Is it vanity or a serious disease?

What Sachin has is called Body Image Disorder or Body Dysmorphic Disorder [BDD], a mental illness involving obsessive focus on a perceived flaw in appearance. Individuals with BDD worry that their ears are very big, nose is blunt or very sharp or large, head is huge, face has lot of acne and so on.

Body Image Disorder involves behaviours like staring at one’s appearance in the mirror for long periods of time, excessive grooming such as wearing trendy clothes all the time, having fashionable hairstyles, changing one’s style to keep up with the current trends, applying a lot of make-up, constantly comparing one’s appearance to others, trying very hard to hide a defect by wearing loose clothes, make-up and accessories like cap, glares, long boots, scarf, etc.

Such people also try to adjust their body positions so as to keep their ‘defect’ from showing to others. They engage in skin picking, repeated checking of the flawed part, are preoccupied with it during conversations and seek reassurance from others. Emotionally, the person feels hopeless that ‘nothing can be done to improve the situation’, embarrassment and shame, as they believe that they look ugly. Cognitively, they remain preoccupied with thoughts of poor body image and continue to think that this is the worst thing that could happen. They are usually delusional or have poor insight, which means that they are completely or almost convinced that their defects are repulsive or deformed. Individuals with distorted body image tend to have ideas or delusions of reference, that others are looking at, talking about, looking down upon or uncomfortable with their defect.

Mental diseases often co-exist with BDD

Body Dysmorphic Disorder often co-exists with other clinical disorders such as anxiety, other OCDs, eating disorders, substance use disorder and depression. The onset of these symptoms is in adolescence and it causes lifetime impairment if left untreated. It is more commonly diagnosed in females than males; however, it occurs equally in both genders. The symptomatology may be different in both genders. For example, men may obsess over their fitness or being too small or insufficiently muscular while women may focus on their skin and facial appearance. Sometimes, individuals have actual flaws in physical appearance which are apparent to others as well. However, their obsession about it is excessive and causes significant impairment in daily functioning.

Individuals with BDD are highly self-critical, apprehensive, withdrawn, feel unacceptable to themselves and others and have low mood. Thus, they are severely distressed which could lead to increased risk of attempting and committing suicide. Sometimes, individuals who are suffering from BDD come to me at a stage when they have already attempted suicide at least once.

The suicidal ideations reported by them are higher than that in general population and sometimes, even higher than those diagnosed with depression or other mood disorders. Thus, those diagnosed with BDD are likely to have higher rate of suicidal ideation.

Body Image Disorder  is one of the least diagnosed disorders in the clinical setting and it often goes undiagnosed as individuals feel ashamed and like to keep it a secret. They also fear that nobody will understand them. Another reason may be poor insight into their problem. This may again lead to an increased risk of suicide due to untimely intervention. Ideally, treating BDD is easier when diagnosed early, before the thoughts and insecurities become deep-rooted.

Signs and symptoms of Body Dysmorphic Disorder

The following signs and symptoms need to be recognised when dealing with individuals suffering from BDD:

1. BDD is diagnosed if the person is markedly worried about slight physical flaws which can be observed with the individual obsessing about them for at least an hour every day and are very difficult to resist or control. This preoccupation may lead to stress and hamper their everyday functioning.
2. An eating disorder shouldn’t be the precursor for the concerns related to one’s appearance to be diagnosed with Body Dysmorphic Disorder .But, BDD and an eating disorder may occur together. Both diagnoses should be avoided and differences analysed.
3. There are subtle signs such as desire to avoid daylight, finding comfort in dark settings, avoiding social outings altogether and being unusually self-conscious around others.
4. The person with BDD may have keen interest in cosmetic surgeries.

Sometimes, individuals opt for cosmetic surgeries as they believe that their problems will disappear once they correct their flaw(s). However, cases of multiple surgeries are not unheard of and surgeries are not the most effective treatment for Body Dysmorphic Disorder. It may benefit some to improve their confidence and make them feel better about their bodies, thereby leading a routine life. However, more often than not, the individuals still remain unhappy with their appearance after the initial phase of satisfaction and may desire more procedures to improve it further, till the time they believe that they have become perfect. Also, their obsession might move onto another body part, once their previously defected part is treated.

How to treat Body Dysmorphic Disorder

The most effective treatment for Body Dysmorphic Disorder primarily includes pharmacotherapy and cognitive behavioural therapy (CBT).

Medications such as Selective Serotonin Reuptake Inhibitors (SSRIS) are very effective to elevate the mood and reduce the anxiety symptoms. If the individual is delusional, antipsychotics may be recommended.

The component factor in Cognitive Behavioural Therapy for individuals with Body Dysmorphic Disorder involves mirror training where a client learns to observe their entire body and see it in a holistic way which involves focusing on the areas of the body disliked by the individual. Further, the individual may be refrained from excessive mirror checking, mindfulness and habit reversal for skin picking or hair pulling or plucking. They are also taught relaxation exercises to help them deal with their anxiety. Another goal of CBT is to change the irrational ideas/beliefs to rational ones.

Individuals with BDD often have ‘all or none’ thinking, they magnify their perceived flaws, discount the positive attributes and often use ‘labelling’ and ‘emotional reasoning’. During therapy sessions, they learn to identify their irrational thoughts and change them through techniques of cognitive re-structuring and affirmations. Clients with Body Dysmorphic Disorder generally have poor insight, so I recommend not asking them direct questions that involve their views on their appearance because for them, their flaws are realistic and not imaginary.

The treatment plan includes a disciplined regime regulating sleep and eating patterns, and physical activity. The family is educated to help them understand the nature and severity of the problem and to help them cope with the same. The other co-morbid disorders are also treated with medication and therapy. Thus, with a holistic approach, BDD is treatable and the person can recover from it completely. An individual, however, may take time to overcome this problem.

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Acclaimed humour writer P G Wodehouse was known for his near-pathological fear of interaction with strangers. One day, as his wife was leaving to look for an apartment in New York, he called out to her: “Please find one on the ground floor!” “Why?” she asked. His reply: “I never know what to say to the lift boy.”

Everyone, including extroverts, suffer from social anxiety once in a while. Occasional self-consciousness has little, if any, effect on your life. But there are those for whom it is a bane. For such individuals, shyness is not situational but built into their very disposition. And it often costs them a lot in life—professionally and personally.

For instance, when it comes to academics, regardless of their aptitude and interest, shy men and women tend to choose subjects in accordance with their shy nature, carefully avoiding fields that need them to interact with too many people. Later, when they appear for job interviews, once again their shyness pushes them back as they find themselves less able to express themselves easily. As a result they do less well in job interviews and are promoted less often than their peers. Not only that, according to some social scientists, shy persons may actually decline a promotion, because the higher you go up the corporate ladder, the more people you will need to interact with. In business too, they lose out on sales and other business opportunities, again thanks to their reticence.

Shy individuals miss the boat in social settings too. Many can’t stand up for their rights and suffer silently. In a group, they are restrained in expressing their views and often forced to go with decisions they don’t agree with. On the personal front, they struggle with finding and making new friends and experience loneliness too. Their diffidence prevents them from letting down their guard and having fun. It is also difficult for them to express their feelings towards their loved ones, creating misunderstandings and heartbreaks. Some even lose out on potential marriage partners, all because they couldn’t muster up the courage to speak to them. In short, there are hundreds of other small and big ways in which shyness kills your joy and steals your potential for success, and shy people know them all too well.

In this issue, Michal Stawicki tells you how overcoming his shyness changed his life. He offers three easy steps that will make you more confident and socially comfortable. “Overcoming shyness doesn’t need polished first liners, wonderfully white teeth or a body language that emanates confidence. It takes minuscule habits practised every day with consistency,” he writes, while urging you to act on your hang-ups decisively.

If you suffer due to your shyness, take heart for in this issue you will discover that shedding it isn’t as ominous as it appears. All it requires on your part are three D’s—dedication, determination and discipline.

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Asking for Help Is an Act of Courage

We’re all afraid to reach out and ask for help because of a reason. We share with each other an unconscious thought­—if everyone else appears to be doing okay, I should also appear okay and be able to manage without asking for help. A cry for help is considered sinister and something to be avoided. To appear weak frightens us. When we can bring those or similar thoughts up into our consciousness and recognise them, we can begin to let them go. Then we are able to be honest with each other and create mutually helpful relationships quite naturally.

Have You Ever Cried in Public?

Canadian poet, Shane Koyczan wrote, “Openly crying is like taking a vacation from the ‘everything’s okay’ mentality that the world wants everyone to adopt.” It’s high time we all take a permanent vacation from that fake worldview and become more authentic with each other. Asking for help isn’t necessarily as straight-forward as we believe it to be. Among my friends, the general consensus about what holds them back from asking for help was ‘not wanting to be a burden’ or ‘appear weak’. So, when finally there comes a point that one does ask for help, those beliefs are triggered, strengthening a particular pattern. We might spend our life making great efforts to be sure we never need ask for help, which can result in catastrophe if we let the pressure of trying to be that person get to us, and have it all go unchecked. Or we might find ourselves asking for the same help over and over. Each time we find help, there’s temporary relief but in a matter of time the same problem plagues us again. Old, conditioned reasoning kicks in, making us believe we must be stupid or lazy because we can’t manage on our own. These sorts of thoughts connect us to a universal victim/tyrant energy, a potent and pervasive pattern that runs our lives.

Crowdfunding and My Fear of Public Humiliation

As I write this I’m in the middle of a crowdfunding campaign to publish my book the Steps, a new paradigm in healing for our time. Crowdfunding is essentially a large number of people contributing small amounts of money in return for ‘perks’ and the opportunity to participate in the manifestation of an idea. When crowdfunding was suggested to me, I dismissed it because, truth be told, I was terrified of the prospect of public humiliation. What if nobody contributed or so few did that I’d look like a fool? What if people ridiculed my project or called me bogus? All those subconscious fears surfaced. Then two women from opposite sides of the world sent me an Internet link to a TED talk by Amanda Palmer, titled The art of asking.  I took it as a sign to take on crowdfunding. What I have found through this experience is that crowdfunding is about much more than financing your project.

It can be the sort of ‘openly crying’ that Koyczan wrote about. It’s like jumping into fire to publicly ask for help in this way. For me, it has brought to the surface every fear of asking. It has allowed me to release unconscious patterns of thought so that I no longer attract circumstances into my life that allow me to play the victim. Bruce Lee said that a goal isn’t necessarily something to be achieved, but is somewhere to aim. Instead of scaling back and playing small, I took the courage to set my crowdfunding budget high enough to achieve my vision of the Steps and risk my biggest fear of looking foolish. In the process, I have freed myself from any fear of humiliation.

Have the Courage to Look Foolish

We don’t all need to launch a crowdfunding campaign to release the unconscious patterns that hold us back from asking for help. We can just begin noticing. We can become our own calm witness to unconscious beliefs and the patterns we create that hold us back. A lovely way to practise asking for help is by asking your guides or angels—even if you don’t believe in guides or angels—you can ask and notice what is triggered, what fears come up to be looked at. The more you have the courage to risk looking foolish or weird by asking your guides for help, the more you will be able to ask clearly for what you need in the physical world. Support networks will appear, what you need will turn up. When you discover this for yourself, you release the victim/tyrant energy that enslaves so many. And as we each free ourselves from these binding energetic patterns, we create a world where everyone is acknowledged, cared for and freed completely from whatever holds them back from asking for help.

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About 700 million years ago, individual cells started to assemble into multi-cellular colonies. The collective awareness afforded in a community of cells was far greater than an individual cell’s awareness. Since awareness is a primary factor in organismal survival, the communal experience offered its citizens a far greater opportunity to stay alive and reproduce.

From awareness to evolution

The first cellular communities, like the earliest human communities, were basic hunter-gatherer clans in which each member of the society offered the same services to support the survival of the community. However, as the population densities of both cellular and human communities reached greater numbers, it was no longer efficient or effective for all individuals to do the same job.

In both types of communities, evolution led to individuals taking on specialised functions. For example, in human communities, some members focussed upon hunting, others upon domestic chores or child rearing. In cellular communities, specialisation meant that some cells began to differentiate as digestive cells, others as heart cells, and still others as muscle cells.

The dawn of consciousness

Most of the trillions of cells forming bodies such as ours have no direct perception of the external environment. For instance, liver cells ‘see’ what’s going on in the liver, but don’t directly know what’s going on in the world outside of the skin.

It is the function of the brain and the nervous system to interpret environmental stimuli and send out signals to the cells that integrate and regulate the life-sustaining functions of the body’s organ systems.

The successful nature of multi-cellular communities allowed evolving brains to dedicate vast numbers of cells to cataloguing, memorising, and integrating complex perceptions. The ability to remember and select among the millions of experienced perceptions in life provides the brain with a powerful creative database from which it can create complex behavioural repertoires. When put into play, these behavioural programs endow the organism with the characteristic trait of consciousness—the state of being awake and aware of what is going on around.

Awareness about the ‘I’

Many scientists prefer to think of consciousness in terms of a digital quality—an organism either has it or not. However, an assessment of the evolution of biological properties suggests consciousness, like any other quality, evolved over time. Consequently, the character of consciousness expresses itself as a gradient of awareness from its simpler roots in primitive organisms to the unique character of self-consciousness that is manifest in humans and other higher vertebrates.

The expression of self-consciousness is specifically associated with a small evolutionary adaptation in the brain known as the prefrontal cortex. This is the neurological platform that enables us to realise our personal identity and experience the quality of ‘thinking’.

Monkeys and lower organisms do not express self-consciousness. When looking into a mirror, monkeys don’t realise that they are looking at themselves; they perceive the image to be that of another monkey. In contrast, neurologically advanced chimps looking in the mirror perceive the mirror’s reflection as an image of themselves.

How is self-consciousness different

Consciousness enables an organism to assess and respond to the immediate conditions of its environment that are relevant at that moment. In contrast, self-consciousness enables the individual to factor in the consequences of their actions in regard to how they impact the present moment and how they will influence the future.

Self-consciousness is an evolutionary adjunct to consciousness in that it provides another behaviour-creating platform: the role of a ‘self’ in the decision-making process. While conventional consciousness enables organisms to participate in the dynamics of life’s ‘play’, self-consciousness offers it an opportunity to simultaneously be an observer in the ‘audience’.

From this perspective, self-consciousness provides individuals with the option for self-reflection, reviewing and editing their character’s performance. Collectively, conscious and self-conscious functions of the brain are referred to as the mind.

Excerpted with permission from Spontaneous Evolution: Our Positive Future [And A Way To Get There From Here] by Bruce Lipton and Steve Bhaerman

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