver didn’t get a good enough look. Maybe they’re just trying to be nice because they’re your friend. And the questioning starts again. As Julie said, “When my surgeon reassured me, I felt a little better, but only for a few minutes. It never lasted very long.” And she’d go back to ask again. A young woman told me, “When people say I’m pretty, I like it. I need the feedback. But I feel good for only a few minutes. I see how I look, and I feel terrible. I know what I see.” When reassuring words temporarily decrease anxiety, they may actually increase the questioning behavior because the fleeting relief of anxiety reinforces and fuels more questioning. The BDD sufferer asks once again, looking for relief, even if only temporary. Responding by agreeing with the questioner and saying that the defect is there and looks bad is usually even worse. This response is often given in desperation because reassurance hasn’t worked. On the one hand, BDD sufferers may welcome the agreement because someone is finally telling them they’re right; at the same time, their worst fear has been confirmed.
Another response that doesn’t work is something like the following: “Well, now that you point it out I can see it, but it’s really not that bad. Before you showed it to me I didn’t even notice it.” The person with BDD usually hears it differently. The “really not that bad” and “didn’t even notice it” parts go unheard or are considered untrue. Responses such as these can plunge the BDD sufferer into a serious depression. To summarize, the bind is this: no matter how you respond, it usually doesn’t help.
The best approach is not to comment on the perceived defect. I have my patients and their loved ones agree together that, overall, responding isn’t helpful. When others don’t respond with reassurance, over time the questioning may diminish.
*104\204\8*


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PSYCHOSOMATIC DISORDERS IN STAGE THREE BREAKDOWN

May 7th, 2011
I just want to mention here how psychosomatic symptoms occur in stage three stress breakdown because of malfunction in conditioned reflexes.
A lot of the housekeeping of the body is done automatically; seeing we didn’t have to learn things like how to sneeze or coordinate stomach secretion of gastric juice with bowel movements, we can’t really forget how to co-ordinate them either. These built-in nervous system reflexes are not affected by stress breakdown.
Instead, it is those reflexes which have been learned through experience which are affected by the switching-off protective responses of the brain in stress breakdown. Thus the reflexes affected in third stage breakdown are those where we have learned, to some extent, to control body functions. These will primarily affect three areas of function.
1. Reflexes concerned with preparing for the ingestion of food.
2.   Reflexes concerned with inhibiting large bowel elimination of faeces.
3.   Reflexes concerned with the contraction of the bladder when it is filled.
When we imagine food, or visualize food before a meal, saliva is produced in anticipation of eating, and the stomach prepares to receive food by secreting gastric juice in anticipation. The preparation for receiving food into the digestive system also includes a readiness of the gall bladder to secrete bile into the small bowel, and a readiness of the pancreas to respond by excreting enzymes into the small bowel and to secrete insulin into the blood stream.
The amount of sensory input into these readiness reflexes determines the response of the system. Therefore, if the food is on the table in front of the person and the sight and smell of the food is increasing the level of input, then the law of strength of the nervous system would normally be in operation. That is, the more intense the input stimuli, the more preparation the digestive system responds with. By the time the food is in the mouth, there has already been some secretion of gastric juice and some increase in stomach movements in preparation.
*36/129/5*


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STRESS AND MARRIAGE BREAKDOWN: ERRONEOUS EXPECTATIONS AND BEHAVIOUR RE-AFFIRMING FALSE EXPECTATIONS

January 29th, 2011
Perhaps the reader has had experience trying to relate to a person who believes he is, and always has been, and always will be, a ‘failure’. Such a person does not seem to be able to be talked out of his negative inner image of himself. I remember a person like this very well. After some time I began to feel sorry for him and, without being aware of it, slipped into the habit of making special concessions to this person. Later, this person said, ‘Well, there you are, you treat me as if I’m a failure, you feel sorry for me! That just proves what I’ve always said about being a failure!’ This person’s negative inner image had caused him to behave in such a way as to evoke a response from me and other people which served to reinforce this wrong inner idea.
We often take into marriage erroneous expectations of the other person, which may unconsciously cause us to behave in such a way as to evoke behaviour from the other person that confirms our basic wrong idea. Take, for example, the man who has an expectation that whatever he does he will be criticized for it by his wife. (It was his mother who was never satisfied.) This man is inadvertently delayed getting home on time. He and his wife are planning to go out. He expects an argument when he gets home, so he prepares himself with a speech in his own defense which he plans to deliver as soon as he walks in the door. His wife says, ‘How did you come to be so late?’ He takes it as a criticism, responds defensively, which leads her to think he has something to hide, which he doesn’t. This makes her suspicious and hurt that he would do something behind her back to interfere with their only night out, etc. As a result of her response, an argument blows up over nothing.
A normal marriage has to withstand a number of wrong expectations which would evoke self-confirmatory behaviour. Stress breakdown seriously interferes with the couple’s ability to handle these misconceptions, as well as interfering with the ability to discuss them rationally.
*57/129/5*


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STRESS AND MARRIAGE BREAKDOWN: COMMUNICATION PROBLEMS AND STAGE THREE BREAKDOWN

January 17th, 2011
In stage three stress breakdown, the over-stressed person is no longer capable of not responding to things he learned to not respond to. Stage three symptoms also include a switching-off response to big problems and worries, while the person continues to respond normally to lesser problems. The result of these two symptoms is to produce a real communication problem. This is true enough if just one of the couple is suffering from stress symptoms, but if both are suffering, as is usually the case, communication becomes very difficult.
In our normal pattern of communicating our feelings and ideas, it is often what we avoid saying that is the real communication. For example, ‘She pointedly didn’t mention making out a new will’, might well mean that the lady in question is communicating to a relative whom she had previously blackmailed with the threat of exclusion from the estate, that all is forgiven. Not saying something when a person might be expected to say something could be a very significant communication in itself.
Meaningful pauses, facial expressions and tone of voice are very important in conveying meaning in spoken language. It is entirely possible to have someone deliver a whole speech on a particular topic and convey something totally different, just by altering the emphasis: overstating the case here, understating it there, etc.
Under conditions of breakdown the ability to respond to tonal communication and to communicate by significant restraint is lost. Many couples under stress complain of not being able to communicate with each other. This complaint is a common reason for referral to marriage counseling agencies. However, it is important to realize that two people who have been getting on well for years don’t just lose the ability to communicate without a particular reason. Stress breakdown is a major cause; it is very important to identify stress breakdown early because quite often, joint interviews aimed at improving communication between husband and wife might just put more stress on either or both, and worsen their already over-strained relationship.
*59/129/5*


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SLEEP PATTERNS: CIRCADIAN RHYTHMS CAN HAVE A PROFOUND IMPACT ON OUR CHRONIC DISEASES

January 7th, 2011
Circadian rhythms can have a profound impact on our chronic diseases. One of the most familiar examples, perhaps, is nocturnal asthma, also known as “nighttime wheeze.” That the severity of asthma can worsen at night has been known for centuries. Nighttime attacks were attributed to a variety of causes, from too many bedclothes to feather bedding and bedbug bites, before more scientific research in recent years implicated circadian rhythms. For example, the dimensions of breathing pathways in the throat and lungs and the ability of air to move in those pathways are known to change at night, in normal people as well as in asthmatics. But in large measure these changes are rhythmic, following a definite circadian pattern that is actually the net result of the effects of other rhythms. For example, the levels of the circulating compounds that act to stimulate the heart, lungs, and other organs reach their lowest levels at night. At the same time, the sensitivity of the bronchial system to allergens is at a maximum. Immunological activity and clearance of mucus by the lungs also exhibit rhythmic patterns. Normally these various rhythms present no problem. For the asthmatic, however, the rhythms seem to conspire to make asthma worse at night. (Low levels of some of these same compounds and low immunological activity also play a role in increasing the severity of rheumatoid arthritis during the first few hours after waking.)
Clearly, those of us who can take a night of sleep for granted are very lucky. With the fine balance between NREM, REM and circadian rhythms, it’s amazing that even more people don’t suffer from sleep disorders. Similarly, the complexity of our sleep can make treating sleep disorders difficult. In the next chapter we’ll look at the reasons why so many of us do have trouble falling or staying asleep.
*103\226\8*


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STAGE THREE OF STRESS BREAKDOWN: LOSS OF ABILITY TO HOLD PREVIOUSLY STRONGLY-HELD VIEWS

December 28th, 2010
We may hold views on politics, morals and religion which may not be held by others but which will be stoutly defended against arguments to the contrary.
In order to hold strong views which differ from those of another person, we need to play down the importance of those things which the other person regards as paramount, and vice versa. Thus our ability to hold strongly differing views relies to some extent on our ability to diminish the importance of what the other person holds dear. This requires psychic energy to negate the value of the other person’s principles. In stage three stress breakdown, a person has begun to lose the ability to negate the other person’s view; the over-stressed person may not be able to resist being talked out of his views where they differ significantly from those of another.
In the third stage of stress breakdown, people have begun to lose the ability to use their will-power to negate a truth held by someone who differs from their own views. Hence it becomes very difficult to resist being talked out of holding views that required the person to ignore the value of an opposing truth.
Commonly used ‘brain-washing’ techniques aim to produce stage three stress breakdown in the victim, who is then no longer able to resist the arguments of the interrogator.
Most brain-washing techniques will aim at getting the person into stage three stress breakdown, often through lack of sleep, torture, and deprivation of various kinds, sufficient to produce severe stress. If severe life-threatening stress is teamed up with measures designed to lower the efficiency of the brain’s processing capacity, as well as encouraging the victim to oppose his interrogators with his will-power, then the appropriate conditions are present for rapid stress breakdown. The victim rapidly develops stage three stress breakdown symptoms, in which state he is no longer capable of resisting the arguments of his enemies.
The victim is then easily persuaded out of previously-held beliefs and will be unable to hold back information which he has been trying not to reveal.
On the basis of my reading, I am sure the evidence is that it is only possible to brainwash someone out of believing some doctrine when it required some form of psychic negation of an opposite view to develop or accept that doctrine in the first place.
Within relationships, this inability to hold to previously strongly-held views may result in what appears to be a change in moral values, work ethic and role differences in families.
The complaint most frequently expressed by married couples experiencing this symptom of stress breakdown is one of unexplained failure of communication. People complain of sudden changes in the value systems of their spouses. The relatively less-stressed person finds the over-stressed person difficult to understand. ‘My wife doesn’t understand me, doctor. I just can’t seem to get through to her. I say one thing and she just hears something else. We can’t seem to communicate.’ Or, ‘I just can’t make him out any more, doctor. He’s definitely not the man I married. I think he must be going through one of these change of life crises or something. I think he’s definitely developing a split personality!’
*33/129/5*


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