Directory of health resources for healthcare professionals.

“Holly was a shy and attractive 16-year-old high school student, who was reluctant to discuss her appearance concerns because she was so embarrassed. With encouragement, she finally did. “I think my problems first began with shyness,” she said. “I felt very self-conscious and uncomfortable being around other people. But then, a few years ago, I started worrying about how I looked. First, it was my body shape. I thought my shoulders and hips were too broad and my waist was too small. Then I got a terrible haircut, and I started worrying about my hair—that it’s ugly and never looks right. It’s a real rat’s nest.”Holly thought about these perceived defects for several hours a day, and frequently checked them in mirrors and windows. “I get down on myself about it, because I shouldn’t be so concerned with my appearance,” she said. “It’s selfish and shallow.” Holly spent at least $40 a week on haircuts, permanents, and hair products—money she really couldn’t afford to spend. She wore loose-fitting clothes  to cover her body. Although she loved to swim, she avoided it because she was so self-conscious about how she looked. “Because I look so bad, I feel I don’t fit in anywhere,” she said. “I’m avoiding my friends, and I hardly ever go to parties.”As these stories illustrate, BDD occurs in adolescents and even young children. Many adults with BDD have surprisingly vivid memories of their early symptoms. A woman whose symptoms began at age 4, for example, clearly remembered hating her “stubby” fingers and insisting on wearing mittens at her fourth birthday party. Another woman had clear memories of hiding behind her mother’s skirt at the playground and refusing to go to nursery school because she looked so ugly. And another told me, “At the age of five I looked in the a mirror and said, ‘I’m ugly.’ To hide my ugly face, I wore sunglasses to kindergarten.”We don’t really know how common BDD is in children and adolescents, because so little research has been done. A study of 208 adolescents in a psychiatric hospital inpatient unit found that 7% had definite or probable BDD. Another study found that 2.3% of 566 high school students had BDD. This latter percentage was obtained with an unvalidated self-report questionnaire rather than an in-person interview, so it’s unclear how accurate it is. However, most people with BDD—about 70%—develop it before age 18. So it’s important to be aware that BDD can occur in this age group. It’s also important to realize that not all appearance concerns in adolescents are normal or simply a passing “phase”—sometimes they’re BDD.*153\204\8*

When Greta, a 69-year-old woman referred to Professor Volz by her GP, was asked what was troubling her, depression was the furthest condition from her mind. Instead she complained of many physical ailments – headache, stomach ache, tiredness and an unpleasant taste in her mouth. Her GP had been unable to find any physical explanation for these symptoms and the only abnormality he could detect was a slight problem with cardiac conduction, as measured by EKG. She had complained of sleep difficulties, for which she had been treated with sleeping pills with some success.

When Dr Volz questioned her, it became apparent that her difficulties had begun about two years before, shortly after her husband died unexpectedly of a heart attack. Despite having enough money and a close relationship with her son, who lived in the same town and visited her twice a week, Greta complained of sadness and hopelessness but, she hastened to add, ‘only when I am alone’. Dr Volz tried to explain to her that her symptoms might be due to depression, but she vehemently objected to such an explanation. When he suggested that she might benefit from a drug such as Prozac, she refused to take any synthetic antidepressants, insisting ‘that’s all chemical stuff.’ After two further visits with Dr Volz, he suggested that she might try St John’s Wort. To his astonishment, she immediately agreed to take this because ‘herbs are not dangerous.’

Dr Volz started Greta on St John’s Wort at a dosage of 900 mg per day. He noticed no improvement until she had been on the herbal remedy for six weeks, and it took another 10 weeks before Greta’s symptoms were reduced to a significant degree. Greta remains convinced that the improvement she has enjoyed on St John’s Wort has nothing to do with relief from depression but rather to ‘non-specific’ effects of the herb. Dr Volz feels no need to challenge this belief. She is no longer depressed and her mood has been stable without any adverse effects whatsoever – reward enough for a caring doctor.

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In the quiet time during relaxation imagine you are holding on to the string of a large balloon. There is a basket on the bottom of the balloon. Without straining to remember everything, put into the basket anything that has ever hurt you since before your birth: lack of love, rejection, failure, hurtful things people have said and done, grief, pain, frustration, anger, feelings of worthlessness, guilt, shame, or anything else lurking around. Now raise your hand briefly in a conscious attempt to let go of the string, and watch the balloon float out of sight. It may take several weeks to get some particularly hurtful things into the basket, but when you have managed it you will feel the release.

Sharing the ‘basket’ experience at the end of the session is helpful in two ways. Fellow feeling in the group is cemented by the realization that we all have similar hurts and insecurities, and also the person who is unwilling to relinquish the past hurts can use the group as a ‘sounding board’ to reflect his or her own thoughts in order to discover why there should be reluctance to let go. Often there is laughter during this sharing time. One man amused a group by saying, ‘It was a struggle, but I got my mother-in-law in the basket this week.’

If you are a private person and do not want to share your feelings it is still a useful exercise.

Be patient with yourself if you suffered a bereavement or other sad experience whilst you were on tranquillizers. You may have to work through those feelings again as you withdraw, even if you feel rationally that the experience is in the past.

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Urinary Symptoms

Frequency, burning, and incontinence are reported. Again, investigations usually prove negative. Treatment for infection is ineffective. If your doctor confirms there is no infection, drink plenty of water and be patient. Young and old, men and women, sometimes have slight (and temporary) urinary incontinence during withdrawal.

Influenza-like Symptoms

If you experience headaches, sore throat, stuffy nose, burning skin, it may be that you are cutting down too quickly. Some people recognize that they have had these symptoms for years. The influenza they experienced several times a year was when they ran out of pills, or forgot to take them on holiday. Many people remember a flu-like illness when their pills were stopped on admission to hospital for routine surgery. The symptoms always disappeared when they resumed taking their pills.

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It may be that the drugs artificially raise the blood sugar levels and therefore low blood sugar (hypoglycaemia) could be expected on withdrawal. Even if this is not so hypoglycaemic symptoms are often present in anxious people. The condition is not serious and is easily controlled by a sensible eating plan. Many have said that some of the withdrawal symptoms, e.g. shaking inside, confusion, and panic attacks improve if they do not allow themselves to get very hungry. You will see from the diet that sugar is not the answer to hypoglycaemia but it can be used as an emergency measure until a meal is possible. Carry glucose tablets, chocolate or sweets, particularly if you are driving or in any situation that needs concentration.

The following diet is an example of an eating plan that helps to keep the blood sugar stable. It is only a guide and not something to become over-anxious about. Many have found it greatly reduces the craving for sugar, or the desire for odd foods.

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1. Symptoms are less severe.

2. Better if you have a stressful job or domestic life.

3. Better for long-term users if hospitalization is not possible.

4. Gives time to adjust to deep emotional problems (if they exist).

5. General health can be improved at the same time, and therefore make withdrawal easier.

6. May be the best way for the person who has always been severely anxious.

7. Reduces risk of going back on pills.

SLOW WITHDRAWAL TABLES

These are only a guide. Where they show unequal dosage work out which part of the day you need the higher dose. Unless you are accustomed to only one dose per day, divide the daily dose as evenly as possible. By doing this you will avoid sudden drops of the level of the drug in the blood.

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