AREN’T WE ALL CONCERNED WITH HOW WE LOOK? THE BURDEN OF ACTUAL DISFIGUREMENTYou might think that people with actual deformities bear an extra burden because the world may actually respond to them less positively, or even with revulsion. But many people with BDD firmly believe that this is how others react to them. A majority believe—and many are completely convinced—that people take special notice of their defects. They may be so absorbed in their perceived defect that they interpret virtually any kind of response by another person as a reaction to the defect.The body-image literature also notes that different people with actual physical deformities adapt quite differently to them. Some cope fairly well, whereas others don’t. Various factors influence how a person reacts to a disability. This is also true in BDD, as some people are able to function relatively well while others are disabled by their body-image concerns. It’s been said that to psychologically overcome a disability, one must stop thinking about it all the time and get on with living. Paradoxically, to stop thinking about the defect is exactly what’s so difficult in BDD.*224\204\8*

ALCOHOL AND CROSS-ADDICTION: WITHDRAWALJust as tolerance develops for alcohol, so can it also develop for some other psychotropic medications. The list of abuse-able drugs mentioned earlier included a number of drugs that produce tolerance. These include the barbiturates, sedatives, and the minor tranquilizers. Just as with alcohol, as use continues, more of the substance is required to keep doing the same job. This is reinforced by the ail-American viewpoint that discomfort is pointless when chemical comfort is only a swallow away. When tolerance develops, withdrawal symptoms may accompany abstinence. Several of these will be briefly described.Barbiturates have been around since the beginning of this century. Central nervous system depressants like alcohol, they have an abstinence syndrome very similar to that of alcohol. At lower doses, withdrawal symptoms will most likely be limited to anxiety and tremulousness. At high levels, more serious withdrawal symptoms may develop. These can include convulsions and a “DT-like” syndrome of delirium, disorientation, hallucinations, and severe agitation. Barbiturate withdrawal presents a medical situation as serious, and potentially as life threatening, as that accompanying alcohol withdrawal.Drugs included within the category of minor tranquilizers can be subdivided into different groups depending on their chemical compositions. These differences are important when it comes to withdrawal and potential problems of abuse. Librium and Valium both belong to the subgroup known as the benzodiazepines. When drugs of this subgroup are abused, withdrawal symptoms may be present if use is abruptly stopped. Withdrawal symptoms can include anxiety, tremulousness, sweating, insomnia, nausea and vomiting, muscular weakness, confusion, psychosis, and possibly convulsions. A full-blown “DT-like” picture is generally not associated with the benzodiazepines. However, it is increasingly recognized that physical dependence is not a casual issue. Clinically, more individuals are presenting for treatment following a longstanding use of Librium or Valium and more recently Xanax. Even if the symptoms of physical withdrawal associated with these substances are not as dramatic as those of alcohol or barbiturates, getting off these medications is no easy matter. For other subgroups of drugs in the minor tranquilizers category, withdrawal can be much more serious. Be particularly alert to abuse of Miltown or Equanil (the brand names for meprobamate) and Doriden (glutethimide). Withdrawal symptoms for these can be as dangerous as those associated with alcohol or barbiturates. (Doriden may have been prescribed for sleep. Don’t overlook “just a few sleeping pills” in pursuing a drug history.)*178\331\2*

I am not sure what is meant by ‘letting the anxiety and the attacks happen’. They are so much a part of my life I don’t know how to separate them from myself.

Answer

When we are feeling happy, we don’t continually monitor our feeling of happiness or think of how happy we are, we just let the feeling of happiness be there as we get on with whatever we are doing. The same applies to the feelings of anxiety and the attacks. We can separate ourselves from them simply by noting them, ‘this is anxiety, this is an attack’. We just let them be there, without concentrating on them. Not concentrating on them allows us to concentrate on other aspects of our lives. The same is true for temporary feelings of depression. We need to be aware of why we are depressed and we let ourselves be depressed, but we don’t become the depression. If we don’t add to it by continually worrying about how depressed we are, it will disappear because we are not fuelling it. Of course, it does depend on the degree of your depression. If the depression stays with you it will need to be treated by your therapist.

*111/94/8*

All we know at this stage is that we are walking into unknown territory and it can seem easier to stop where we are, despite our unresolved difficulties. What we don’t know is that the unknown territory is that of the self. As the ‘disordered’ self breaks down it can mean the birth of our real self.

*103/94/8*

People have asked the question of what to do with their thoughts while working through issues in psychotherapy. There will be issues in therapy which need to be thought through and worked with, and they may cause anxiety and attacks. Again, it means walking a fine line. Be aware of why they have occurred and let them happen.

As our management skills increase we will begin to realise a subtle pattern emerging with our anxiety and attacks. When we are avoiding confronting particular personal issues, or in other words, not being honest with ourselves, we may find ourselves reacting with anxiety or an attack. We can use these subtle guides to get to know and understand ourselves on a deeper level.

*96/94/8*

The working-through process means we are getting in touch with ourselves, perhaps for the first time. We become aware of how we think and react on a day-to-day basis, which usually gives us insights into ourselves which we have not had before.

Sometimes these insights can be quite threatening, as they could signal the need for changes in our life.

The drop in motivation may mean we are avoiding these insights. Everyone wants to recover, but many of us want recovery to mean we will return to our former self. The working-through process means we are getting in touch with ourselves, with feelings, needs and desires we may never have known existed. These will need to be integrated and their integration will mean not a return to the old, but the birth of the new.

Have a look and see if fear of change has caused the drop in motivation. Become aware of how those fears are holding you back.

*95/94/8*

Our loyalty has to be to ourselves. This can be very difficult for many of us because we feel we are being selfish in putting our own needs first. How can working towards our recovery be selfish? In the working-through process, especially at the beginning, we need all of our energies for ourselves.

The lack of understanding by those close to us can create extra stress. All of us are extremely sensitive and vulnerable to other people’s suggestions or ideas, even if it means doing the opposite to what we feel is right for us. Part of the recovery process means accepting that we don’t have to go along with what other people expect from us. We don’t have to do, or accept, anything we know is going to be detrimental to ourselves and/or our recovery. Like everyone else, we have the right to do what is right for us.

*90/94/8*

*49/75/2*

*19/57/2*