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POST-TRAUMATIC STRESS SYNDROME
When stress breakdown symptoms have been experienced over a period of time in relation to one specific stress, the person may become conditioned to associate the symptoms of breakdown with memories of the stressful situation. Just as a person can be conditioned to associate unpleasant or pleasant memories with odours or sounds, the person who has undergone severe stress may re-experience some of the feelings experienced at the time of the stressful event when these are triggered by stimuli which rekindle memories of the event.
Thus, a person who experienced anxiety with the sound of helicopters in a war zone may re-experience some of that anxiety at the sound of a helicopter passing overhead years later. If a person held prisoner in an airplane hijacking experienced stage three symptoms, mention of the event or associations with it might recall the memories of what the breakdown symptoms felt like.
Moreover, if the person still has a lot of unresolved feelings and repressed conflicts about this stressful period of his life, then the rekindled feelings might re-introduce those emotional conflicts. This vicious cycle of after-effects can be called the post-traumatic stress syndrome.
It is not the aim of this book to deal with the post-traumatic stress syndrome, a complex problem requiring those skills necessary to examine conflicts which have been repressed into the unconscious mind. The correct treatment of post-traumatic stress disorder is by skilled psychotherapy.
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WHY BDD IS UNDERDIAGNOSED: HOW TO AVOID MISDIAGNOSING BDD
Anti-DepressantIt’s important to note that all of the disorders in this table can co-exist with BDD. In other words, a person with BDD can have other disorders in addition to BDD. In fact, people with BDD often have depression, social phobia, or OCD as well as BDD. (See Appendix D for more detailed information). If a person with BDD also has other psychiatric disorders, both those disorders and BDD should be diagnosed and targeted in treatment.
BDD is usually easy to recognize if you keep in mind the reasons for misdiagnosis and underdiagnosis, as well as the clues in this chapter. But what’s most important is taking your own concerns or those of someone else seriously. If you simply reassure someone with BDD that they look fine (even though they do), they may take this to mean that you aren’t really listening to or don’t understand their problem. Asking about and listening to the concernsЂ”and taking them seriouslyЂ”is the best approach to take.
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Anti-Depressant
Anti-Allergic/AsthmaTo return to BDD’s definition, noting that the degree of distress and impairment in functioning varies considerably. This criterion is very helpful; requiring significant distress or impaired functioning for the diagnosis helps guard against overdiagnosis of BDD. Not everyone who dislikes his or her appearance has BDD. After all, concern with appearance is very common, especially during adolescence. Studies have shown that most of us dislike at least some aspect of how we look. And this concern is no doubt amplified by the messages that bombard us in fashion magazines, clothing advertisements, and makeup commercials. Magazines, television, billboards, and movies are filled with beautiful and glamorous people who, intended or not, set a certain standard for how we should look.
So this criterion (along with the requirement for preoccupation in criterion 1) draws a line between normal and excessive concern, and it indicates that people with normal appearance concerns shouldn’t be considered to have a psychiatric disorder. A problem with this criterion, however, is that it isn’t clear exactly where to draw this line. How much distress is required for the diagnosis? And how much impairment? While this issue of how to distinguish between “normal” and “abnormal” also applies to other psychiatric and medical disorders, it’s particularly complicated with regard to BDD, because BDD echoes the very common concern so many of us have with how we look. Where normal concern leaves off and BDD begins is sometimes a difficult judgment call.
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YOUR SLEEP AND OTHER PEOPLE: NOISY NEIGHBOURS
Meanwhile, what about those neighbours thumping about upstairs or next door? They can be infuriating, and getting infuriated is going to keep you awake just as much as the noise. If it’s really horrendous, with regular all-night parties, for instance, you can complain to the police, who may or may not be helpful, your local authority (some of whom are helpful about asking noisy neighbours to keep it down), or your Environmental Health Officer. Very often the trouble lies as much with bad soundproofing, particularly in flats, as with the noisy neighbours. The construction of some buildings actually magnifies noise, and the people making it may have no idea that they are disturbing you.
If you can’t do anything about improving your soundproofing and the noise is consistent, tell the neighbours about it, unaggressively. If you don’t already know them, forming friendly relations with the person who is thumping above your head or next door makes the disturbance much less threatening and therefore more bearable.
Try to keep a sense of humour and think of other possible solutions. A friend of mine, woken every night by a pair of high heels clomping about on an uncarpeted floor, presented their owner with a pair of moccasins, which she wore at night from then on, to the benefit of my friend’s sleep.
Anti-DepressantYour attitude can make a lot of difference to how badly you are disturbed. Our sensitivity to noise varies; some people can sleep through a hurricane, but wake when their baby cries. Babies themselves seem to be able to sleep through anything. And my cat will sleep contentedly through other people’s parties; she isn’t telling herself that she’s being disturbed by nasty, inconsiderate people.
The next time noise starts up just as you are going to sleep, give yourself a choice: you can get angry and tense, or you can treat it as a challenge. Try simply living through the noise without attaching to it any emotional thoughts about other people’s selfishness. Relax your body, breathe deeply and regularly; know that you are getting the physical rest you need, and congratulate yourself on not getting worked up.
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CAUSES OF INSOMNIA: BABIES AND CHILDREN
The arrival of a new baby is bound to cause a disruption of sleep, though hopefully a welcome one. Parents who accept that their sleep will be broken while the baby needs night-time feeds suffer less from fatigue than those who feel resentful about it; feeling irritable about losing sleep will lose you more sleep, and will convey itself to the baby. But there is no doubt that this is a tiring period, particularly for mothers. If possible, take time during the day to catnap or simply relax.
Children can suffer from disturbed sleep too, which disturbs parents’ sleep in turn. There’s nothing like a screaming baby or a bedtime battle with an older child, to create irritability and taut nerves, which will affect you during the day as well as at night.
During the 1980s a number of sleep disorders clinics were started to help the parents of small children suffering from sleep disturbances. Children’s needs vary as much as adults, and parents are not always certain whether they are doing the right thing. Nowadays we are beginning to accept that being a parent is an art that not everyone possesses by instinct, and parents feel less defensive than they used to about asking for expert advice.
Anti-DepressantThe subject of sleep in children demands more space than I can give it here. For practical advice on establishing a good sleeping and waking routine and dealing with specific problems, I suggest you read My Child Won’t Sleep, by two child specialists; clinical psychologist Jo Douglas, and psychiatrist Dr Naomi Richman.
I am sorry, however, that although generally not in favour of giving drugs to children the authors suggest that diazepam, for example, might occasionally be prescribed for children with night terrors or in emergencies. If you have to give a child a sedative, there are equally effective, non-chemical, herbal or homoeopathic remedies. Children also respond very well indeed to Bach Flower Remedies.
*39/169/2*

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WHY BDD IS UNDERDIAGNOSED: MISDIAGNOSIS, PURSUIT OF NONPSYCHIATRIC MEDICAL AND SURGICAL TREATMENT
Misdiagnosis
Anti-DepressantPursuit of Nonpsychiatric Medical and Surgical Treatment
Many people with BDD see dermatologists, plastic surgeons, and other physicians rather than mental health professionals. They search, usually unsuccessfully, for a cosmetic solution to a body-image problem. Many people are unaware that BDD is a known psychiatric disorder for which psychiatric treatment is often effective. Although surgeons and dermatologists are increasingly aware of BDD, many are not. A 2001 survey of 265 members of the American Society for Aesthetic Plastic Surgery found that the surgeons thought that only 2% of patients seen for an initial cosmetic surgery consultation have BDD, whereas research studies indicate the rate is actually 7%-20%.
*35/204/8*

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STRESS BREAKDOWN: LEARNING/UNLEARNING NEURONES AND INHIBITION
I didn’t have to learn how to sneeze, breathe, cry, swallow, blink or smile at my mother when I was a newborn baby. I didn’t have to learn how to do these things and I am not really able to forget how to do them. I can choose to inhibit or try to inhibit these reflexes, but I can’t really forget them.
On the other hand, I did have to learn how to write my name, how to speak English, and how to tie my shoelaces. These things I can forget if I neglect to practice them daily.
The nerve cells involved in learning must also have the capacity for forgetting, otherwise real learning would not be possible. If it were otherwise, we would never be able to learn from our experiences, forgetting the wrong and remembering the right way of doing something.
Built-in knowledge, such as knowing how to blink in response to sudden movement in front of the eyes, is not able to be forgotten in the same way as we forget algebra we learned at school. Usually, this built-in knowledge is handled by brain-cell networks in different areas of the brain from those that contain the learning /unlearning brain cells, which have the capacity to learn and forget as well.
It is the learning / unlearning brain cells which have their function disturbed by excessive stress.
These learning/unlearning cells are usually situated in the cerebral cortex, the folded outer layer that we call the outer grey matter of the brain; these cells are able to be stimulated or inhibited by the reticular activating system as being responsible for the willpower, and which is also responsible for the selective attention mechanism.
It is important to know that these learning/unlearning brain cells can be either stimulated or inhibited by the reticular activating system, because it is often the over-stimulation of the learning/unlearning cells by the reticular activating system that provokes the switching off phenomena responsible for third stage stress breakdown symptoms.
I hope my explanations have made it possible for the reader to see how a person experiencing excessive stress, and who attempts to ignore the warning signals of persistent anxiety and loss of emotional control, could so over-stimulate the cells of the brain cortex as to require the brain cortex to protect itself by switching off overloaded circuits. It is this switching off in response to excessive stress that causes the symptoms of third stage stress breakdown.
*29/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: WHO’S IN THE DRIVING SEAT?
Sometimes we don’t know why we feel anxious; some people don’t even recognize that they are anxious. Hypnotherapist Gloria May points out: ‘A lot of chronic insomniacs seem to rush around trying to get themselves tired enough to go to sleep, but it doesn’t tie up like that. I think sometimes they are seeking oblivion from problems they’re unaware of. The state of going into sleep is when your unconscious chucks things up, and they want to avoid that. But even then, they’re often not even aware of worries popping up; they just say “I can’t get to sleep”.’
Rushing round all day and going to bed with a mind that’s exhausted but awake is all too common these days. Modern life doesn’t encourage natural rhythms. We start work at the same time all year round, whether it’s dark or light; commuter travel is uncomfortable and frustrating. Office atmospheres are often unhealthy as well as fraught; lunch may be a snatched sandwich or hamburger. For many people ‘relaxation’ takes place in the artificial atmosphere and noise of pubs and discos.
Small wonder that rushers-round can’t sleep. The whole physical and nervous system becomes jangled and out of gear. There is no breathing space to look at problems Ђ” or just to breathe! Body and mind are poorly nourished. And underlying this frantic rush, an anxious little voice is often sending anxious little messages that we don’t want to hear Ђ” Am I good enough?’ Ђ” ‘Is this all there is to life?’ Ђ” ‘Why aren’t I happy?’
If your life is anything like this, and it has resulted in insomnia, ask yourself what you are truly getting out of it. OK, so modern life is like that. But does that mean yours has to be? What or who is driving you to over-work, eat badly, maybe drink too much, or work till all hours so that by bedtime your brain is buzzing?
Much of our busy-busy behaviour is due to conditioning by other people, and our beliefs about how life should be lived may be nothing to do with what we really need. The work ethic says we mustn’t waste a moment; social standards say we must have a ‘good time’ and be successful. We must also be seen to be successful by buying and owning more and more goodies for ourselves and our families; to keep the merry-go-round turning we have to work even harder. Yet when you were a child, was it this that you wanted from life? Who programmed your computer?
Anti-DepressantNone of these voices are the whole you. But you may be allowing one or a few of them to drive you into more and more activity, because that’s what they see as ‘leading a full life’. They are kidding you. What they are actually doing is forcing you to drive on one cylinder, heading towards burn-out. To be your whole self, in touch with all your resources, you need to recognize the existence of those other, neglected parts of you. It could be their need to be heard that is keeping you awake.
So, see if you can hear the thoughts and voices underlying your daily rush. Who’s driving you on? Are you responding to other people’s programming Ђ” perhaps a critical father demanding that you prove your worth, or a perfectionist mother setting you impossibly high standards? Do you have to believe those voices from the past? What does the real you need and want from life, and are you getting it?
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Other names: Wellbutrin, Bupropion
WHY BDD IS UNDERDIAGNOSED – ADDITIONAL CLUES: DEPRESSION, SOCIAL ANXIETY, AND OTHER SYMPTOMS
Many people with BDD are depressed. Others have problems with alcohol or
drugs. Many are anxious, and some have panic attacks. Indeed, BDD often
coexists with or causes other psychiatric symptoms and disorders, which can
Anti-Depressant
Anti-SmokingI and other researchers have carefully assessed the frequency of other psychiatric disorders (e.g., depression) in people with BDD. Conversely, we have studied BDD in patients with other psychiatric disorders. Appendix D shows these findings in greater detail. These study results indicate that major depression is the most common disorder in people with BDD. Major depression is characterized by depressed mood, decreased interest and pleasure, and other symptoms, such as sleep and appetite disturbance. While major depression is fairly common, affecting 10 to 20% of the general population at some point in their lifetime, more than 80% of people with BDD have major depression at some point in their life. For many, the depression is quite severe. In some cases, the depression and the BDD seem to be somewhat “separate,” whereas in many cases, the depression appears largely due to BDD.
In a study that my colleagues (Dr. Andrew Nierenberg of Harvard Medical School) and I did, BDD was more than twice as common as OCD in people with depression. In a research study of depressed people in Italy, BDD was more common than many other disorders, including OCD, social phobia, simple phobia, generalized anxiety disorder, bulimia nervosa, and substance abuse or dependence. These results are striking because, as a little-known disorder, BDD generally isn’t looked for in people with depression. In addition, Dr. Nierenberg and I found that depressed people who also had BDD had onset of depression at a relatively young age and unusually persistent depression. These findings suggest that depressed peopleЂ”especially those with long-standing depressionЂ” should be asked whether they have BDD symptoms.
*39/204/8*

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Other names: Neoral, Sandimmune

THE THIRD STAGE OF STRESS BREAKDOWN: DISTANCING AND STIMULUS-AVOIDING BEHAVIOUR
In the third stage of stress breakdown, the discomfort caused by high levels of stimulation will cause the over-stressed person to behave in such a way as to reduce incoming stimulation. This is the time, for example, when the over-stressed person becomes seemingly suddenly interested in watering the lawn with a hand-held hose, with his back towards the house. The masking noise of the rushing water, the fact that people rarely insist on walking over wet grass to talk, and hosing being a solitary occupation, makes this a favourite activity of the stressed person seeking to reduce sensory input. Pulling out weeds is another useful ploy. I remember once, in a period of overwhelming stress, just how interested I became in digging weeds out of the lawn with a dinner fork.
I have found over the years that over-stressed people can often be found sitting on their back steps, back to the house, looking out into the backyard. This seems to be a suitable spot for minimizing the possibility of being spoken to.
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Other names: Endep

STRESS BREAKDOWN: FIRST SYMPTOM – HIGH LEVELS OF SENSORY INPUT CAUSE DISTRESS
Information comes in to the brain through sensory nerve fibres. Usually sensory nerves are activated by tiny sense organs or ‘receptors’ which respond to certain sensations and fire off the nerve. There are receptors for heat sensation, touch, position sense, balance, acceleration, cold, light, sound, taste and smell. As well, the muscles and the joints are supplied with stretch receptors which provide the information necessary for the body to know where its various parts are.
There doesn’t seem to be a specific receptor for pain impulses. We experience pain from over-stimulation of nerves which don’t have specific sense receptors, and also whenever specific sensor receptors are over-stimulated. Thus a too-loud noise, a too-cold stimulus, a too-hot stimulus, or a too-bright light, will all cause the person to feel pain.
Pain is experienced, therefore, when the sensory nerve fibres are over-stimulated. There is a corresponding hypersensitivity which occurs not when the incoming fibres are over-stimulated, but when the receiving brain cells are over-sensitive. Receiving brain cells become over-sensitive when they are over-stimulated in stress breakdown. Thus the over-stimulation of brain cortex cells in stress breakdown may have the effect of making the incoming information disagreeable, just as excess actual stimulation makes the sensory input disagreeable or painful.
In stress breakdown which has gone beyond second stage, the receiving brain cells are so over-sensitive that strong sensory stimulation becomes actually disagreeable.
Even stimulation which has previously been highly enjoyable, such as sexual stimulation, music and perfume or exotic tastes can become disagreeable in the third stage.
In third stage breakdown, women who previously enjoyed an active sex life might claim to be totally uninterested in sex and, even more than that, actually turned off it. ‘I can’t stand him to even touch me, doctor. What’s wrong with me?’ In the third stage, over-stressed people who normally love music might be irritated by the very music they previously enjoyed. This leads to over-stressed people complaining that the radio or TV is too loud, and that they have ‘gone off’ their favorite programmes or activities.
*30/129/5*

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HOW IS BDD DEFINED: DISTRESS OR IMPAIRMENT IN FUNCTIONING – TYPES OF DISTRESS
Nonetheless, if a person experiences at least moderate distress because of their perceived defect (as opposed to none or only mild distress), this is compatible with a diagnosis of BDD. More severe distressЂ”or extreme and disabling distressЂ”is clearly indicative of BDD. Regarding impairment in functioning, if a person avoids anythingЂ”for example, dating, school, or any social situationsЂ”that’s consistent with having BDD. Even if the person doesn’t avoid anything, they may still qualify for BDD if their appearance concerns interfere with their functioning in other waysЂ”for example, if their work or school performance are impaired to at least a moderate degree. This might occur because their concentration is poor, their work or schoolwork is interrupted by BDD thoughts or behaviors, they’re late for things, etc. And in cases of moderately severe or severe BDDЂ”like Jennifer’s, Chris’s, and Andrew’sЂ”it’s crystal clear that the impairment is significant and, therefore, the diagnosis applies.
People with BDD commonly experience interference in areas such as the following. They may avoid these situations partially or completely, or they may experience other types of interference in these areas:
Ђў Spending time with friends
Ђў Dating
Ђў Intimate relationships
Ђў Attending social functions and events
Ђў Doing things with their family inside and outside of home
Ђў Going to school or work each day
Ђў Being on time for school or work
Ђў Missing school or work
Ђў Focusing on school or work
Ђў Productivity at school or work
Anti-DepressantЂў Daily activities
Ђў Maintaining a household, doing errands, going shopping
*28/204/8*

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STAGE THREE OF STRESS BREAKDOWN: THE PROBABLE STRUCTURE OF THE ‘CIRCUIT BREAKERS’
In order to understand the circumstances under which the brain s circuit breakers begin to function, and how their function affects human behaviour, we don’t really have to know their actual structure. After all, we don’t have to know how a digital watch works before making use of it. For those who are interested, however, it is probable that the ‘circuit breakers’ are small groups of cells which release neuro-transmitter chemicals. These chemicals have the effect of rendering the brain cell receiving strong levels of input less able to fire off. These small groups of cells are arranged so that they are activated by the same incoming stimuli as the receiving cells but they can also be activated by the reticular activating system.
When we use our will-power, or we concentrate hard in trying to remember or to forget something, it is the reticular activating system that either activates or inhibits areas of the brain in accordance with our wishes. When this reticular activating system is over-strained or malfunctions, then grossly abnormal responses might be expected from an otherwise normal brain.
Regardless of what their structure actually is, these inhibitory cell circuits function just like ‘circuit breakers’ when the person is experiencing excessive stress.
In exactly the same way as the circuit breakers in our domestic electrical circuits will switch the current off if the current flowing in the circuit is too high, the brain appears to be able to switch off overloaded circuits to protect itself from overload.
The reader may in fact have experienced this switch-off response of the brain to sudden, overwhelming input, or perhaps observed it in others. People who are informed of a sudden tragedy affecting a loved one, may appear stunned and unable to think, incapable of making a coherent response. They may even appear not to have heard the person who brought the bad news, and may make no visible or audible response. The person who hears the tragic news may later be able to describe the experience as a total switching off of thinking. The switching off which occurs in stress breakdown is something like this.
In third stage stress breakdown, the brain has been forced to allow its function to be disturbed in order to protect itself.
If we can’t protect our nervous systems from over-stimulation and overload by some suitable circuit breaker mechanism, we may well suffer epileptic discharges which will render us incapable of survival.
It is the way the brain tries to protect itself from overload that determines the symptoms of third stage stress breakdown.
*27/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: FACING UP TO THE PROBLEM
Night-time is no time to deal with anxieties, regrets and general unpleasantness. But it may be the only time you’ve left for them to be heard, because they are uncomfortable. Busy with other things during the day, you brush your worries under the carpet and promise yourself you’ll deal with them later. Only you don’t. Meanwhile, under the carpet they grow into monsters which creep up on you when you’re at your most vulnerable.
It’s really vital to deal with that unfinished business during the day. It’s not going to go away until you do. Once you start taking some sort of action, even if it’s only the decision to take action, the energy that has been stuck, going round in circles, or keeping you depressed, will begin to flow.
Talking to someone else is a good start, whether it’s a professional counsellor, your partner or an understanding friend. Airing your troubles begins to get them out of your head, and once they’re out they can look far less frightening than when they loom up in the dark hours.
If you’re anxious, talking with someone else may help you to realize that anxiety is actually quite normal; other people get anxious, too, and ride it out. Without uncertainties life would be pretty boring. Half the enjoyment of films and books is not knowing how they will end. Anxiety in fact is very akin to excitement. It can spur you to action. It’s only when it becomes crippling that anxiety itself is something to worry about.
For depression, too, finding a good listener can help you to get those debilitating feelings out of your system. Don’t be ashamed to ask for professional help in the form of counselling or psychotherapy; I’ll talk more about this in the next chapter.
For the unfulfilled, talking with someone else can help you to uncover what’s holding you back, and help you to move forward.
Meanwhile, if you’ve no one to talk to, start getting things out of your system by writing them down, or even drawing pictures of them. Some people find it helps to have a teddy bear or a doll to talk to Ђ” it may sound childish but it often works. Or keep a ‘worry-jar’: every time a worry pops into your head, write it on a slip of paper and put it in the jar.
Change your self-talk
Really listen to your thoughts, and see if you can’t change them. Is your anxiety based on reality? Supposing you don’t pass that exam, or driving test, or get through that interview, is it really a matter of life or death? What’s the worst that can happen? Can you remember a previous time when you were anxious and everything turned out fine?
Similarly, if you are depressed, you are probably regularly feeding yourself negative statements. Remind yourself that they are the result of faulty computer programming. What parents or teachers said about you in the past has nothing to do with the real you, now. Start to talk kindly to yourself, as you would have liked to be talked to when you were a child. Eventually that inner child will begin to feel happier.
Above all, resolve not to focus on your depression. It may hang around you like a cloud, which makes it difficult to ignore, but you don’t have to get sucked into it. Try to regard it as you would regard bad weather; it’s making the world look grey for the moment, but it will pass. Meanwhile, it doesn’t have to stop you living life to the full.
Anti-DepressantTake some action
Whether you’re anxious, depressed or unfulfilled, it’s important to start moving. The longer you put off doing something about an unsatisfactory situation, the worse it gets Ђ” and the more your mind will churn when you get to bed. Energy that you could be using during the day revolves in circles, keeping you unhappy and uncomfortable, instead of being used creatively. When you start to move forward, that energy will support you.
*31/169/2*

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Other names: Clomicalm

Anti-DepressantI should emphasize, however, that in my experience the need to make difficult judgment calls is the exception rather than the rule. Of the patients I’ve seen, only 3% have had an unassessable defect in the absence of others I could assess. Only about one-third have had an actual defect, and in only a minority of cases was it difficult to determine whether it was “slight” (therefore qualifying for BDD) or clearly present. Most people I’ve seen had what I considered a nonexistent defect. In some cases, the disliked body part is actually very attractive. One woman who was obsessed with her “ugly” hair actually had beautiful hair. While she despaired because she thought it was “frizzy and ugly,” other women asked her who her hairdresser was so they could have theirs done in a similar style. Another young woman had been asked to work as a model, and as a child she’d been told that she would someday be Miss America; however she believed that such requests and statements were motivated by pity for her ugliness.
It’s worth considering whether people with more noticeable, “clearly present” defects (who don’t qualify for a BDD diagnosis because of the obvious nature of their deformities) might nonetheless have features of BDD. Do people with birth defects, accident victims, or others with very noticeable physical flaws have experiences similar to those of people with BDD? Are they preoccupied with their flaw? Do they suffer as a result? Does it interfere with their functioning? Do they feel very self-conscious in social situations?
I’ve met some individuals with obvious defects for whom the answers to these questions are “yes.” And research findings suggest that, for some individuals, the answers are “yes.” Although by definition they don’t have BDD because their defect is very obvious, they’re preoccupied, distressed, and sometimes impaired by their appearance concerns. It’s possible that much of what I’ll be describing in this book applies to them as well. And what about people with physical features that, strictly speaking, aren’t defects or flawsЂ”for example, tattoos they no longer like? Do some of them have features of BDD? Some appear to. This is another important question that needs to be studied.
*26/204/8*

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LOSS OF THE ‘LAW OF STRENGTH’ IN CONDITIONED REFLEXES UNDER CONDITIONS OF SEVERE STRESS BREAKDOWN
In stage three stress breakdown the law of strength of the nervous system no longer operates; the more intense the stimuli coming in to the nervous system in preparation for eating, the less the response might be. The proper reception of food into the stomach and the efficient initiation of the appropriate stomach, gall bladder and pancreatic responses to the food, might well be interfered with. Thus real difficulties with the initial handling of food could arise as a symptom in third stage stress breakdown. Such a disorder would usually be described as nervous dyspepsia.
There is a reflex concerned with the elimination of faeces, which we human beings are able to inhibit to some extent. This is the gastro-colic reflex. When food reaches the stomach, the large bowel automatically increases the rate of propulsion of its contents towards the rectum. Thus our bowels usually move after breakfast. However, if we don’t eat breakfast, the regular association of eating breakfast at that time of day will result in a bowel movement anyway, because the nervous system has been conditioned to move the bowels first thing in the morning.
We have usually learned to inhibit this reflex later in the day. Most people find they don’t have to move their bowels after lunch at work. Some people do, some don’t. We have therefore learned how to inhibit this reflex when it is socially inappropriate for our bowels to move. We can see that the task we set the nervous system with regard to when we will allow elimination of faeces is very complex, and it is not difficult to imagine that malfunction of these conditioned reflexes in third stage stress breakdown might be responsible for abnormal large bowel activity. This disordered state is usually diagnosed as irritable bowel syndrome.
*37/129/5*

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Other names: Fludac, Rapiflux, Sarafem

DEALING WITH THE CAUSE OF INSOMNIA: YOUR SLEEP AND OTHER PEOPLE
As I mentioned earlier, some sleep experts believe that anger and resentment are more common causes of night-time churning than anxiety or depression. If that’s the case with you, it’s important to drop them, for the sake of your sleep. It is possible!
If you’re angry about a current situation, either accept it or do something about it; otherwise all that negative energy (and there’s a lot of energy in anger) will go on keeping you awake.
Many people fear confrontations, but it is possible to say what you feel about a situation without having a violent explosion. Telling the person or people concerned calmly how you feel about their behaviour, without blaming or accusing them, can often open up better communications.
If you can’t confront the person, or if the anger-making situation is in the past, whether it’s last week or several years ago, tell yourself that whatever anybody else has said or done, however unfair, cruel, snide, or dishonest, it’s over now. While you are brooding, going over the scene or scenes, rehearsing the remarks you could have made, or intend to make in the future, the other person may well have forgotten the whole thing. The only person who’s making you angry now is you, every time you mentally relive those scenes.
In addition, if you accept the suggestion that thought is energy, consider this: what we think comes back to us. It is generally accepted in healing and spiritual groups that when we send thoughts of healing and kindness to other people, not only will those people benefit but so will we. Thoughts of resentment and vengeance may not affect other people at all, unless it’s to make them even more unpleasant; but they most certainly will boomerang back at us.
A young woman was persuaded by a friend to take the Silva Method course, though she wasn’t too keen. She had been going through a bad time. She hadn’t been able to sleep without pills since a car accident, and she was also full of vengeance towards her ex-husband. When her friend told her her vengeful thoughts would attract negativity to herself, she dismissed the idea as rubbish. However, during the course, she began to understand the sense of it. After regularly practising the techniques, including forgiving her husband, her life has become happier, she sleeps well without pills, and is amazed at the happy relationship she has with her ex-husband; she has also developed powers of healing.
There are other considerations in storing anger. You are not only keeping yourself awake. Firstly, you are setting yourself up for physical problems: high blood pressure, heart problems and arthritis are among the side-effects of long-harboured anger. Secondly, when you let someone else’s behaviour rule your thoughts, emotions and sleep, you are making the person responsible for your peace of mind, handing over to them your personal autonomy.
So, anger and resentment and all those feelings of ‘it’s not fair’ are best dropped. I know that’s easier said than done. But once you really see that they’re doing you no good, you can at least decide to let them go. This decision is the first step towards freedom; it will set your thoughts moving in a different direction.
Resentment is often a deeply ingrained habit, but it’s one we may have been taught by others. Small children are naturally forgiving; I suspect that some of us learn to be resentful from our elders. It’s an unhealthy habit, and once you’ve given it up you will feel better all round.
Do try to get it physically out of your system, during the day. Anger creates the tense muscles that give you headaches and shoulder pain, as well as stimulating the release of stress hormones, all of which can contribute to your insomnia.
One way is the famous pillow-bashing technique, which really does work. Find a time and a place where you can be alone, and make a pillow the focus of your anger. Don’t think of it as the person you are angry with: you are not trying to hurt anyone else but to heal yourself. Start thumping. Yell at the same time. Really let go, and keep shouting and thumping until you are exhausted, drained of your angry feelings, and with your shoulders and arms released of all that tension.
If punching pillows is not your scene, there are other options, like driving to a lonely spot and shouting at the top of your voice. Or write a letter to the person who’s bugging you and then tear it up and burn it. Get all the exercise you can, particularly exercise which uses your arm muscles.
The next stage is to forgive the person or people in question. That can be a hard one, but the important thing is your willingness to forgive. Forgiveness doesn’t mean that you condone bad behaviour, or that you have to let anyone continue to treat you badly; it means that you are wiping your own slate clean and getting the past out of your system.
Visualization techniques can be helpful here. In a relaxed state you can visualize the other person, possibly attached to you by cords that your thoughts and feelings have created. See yourself cutting through those cords and burning them, freeing you both. Or imagine a conversation in which you tell the person that you’re releasing them from your thoughts. It may help to imagine them apologizing to you!
Another approach is to imagine your mind as a beautiful room, in which you have the right to entertain the guests of your choice. At the moment it’s full of these cross, grumbling people, reminding you you’ve been hard done by. Tell them you don’t enjoy their company, and show them the door. If they’re reluctant to leave, sweep them out with a broom! Your room is now empty and clean, and there is space in it for more welcome visitors, including peace of mind, serenity and better sleep. Show them in and make them at home.
Anti-DepressantA lot of depressed people suffer from guilt and anger towards themselves, quite often for no good reason. If you belong to this group, do be kind to yourself. Forgive yourself as you would forgive anyone else. Use visualization to let go of those feelings and start afresh, reminding yourself of all the good things about you.
Sometimes anger and resentment are so deeply rooted that people need help in sorting them out Ђ” if their parents neglected or ill-treated them in childhood, for instance. In that case, do get some professional counselling. Of course, it’s usually easier to forgive someone who’s not around than the person playing records upstairs all night Ђ” or snoring beside you in bed.
*36/169/2*

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THE THIRD SYMPTOM OF STAGE THREE BREAKDOWN -APPARENT CHANGE IN PERSONALITY AND PRIORITIES
When the brain has to begin switching off overloaded circuits to protect itself, the law of strength which I mentioned before, fails to operate. This is because strong stimuli cause switching off responses while weak stimuli do not. Therefore, the person with stage three stress breakdown symptoms begins to respond inappropriately, making little or no response to big problems while responding normally to little problems. Not unexpectedly, while the over-stressed person is ignoring those problems that normally worry him the most, attending instead to trivial details, his behaviour quite mystifies his workmates and relatives.
After all, our personalities are often defined on the basis of our priorities. Obsessive people are pre-occupied with lists and procedures; narcissistic people place a lot of emphasis on appearances, and so on. In third stage stress breakdown, problems that bother us most may begin to evoke the least response, which is actually the opposite to the way we usually behave.
Because the behaviour of a person exhibiting third stage stress breakdown symptoms can be so out of character for that person, others find it difficult to describe the over-stressed person’s behaviour adequately. Thus members of the family or workmates of the over-stressed person may sometimes resort to extravagant psychiatric diagnoses or accusations of moral degeneration, because the over-stressed person’s behaviour has become incomprehensible on the basis of his previous personality.
*34/129/5*

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HOW DO I KNOW IF I HAVE BDD? BDD IS COMMON BUT UNDERDIAGNOSED Ђ“ THE PATIENT GROUPS
BDD also appears fairly common in other patient groups. In a research study I and my colleagues did of people who were seeing a dermatologist, 12% had probable BDD. Studies of people seeking cosmetic surgery have found that from 6% to 20% have BDD.
Anti-DepressantIt is clear, however, that health care professionals usually miss BDD. As a result, BDD sufferers may not find out that they have BDD, and treatment may not succeed because it doesn’t target BDD. Five research studies have looked at this important question. In these studies, the researchers asked a series of people about BDD; they detected and diagnosed it in people who had it, because they systematically asked everyone in the study about BDD symptoms. Then the researchers looked at the patients’ medical records to see whether their clinician had correctly diagnosed BDD. The dismaying finding was that in all five studies, the doctor or therapist hadn’t diagnosed a single person with BDD. This was the case in the Minnesota inpatient study; in that study, all of the patients with BDD said that BDD was their most important problem or a major problem. And in my study of 200 people with BDD, half of those treated with psychiatric medication never revealed their BDD symptoms to their doctor.
These research results are very consistent with what I’ve heard for more than a decade from my patients and people participating in my research studies. A staggeringly high proportion of them have suffered with BDD for many years, even decades, but were never diagnosed, even though they’d seen plenty of doctors and therapists.
*32/204/8*

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DEALING WITH THE CAUSE OF INSOMNIA: DEPRESSION AND SADNESS
Although it’s possible to be both anxious and depressed, usually the last thing a depressed person wants to do is rush around: one of the most common symptoms of depression is lack of energy. Depression comes in many forms and degrees of severity There are two main types: reactive depression, triggered by unhappy or difficult events, and endogenous depression that can strike some people regularly for no good reason at all. At its worst it becomes clinical depression, which may need medical or psychiatric treatment.
As long as you are not clinically depressed, you can start helping yourself Ђ” and the sooner the better, before the habit of depression becomes too ingrained. You will need to make an effort to go against the lethargy that keeps you down. But it really is possible to change your self-denigrating thoughts and feelings about yourself, though you may need some help in doing so.
Anti-Depressant
Mental DisordersLong-term depression often harks back to childhood. Unloving or over-critical parents have perhaps instilled the message that you are no good, unlovable, or always in the wrong, and the computer obediently repeats these messages. You don’t have to believe them.
The vast majority of people can learn to feel better about themselves, just as one learns a new skill. But you will have to take the first steps, by deciding to make the change.
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