Archive for the 'Anti Depressants-Sleeping Aid' Category
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GENDER AND BDD ACROSS THE LIFE SPAN BDD AND GENDER: BDD ACROSS THE LIFE SPANBDD usually begins during adolescence, but can start in childhood or adulthood. The people I’ve studied (more than 500) started disliking their appearance, on average, at age 13. Full-fledged BDD began at an average age of 16. The standard deviation was 7.0 years, which means that the majority—two-thirds—were between 9 and 23 years old when their BDD began. The most common age of onset of full-fledged BDD was 13. The earliest age of BDD onset in this group was 4, and the oldest was 49.* The graph on the next page illustrates these findings.BDD usually begins gradually, but about 20% of people report a sudden onset, going from no concern to a full-fledged concern in less than a week’s time. A 21-year-old woman told me, “It started suddenly. I went into the bathroom one day, and I saw a mustache.” In some but not all cases, the sudden onset of BDD appears to be precipitated by a negative comment about appearance, a stressful event, or even a benign comment—for example, “Your face looks a little red today.” Sometimes it’s triggered by disappointing surgery or the acne medicine Accutane. More often, however, BDD begins gradually, with no obvious triggering event.An important question is: How do people with BDD do over time? Do they get better, stay the same, or get worse? Does BDD tend to be life-long, or do people get over it by early or middle adulthood? Can we predict who will get better and who won’t? At this time, we have only very preliminary answers to these important questions. And the answers vary.When I’ve systematically asked people I’ve seen whether their BDD has improved or not over the years, their answers are somewhat discouraging. Looking back over time, 84% report that their BDD symptoms have been continuous and chronic. That is, they haven’t been free, or nearly free, of them for at least a full month since they began. When I ask, “What’s the longest time you’ve gone without worrying about your defect since the problem began?” by far the most common answer is “less than a day.” Equally concerning, a majority— 59%—said that their symptoms had gotten worse over time. Only 13% reported that they’d improved. For the rest (28%), BDD symptom severity stayed fairly stable.While these numbers suggest that BDD tends to be a chronic illness, or even a worsening one, it’s important to keep a few things in mind. One is that there may be a bias toward a worse course of illness in people who come to see me, because those who improved wouldn’t need to see me. Equally important, relatively few of these people had received adequate treatment for BDD. This is in part because when I started this study, no one knew how to successfully treat BDD. Even now, when we know a lot more about treatment, BDD is still often not correctly diagnosed and treated.To better understand how people with BDD do over time, we need prospective studies of course of illness, in which symptoms are systematically assessed going forward over time. This is being done in one of my ongoing studies. Preliminary results from this study, too, indicate that BDD tends to be chronic. Over 1 year, the probability of being free of BDD symptoms for at least 8 consecutive weeks was only 9%. The probability of being partially free (not meeting full DSM-IV criteria) was only 15%. Over 2 years, the probability being free of BDD was 14% and of being partially free was 18%. People who had more severe BDD or a personality disorder (see Appendix В for a definition) were less likely to recover. While these numbers may sound dismaying, very few people received adequate treatment for BDD—so for this reason, the results aren’t surprising.*150\204\8*
I have mentioned the difficulty of finding a suitable stimulus which produces pain without too much injury to the tissues. I have avoided electric shock as this is not a natural stimulus in the biological sense. After considerable experimentation I have concluded that burning the skin with the glowing end of a thin piece of string is the most convenient stimulus for severe pain. There are different qualities of string, and they vary in the way that they burn. Select the type of string that burns slowly with the end glowing red hot, but without any actual flame. It is desirable to use as thin a string as possible as this provides an adequate stimulus without causing too much blistering. String is often made from winding together three or four thinner strands. If the string is unravelled, one of these thin strands is very suitable.
We expose our forearm. We light the string and have it glowing red.—We relax completely.—With our eyes only half open we see our forearm, and we see the glowing end of the string.—We are very relaxed.—We see the glowing end moving about over our skin.—If there is hair on our arm, we soon smell it burning.—We are very, very relaxed.— For a moment the glowing end touches the skin.—We feel it touch the skin, but it does not disturb us.—We rest.—We relax again, and repeat the experiment. In general it is easiest to do it on an area where there are not many hairs.
Next day there are little blisters on our forearm.
I must warn you again. Do not say that this is something that you could not do. This is not so. Each step follows easily on the previous one. This follows easily on the experiment with pinpricks. Do not say that this is something that you would not wish to do—that there is something wrong about wilfully injuring your body. Remember that we have to injure the body in many ways to promote healing. We cut the skin to open an abscess. Many drugs act by injuring the tissue or certain organs and thus reducing their output. So in the present case, we injure the skin in order to promote the relief of pain.
The experiment with the glowing string can be done in another way. The string is placed on our forearm, and is held in place by resting a fairly heavy metal object, such as an ash tray, on top of it. About two or three inches of string are left protruding from the edge of the metal object. When the end of the protruding string is lighted, it burns down to where it emerges from the edge of the metal object. It then goes out. But at this point is it in firm contact with the skin, and thus provides quite a strong painful stimulus. It is wise at first to be sure that the string projects upward, and does not lie in contact with the skin, or the pain will be too prolonged for a first experiment. This is a good experiment because it creates the feeling that we no longer have control over the painful stimulus. Once we light the string we have to wait until it goes out of its own accord. Until it goes out, we have to control the pain by the depth of our own relaxation. In this way there is a much closer resemblance to pain as it occurs in ordinary life.
When we find that we can do these experiments easily and naturally and without discomfort, we can make another modification. We bend the string so that it lies on our bare skin for a little way before coming to the edge of the metal object which keeps it on our arm. At first try it with the string lying on the skin for only an eighth of an inch. Then when you have done this, have it lie on the skin for greater distances, up to half an inch or longer.
In the early experiments be sure that you use as thin a strand of string as will burn evenly by glowing. Later on, slightly thicker string can be used and the stimulus will be ‘ more severe.
*142\57\2*
INVALIDISM AND STRESS
Author: admin
Anyone suffering from a chronic illness or disability receives nervous impulses into the brain from the disordered tissues, from any pain or discomfort, and from worry about the illness. This stream of impulses produces a background of activity in the brain which predisposes the individual to stress which may come about from other problems.
However, there can arise an inverse relationship between invalidism and stress, so that invalidism becomes an inferior way of coping with stress.
We have seen how early retirement may become an inferior way of coping with stress by avoiding the problems of work. In our society it is usual for the man to work away from home while the woman works in the home and in caring for the children. Unlike the man, the woman who finds her home duties a problem that produces stress is unable to seek early retirement from work to avoid stress. The alternative is chronic psychosomatic illness. She is relieved of some of the problems of the home, her stress is reduced, and in spite of the discomfort of her illness she does in fact feel better.
This process is technically known as secondary gain from illness. We must remember that the process is unconscious. She is quite unaware of the underlying motivation, and the individual involved in this way of coping with stress hotly denies that there is any gain from her invalidism.
Housewives who succumb to this female equivalent of a man’s too-early retirement are often fussy, over-tidy, perfectionistic women who take a pride in having everything in the house spick and span, and in its proper place. I well remember such a case. Perhaps I remember it well because the patient was a particularly attractive young woman, a nurse. She had graduated top of the state, receiving many prizes. Two years later she was awarded a gold medal for her exceptional services. She soon found herself in charge of the intensive-care unit. Life and death were her daily companions. Everything was in order. She always had a smile. She was everybody’s darling. She married, and quite soon had two babies. She became ill. The local doctor could not understand it, except that she was obviously ill. Two consultant physicians did no better other than vaguely suggesting that her illness may be due to some glandular disorder following the birth of the two babies. She eventually came to see me. With her fastidious personality she had found the inherent disorder of two young babies a matter of great stress. She could not cope. She had unconsciously escaped into invalidism.
*75/98/5*
STRESS: WARNING SYMPTOMS
Author: admin
Mind goes blank
«I am a good student. Study well, know my work. But last year I went to pieces at the exams. Mind just went blank. And as it went blank I got the jitters, terrible jitters. Kept thinking, what if I should fail? It was an hour before I got started. Then went like mad. It was too late. I did fail. Spoilt my whole record. I am repeating. I know my work. Know it well. What if I should do it again?»
The student whom I have in mind did not do it again. In fact he came top. During the year I had him practice meditation regularly. This gave him the calm and ease to ward off” another acute stress reaction. Some years later I had a letter from him from America, where he is pursuing a distinguished career in medical research, just to thank me once again.
There are others who suffer this type of reaction. We have all seen it in the unfortunate bridegroom. He rises to make the speech which he has prepared for weeks. But the occasion is too much. His brain is flooded with impulses. He is struck dumb. His mind is blank.
Distractibility
«My mind wanders off the subject. No. It flits off. Here and there. All over the place. Can’t keep my thoughts on the topic in hand. I am attending to some simple, everyday business problem. There is some unimportant noise in the street. Then I find myself miles away from the matter I was working on, following up trains of thought about the noise in the street.’
‘At lunch with two or three others, the talk is pleasant enough. Then find my thoughts have been waylaid on to something else.
‘Mind is too active. Jumping about all over the place. Help me to use this activity. Help me to keep it on the one subject. »
Stress over-alerts our nerve cells. They fire off too readily with messages that are not relevant to the matter in hand. It is usually the observer, rather than the person concerned, who notices that the person under stress is not keeping to the subject under discussion.
Our brain has a complicated mechanism which allows our thoughts to flow freely. One subject of thought follows the next because it has a relevance to it in some way, logically, emotionally, or by similarity. And so the process of thought flows on. If our nerve cells fire off too easily, we become distracted from our main topic, and our stream of thought is diverted into quite irrelevant channels.
*37/98/5*