Stephen, Author at BDD SUCKS

Hopeful – Using Cognitive Behavioral Techniques to Test My Body Image Concerns

November 4, 2012 By Stephen

After last nights depressing, over-tired post, today turned out to be a good day.

I have been going to church again, mostly for the kids, so that they may know God and understand that somebody may have their back in the bad times, and the good ones.

This has helped me through my BDD, and I figure it is best that they have God’s love to guide them as well.

Going to church helped to get me out of the house, my bedroom and my mind. Writing here on this blog is a lonely outlet, at the end of the day the only way to overcome my BDD is in the presence of others.

It is among others that I can prove (or more likely disprove) my many skin concerns.

Today, sitting in church, in full light, close to people, I could see that no one cared. My facial scar in full view may or may not have caught the attention of others who, in all honesty, seemed to care less. They were more concerned about what I had to say, and I am more concerned about what they have to say.

I feel good when I am out, yes I feel anxious, and yes, I feel self conscious but, at the end of the day, being out and about always has a positive net effect on my attitude.

I stayed after church to sit and write in the open air cafe, afterwards I attended a waffle party with some families that attend my daughters school. One of the dads commented on how he hadn’t seen me around (my daughter just started Kindergarten in October) and I made up some sorry excuse about late nights at work.

Honestly, there is no reason to tell others of my body image concerns. I know my wife was happy to see me there, as were my kids.

Face your Fear and it will Disappear?

My fears have not disappeared But today, out and about, at church, at a party, out on the bike, this afternoon, I started to feel better.

It is hard to believe how I can be on the edge of destruction one moment, and feeling so good the next. This is the nature of the beast when it comes to body dysmorphic disorder. My moods rise and fall like the ocean tides.

Moral of the story: Getting out and being around people is a known cure for depression which, I have along with my BDD. The Lexapro hasn’t seemed to help as much as I would have liked, but then again I need to increase my dose but haven’t been able to in fear of (believe it or not) what the pharmacist will think. This is incredibly irrational and is further proof why I shouldn’t be treating and prescribing for myself.

I skipped my first counseling session this week because I am a coward, and I was tired of talking about my scar.

I wrote a lot here and started to work a bit more on my art. I spent time with my children, I took my wife out on a date, I did avoid the mirrors and I had my wife take the one down at the front door… The last one I see as I head out of the house, it has been known to change my attitude pretty quickly.

My wife continues to be an amazing support of my BDD . She doesn’t give me a bad time about some of my avoidance rituals. She seems to understand what I am going through right now, I am so thankful for that.

I am exhausted, but I made some positive steps this week. My facial scar is hurting me today, I am not sure how much of that is in my mind. But maybe it is because I stretched it today, I showed it to the world, I overcame some fears. And I lived to see another day.

Hope – The Lost Frontier on the Road to Overcome BDD

November 4, 2012 By Stephen

My hair is long, and itchy, yet I don’t know how to get a haircut as the fear of the cutting room mirror haunts me.

I spend a lot of my time thinking about dying, because that is all I want.

Not to die necessarily, but to sleep. To set the worry and the anxiety aside. I wish there was a pill for this.

Alcohol gives me a temporary respite from the horrors of my mind, I have to take Ambien to sleep.

I just took one because I am up and it is three thirty in the morning. I want to be asleep.

Hope: the lost frontier

I have lost the last thing that I had to hold onto

I have lost hope of a better tomorrow. Instead it is one filled with scarring, that I can’t escape.

I fear this entire “learning process” may end in my early exit… A door in the back of the theater, that is reserved for emergency personal. This is such an emergency.

Why I have lost hope in the face of this above all else blows my mind.

Maybe it is the lack of will power, or maybe, it is that a facial scar is a wound to deep.

Exposing me for what I truly am:

A coward and a fraud of the worst kind.

Hope is lost over the horizon.

Accept Life as it is to Overcome BDD: There is Endless Futility in Regret and Worry

November 3, 2012 By Stephen

There is a principle in Daoism that may very well hold the key to happiness: “All Things Change.” Today when I was in the mirror lamenting my body image concerns I found this poem. I think it speaks highly to BDD and is a lesson in the futility of regret and worry. For me, it is also an extremely hard pill to swallow.

Life as it is – by Ralph Marston

Whatever may happen, there is no need for dismay.

Always, there is the opportunity to creatively and successfully deal with the things life sends your way.

There’s nothing to be gained by wishing that things had turned out differently.

Pick yourself up, connect with the energy of your passion, put a smile on your face and move forward with what is.

Your best choice is always to be your best. And you can’t be your best when you’re complaining or regretting or worried or dismayed.

Every situation generates a new set of positive possibilities. So in every situation, choose to see those possibilities and to enthusiastically follow them.

Each setback is just another step toward getting where you have chosen to go.

Learn, adapt, re-commit, and get quickly back on track.

Every twist and turn in the road of life gives you the opportunity to make a difference. Relish those opportunities, make the most of them, and build a magnificent life.

– Ralph Marston

The Best Books for Treating and Understanding Body Dysmorphic Disorder

November 3, 2012 By Stephen

Here is my list of the best books on the subject of Body Dysmorphic Disorder. There is other literature which focuses more on the topic of body image that I will discuss in a later post.

My Favorites

[easyazon_link asin=”0195379403″ locale=”US” new_window=”default” tag=”4hourlife00-20″ add_to_cart=”no” cloaking=”default” localization=”default” nofollow=”default” popups=”default”]Understanding Body Dysmorphic Disorder[/easyazon_link]by Katherine Phillips, M.D.

[easyazon_image add_to_cart=”no” align=”left” asin=”0195379403″ cloaking=”default” height=”160″ localization=”default” locale=”US” nofollow=”default” new_window=”default” src=”http://ecx.images-amazon.com/images/I/41EPnEUr9pL._SL160_.jpg” tag=”4hourlife00-20″ width=”112″]A Wonderful, concise and essential book to understand the diagnosis and treatment of Body Dysmorphic Disorder. It is a fairly short and easy read, that is full of top-notch information!Material is complete and presented in an organized and useful way. The understanding enabled for both client and therapist is one of the main traits of this book. And the author is obviously committed to the betterment/healing of her clients

[easyazon_link asin=”1572307307″ locale=”US” new_window=”default” tag=”4hourlife00-20″ add_to_cart=”no” cloaking=”default” localization=”default” nofollow=”default” popups=”default”]Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems[/easyazon_link] by Sabine Wilhelm, Ph.D.

[easyazon_image add_to_cart=”no” align=”left” asin=”1572307307″ cloaking=”default” height=”160″ localization=”default” locale=”US” nofollow=”default” new_window=”default” src=”http://ecx.images-amazon.com/images/I/51FiFo3cq0L._SL160_.jpg” tag=”4hourlife00-20″ width=”107″]This is a wonderful book! Written by the Director of the MGH OCD and Related Disorders Program, and Founder of the Body Dysmorphic Disorder Clinic, this book offers individuals suffering from Body Dysmorphic Disorder with critical tools to understand BDD and to bring their disorder under control.

The step by step approach detailed in the book is exactly what is needed for patients and clinicians alike. I have enthusiastically been recommending it to all of my clients who have BDD, and to colleagues interested in learning more about it. This book offers new hope to the millions of people worldwide who live with this troubling, but treatable disorder.

[easyazon_link asin=”1572242930″ locale=”US” new_window=”default” tag=”4hourlife00-20″ add_to_cart=”no” cloaking=”default” localization=”default” nofollow=”default” popups=”default”]The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessions[/easyazon_link] by James Claiborn, Ph.D. and Cherry Pedrick, R.N.

[easyazon_image add_to_cart=”no” align=”left” asin=”1572242930″ cloaking=”default” height=”160″ localization=”default” locale=”US” nofollow=”default” new_window=”default” src=”http://ecx.images-amazon.com/images/I/417CIWn0qSL._SL160_.jpg” tag=”4hourlife00-20″ width=”124″]This workbook really delves into the thought processes of a person who suffers from this exhausting illness. The worksheets and exercises really cause you to challenge the beliefs which have been engrained in your memory for decades.I would highly recommend this workbook for anyone who is self directed and able to work through the exercises on their own.

[easyazon_link asin=”0195167198″ locale=”US” new_window=”default” tag=”4hourlife00-20″ add_to_cart=”no” cloaking=”default” localization=”default” nofollow=”default” popups=”default”]The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder[/easyazon_link] by Katherine Phillips, M.D.

[easyazon_image add_to_cart=”no” align=”left” asin=”0195167198″ cloaking=”default” height=”160″ localization=”default” locale=”US” nofollow=”default” new_window=”default” src=”http://ecx.images-amazon.com/images/I/417CpMIe55L._SL160_.jpg” tag=”4hourlife00-20″ width=”100″]KatherinePhillips other book “Understanding Body Dysmorphic Disorder” is a more concise and consolidated read, it is also newer.But, if you want a more in-depth look into BDD and it’s treatment by the worlds leading expert, then “The Broken Mirror” is a must read. Probably still considered the gold standard.

Cognitive-Behavioral Strategies for Improving Insight in Body Dysmorphic Disorder

November 2, 2012 By Stephen

Here are several cognitive-behavioral strategies that are described by the San Francisco Bay Area Center for Cognitive Therapy to improve insight into your BDD

Self-Monitoring

I ask the individual to monitor how his BDD symptoms vary over time. Every hour he rates (0-10) how strongly he believes, for example, that his nose is too large. He also notes what was happening at the time and how he was feeling. We then plot on graph paper the strength of the person’s belief, where 10 is “my nose is too large” and 0 is “my nose is fine.” Sometimes seeing his belief fluctuate by the hour helps the client recognize that he can’t always trust his view of himself.

Cognitive Restructuring

Individuals with BDD have distorted beliefs about their appearance, such as “I have to look perfect,’ or, “If I don’t look good, I’ll be rejected and alone.” Teaching individuals to identify and restructure these distorted beliefs can sometimes help the person gain enough insight to try other bognitive-behaviroal strategies.

Cognitive Distancing

Individuals with BDD have difficulty accepting that they have BDD because that would mean their appearance is okay. One young man who told me session after session that he did not have BDD. What he had was a left ear that was lower than the right ear. He insisted that only plastic surgery would correct the problem.

I commiserated with him and said that plastic surgery was certainly a logical solution to the problem of a true flaw in his appearance but that it was not a solution to BDD. The problem as I saw it was that every time his BDD flared up he bought into the belief that his appearance was flawed. I then taught him a cognitive distancing strategy described by Jeffrey Schwartz in his book titled Brain Lock: Free Yourself from Obsessive-Compulsive Behavior.

Schwartz describes the 4 Rs. I’ll cover the first three here. The first R is “relabel.” The client was taught to relabel any concern, thought, or belief about his appearance as a feature of the BDD, not proof of a physical flaw. He was then to use the second R (reattribute) to attribute every aspect of his experience (his thoughts, feelings, urges, and behaviors) to the BDD. He was then instructed to refocus (3rd R) or distract himself from the BDD thoughts.

An “as if” Attitude

At times I have asked a client to act “as if” he looks okay even if he doesn’t believe it. An “as if” attitude is particularly helpful when trying to get a client to try an exposure exercise that, because of his poor insight, he believes is useless.

I’ve asked clients to use the “as if” attitude to stay at a party when they have a strong urge to leave, to go to social situations when they are inclined to remain home alone, or to stop looking in a mirror when they feel that they must continue. One of my clients used this strategy to go to a party that he wanted to avoid by acting “as if” he was okay and “as if” going to the party would help his BDD and his depression. Once at the party, he was able to use his CB strategies to manage his BDD and that as the evening progressed, he was much less worried about his appearance.