IMPROVING BODY IMAGE IN BDDSeveral studies have investigated whether body image improves when BDD is treated. Dr. Rosen’s study of cognitive behavioral therapy (CBT) evaluated body image before and after CBT treatment using a subscale of the MBSRQ. After treatment, the study participants felt more physically attractive and more satisfied with their appearance. In my study of fluoxetine versus placebo, which also used the MBSRQ, fluoxetine did not improve appearance satisfaction more than placebo (a sugar pill). However, fluoxetine was more effective than placebo in diminishing the importance of apactivities). And in my fluoxetine (Prozac) and fluvoxamine (Luvox) studies, treatment with the SRI generally improved the perceived appearance flaw, in some cases even making it disappear. Of the people who responded to one of these medications, 60% said that the appearance flaw seemed better when they were taking the medication. Of this 60%, two thirds said that it actually looked better visually; the other one third said it looked the same visually, but they liked it better.It’s interesting that in the computerized visual discrimination study I mentioned above, BDD participants who were taking an SRI tended to perform more like healthy control subjects, whereas BDD participants who weren’t on an SRI performed more poorly. In other words, those on an SRI had better visual discriminatory abilities. The reason for this isn’t clear. However, because SRIs decrease appearance-related preoccupations and anxiety, they may have helped BDD participants better attend to and focus on the computerized task.*219\204\8*

GENETIC/NEUROBIOLOGICAL THEORIES: ARE CERTAIN BRAIN AREAS INVOLVED IN BDD?Might BDD also involve certain brain regions—for example, regions that are rich in serotonin? That is, can subtle anomalies in certain brain structures be identified? Recent brain-imaging techniques have greatly advanced the search for abnormalities in brain structure and functioning in a variety of psychiatric disorders. To my knowledge, only one brain imaging study of BDD has been published. Dr. Scott Rauch, his colleagues, and I compared 8 women with BDD to 8 healthy comparison women using a brain imaging technique called morstructure. The number of study subjects was small, so the results are preliminary, although the study had many methodologic strengths. We found that the MRI scans of the BDD group differed in some ways from those of the healthy controls. In technical terms, the BDD group had greater total white matter (the part of the brain consisting of myelin, which acts as an insulator and speeds up nerve signal transmission, and connecting fibers). The BDD group also had a “leftward shift” in caudate nucleus asymmetry, meaning that the left caudate was relatively larger than the right. The caudate is a C-shaped structure deep in the brain’s core, which is involved in regulating voluntary movements, habits, and cognitions; it may be involved in “pre-packaged” repetitive behaviors such as BDD rituals. The other brain areas we examined were similar in the two groups.It isn’t entirely clear what these results mean. They suggest that, on average, the brains of people with and without BDD differ in some subtle ways, perhaps (but not necessarily) reflecting differences in brain development. (These findings do not, however, indicate that people with BDD have brain “damage.”) It’s interesting that the brain regions affected in our study are the same regions that tend to be affected in people with OCD. However, the specific findings are actually opposite from OCD: OCD studies have tended to show reduced (rather than increased) white matter volume and a rightward (rather than a leftward) shift in caudate asymmetry. We could conclude from this that BDD and OCD may be related disorders because they seem to involve similar brain regions. However, they don’t appear to be identical disorders, because the details of the MRI results differed. Our study also found that the brain regions involved in BDD differ from those involved in depression (e.g., the hippocampus). This finding, while preliminary, suggests that BDD isn’t simply a form of depression.*175\204\8*

Our brain sorts out the stream of impulses effectively if given moments of profound quietness, as in the meditation. Sleep works in a similar way but less effectively.

Moments of profound quietness come to us naturally, as in moments of repose, day-dreaming, pondering nature, or just strolling aimlessly, and in the togetherness of man and woman. In these conditions our brain idles and, unbeknown to ourselves, lapses into a rhythm in which the disturbing impulses are better integrated.

When our level of nervous tension is high, these natural ways of avoiding stress tend to elude us.

We can easily discipline ourselves into moments of profound quietness by simple meditation. This type of meditation works by producing conditions which help the brain integrate the nervous impulses coming into it; and its effect flows on into daily life.

To obtain the full effect of meditation we need to follow certain simple rules such as transcendence of slight discomfort, avoidance of awareness of our breathing, and the avoidance of any sense of striving.

Meditation is the key to the management of stress which allows us a full and active life without avoiding the problems which may beset us.

Additionally, those people who learn to use the inner resources of their mind in this way, not only enhance the coping power of their brain and suffer little stress, but also come to experience a heightened dimension of life that eludes most of us.

*90/98/5*

Every now and then people come and consult me professionally, not because they are ill, but because they feel that they are missing out on something; they feel that their quality of life could be better.

“Not a complaint for what I do not have; but a yearning for something better, and knowing that the barrier is within me, within myself.’

‘I have the feeling that life could be better, together with the knowledge that such an experience is not dependent on the material circumstances of our life.”

The barrier that holds us back from this experience is the tension, anxiety and defensiveness engendered by stress.

Just look for a moment at the one or two people whom you know and whom you feel have moved in the direction of a heightened quality of life. They are all people who, by our standards, are remarkably free of stress.

Turning to religion

“As a young person I was quite religious. I had strong beliefs, and used to pray. In fact, at one time I had ideas of having a religious life. I suppose they were just vague ideas, but they soon left me. There were so many distractions of life around me. There was my job, then love, and then later the children. Now with this trouble, this going to pieces of myself, I have tried to return to religion; but it does not help. I don’t experience the reality of it as I once did. I feel barren.”

Many people suffering from stress have talked with me about their experience of turning to religion for help. Like the person just quoted, many of these have been people who have had an active religious life in childhood and their youth, but have dropped it when taken up with the distractions and problems of early adult life.

Two clear patterns of reaction have emerged from talking with these people. Those who are disturbed by stress, and who turn to religion with the object of obtaining relief from their symptoms, in general do not get much help. However, there is a second group, equally disturbed with symptoms of stress, who turn to religion, not for the express purpose of getting help from their distress, but rather for an inner need to find some religious experience. This second group, unlike the first group, does in fact gain relief from their stress, although they have not directly asked for it.

I think the explanation is along these lines. Those who call upon God – ‘Help me, help me, help me!’ – are in fact increasing the level of their anxiety, and the physiological effect is actually an increase in the severity of their symptoms. On the other hand, those who seek some kind of religious experience, simply because they feel the need of it, gain an inner calm. The level of their anxiety is reduced, and the severity of their symptoms wanes.

*83/98/5*

«I have to be careful about everything I eat. Just terribly careful. If I am at home it’s OK. I eat what I know I can manage. Go out anywhere, eat something different and it’s terrible. Pains in the tummy. Diarrhea. The evening is a disaster. Better to stay at home. But you can’t always do that. It affects the two of us. »

The brain cells, over-alert due to stress, respond to very little stimulation. If our food is very bland, the stimulus is minimal, and the rhythmical contraction of the muscles in the wall of the bowel proceeds normally. However, if we eat food that has stimulant qualities, either through its chemical composition or its physical structure, the bowel overreacts, and produces discomfort and diarrhea.

Nervous urination

«I have to make speeches and give lectures. This is part of my life- It is often very inconvenient. But just before I give the lecture, I feel I must pass water. This in itself adds to my tension about the lecture, and makes everything so much the more difficult. »

Nervous urination is one of the commonest symptoms of stress. It is brought about by similar mechanisms to those which produce nervous diarrhea. To those there is added the conscious reaction, ‘I had better pass water just to be on the safe side.’ This conscious reaction of prudence is distinct from the stress reaction which manifests itself as a need to urinate.

Muscle tensions

«My muscles get tense and sore, particularly around my neck and shoulders. I go for regular massage. It helps a bit. But I am always told that my muscles are very tense, and that I am a very tense person. »

The increase in anxiety, which is part of the stress reaction, prepares us for action. Extra blood is diverted into the muscles, and the over-alertness of nerve cells in our brain holds some of our muscle fibres in a state of contraction instead of their normal relaxed state. The muscles become sore as a result of many of the fibres remaining contracted.

Massage helps, but the better way is to get the mind relaxed, and so reduce the stress that is affecting the muscles.

*45/98/5*