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SURGERY, DERMATOLOGIC TREATMENT, AND OTHER NONPSYCHIATRIC MEDICAL TREATMENT FOR BDD: DO THESE TREATMENTS WORK? OUR RESEARCHES’ ANSWER

admin — Wed, 05 Jan 2011 13:48:07 +0000

In an important 2001 survey of 265 members of the American Society for Aesthetic Plastic Surgery (ASAPS), 84% of the surgeons who responded said they had operated on a patient who they thought was appropriate for surgery, only to realize after the operation that the patient had BDD. Eighty-two percent of these surgeons thought the patient had a poor outcome with surgery: 43% said the patient was more preoccupied with the perceived defect than before surgery, and 39% said the patient was now preoccupied with a different perceived defects Eighty-four percent had refused to operate on people with BDD.
It’s interesting that only 30% of the surgeons who responded to the survey thought that people with BDD should never have cosmetic surgery. This may reflect the fact that some people don’t tell the surgeon about their unhappiness with the surgical outcome. Others do worry less about the perceived defect after surgery, but the problem is that most don’t experience improvement of BDD overall (for example, their concern may shift to another body area); often, the surgeon isn’t aware of this.
In my experience, most people with BDD are not litigious, physically aggressive, or violent, but 40% of the ASAPS survey respondents said that a patient with BDD had threatened them. Twenty-nine percent of the surgeons said they were threatened legally, 2% physically, and 10% both legally and physically. Certainly, this is a terribly unfortunate outcome for the surgeon and BDD sufferer alike, and it’s yet another reason to avoid surgery.
Recent surgery studies from Sweden and Finland may be relevant to BDD. These studies found that women who have cosmetic breast augmentation surgery are more likely to commit suicide (about three times more likely) than women from the general population. An American study also showed an increased risk of suicide in women opting for breast augmentation. One wonders how many of these women had BDD, and whether BDD might have contributed to at least some of the suicides.
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LEARN TO SLEEP

admin — Fri, 08 May 2009 09:28:43 +0000

Do we learn to sleep? The answer is yes. This is for the same reason as a little boy knows that when he feels the urge he should do it in the toilet and not in the sitting room. A learning process, popularly known as toilet training, is involved. The same is true of sleep. We learn to sleep at night and stay awake during the day, even if we sometimes feel sleepy during the day.

We are more familiar with other learning experiences, such as learning to drive a car, learning to ride a bicycle, and so on. We take for granted that we know how to sleep, but in fact we all had to learn to sleep.

Psychologically, there are three kinds of activities:

* Innate activities—no learning is required

* New activities—a lot of learning is involved, e.g. driving

* Modified innate activities, such as toilet training and sleeping

Innate activities are basic activities that require no learning, including breathing, crying, smiling, reaction to pain, and so on. These are biological activities that are built into our system.

At the other extreme, there are new activities and skills which require learning from scratch. We spend years in school to learn how to read and write. We attend many lessons to learn to drive, and we learn to ride a bicycle after many falls. In fact, we are learning all the time without knowing it. We are imitating, copying from others, and modifying ourselves all the time. Indeed, it is the acquisition and accumulation of new skills, created and handed down through previous generations, that makes the human race so superior.

‘Modified9 innate activities are innate activities that are modified by learning; this learning is seen to be essential if the person is to conform to the norms of society. The most well known example is toilet training. From birth, babies have no concept and respect of when and where to relieve themselves; hence they have to wear nappies. It is considered normal for babies to wet and dirty their nappies at any time of the day. When they reach the age of about three it is no longer considered normal for them to do it anywhere they wish. They learn to go to the toilet and to do it properly there. This learning is gradual, and the activities are modified to conform to the expectation of parents and the pressure of society.

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COMMON CAUSES OF ANXIETY: PROBLEMS OF THE OVERSEXED AND THE UNDERSEXED

admin — Wed, 29 Apr 2009 10:19:15 +0000

It is unlikely that any two individuals will have exactly the same sexual appetite. In this respect the early steps of marriage are a period of adjustment for almost every couple. It is common for the man’s desire to be rather greater than that of his wife. He adjusts to a little less and she to rather more. However, sometimes there is a gross difference in sexual appetite which may remain throughout marriage and serve to keep both partners in a state of tension. In the less common situation in which the wife has the greater sexual appetite, her repeated demands may be particularly destructive to her husband because they psychologically threaten his masculinity.

If the adjustment of the partners one to the other is incomplete, the actual sexual experience itself may become a potent cause of tension. Thus if the sexual response of the husband is too rapid, his wife is left unsatisfied. If this pattern is constantly repeated the wife is likely to show signs of nervous tension and may develop any of the symptoms produced by anxiety.

Many introvert men are not as sexually active as their extrovert brothers. An attractive woman with four children was married to an introvert husband who was some years older than she was, and who no longer satisfied her feeling of sexual need. She was tense and irritable, and disturbed by sexual feelings. She had an affair with another man. This, through guilt and fear lest her husband should find out, only increased her anxiety, and she soon abandoned her lover.

She gradually learned to cope with her anxiety and the disturbing sexual feeling by practising the relaxing mental

A young couple who had been married five or six years consulted their local doctor because they were not getting on together. He referred them to me. The wife was an attractive girl, who covered up her tension very well. However, she openly admitted her irritability with her husband and the children. The husband was a big extrovert athlete, very much in love with his wife, and very willing to help in any way he could.

The wife eventually disclosed that she had come to dread going to bed. Her husband desired sex relations almost every night. Whatever her state of mind, she always created the illusion for her husband’s sake that her sexual desire was as strong as his. This she was able to do because of her control over her feelings. The situation had eventually become impossible and she had broken down with anxiety. All the time the husband was completely unaware of his wife’s

sacrifice, and he was simply astounded when it was explained to him. He promptly reacted by curtailing his sexual appetite and heaping gifts on his wife.

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HOW LONG AFTER STARTING ST JOHN’S WORT SHOULD I EXPECT IT TO TAKE BEFORE I SEE AN IMPROVEMENT?

admin — Wed, 29 Apr 2009 08:52:32 +0000

Although some people may experience relief from the symptoms of depression within days of starting St John’s Wort, for others it may be as long as six weeks before there is a real sense of improvement. A informal survey of European psychiatrists who have treated hundreds of patients with St John’s Wort revealed that most believe that one should wait at least three weeks after a full dose (900 mg per day) of St John’s Wort has been started before judging whether it has been effective or not. In this regard, St John’s Wort is similar to other anti-depressants, most of which take between two and four weeks to produce their initial anti-depressant effects. The reason for this delay in response to anti-depressants has been the focus of considerable research, but at this time no one has really come up with a satisfactory explanation for it. If you detect no benefit after three weeks, you have the choice of increasing the dosage of St John’s Wort, switching to a conventional anti-depressant, or adding the anti-depressant to St John’s Wort.

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