GENETIC/NEUROBIOLOGICAL THEORIES: IS BDD A BRAIN DISEASE?”A PERSON WITH CURIOUS HAIR”

How could excessive appearance concerns—which might seem clearly caused by sociocultural factors, such as the media’s influence, or by psychological factors, such as low self-esteem—be rooted in a person’s penes and brain chemistry? How could BDD be a brain disease?
I start with this perspective because I think it’s likely that neurobiology lays the groundwork for BDD—that genetics and biologically based tendencies make BDD possible by creating a vulnerability to developing the disorder.
This hypothesis seems less strange when you consider that some patients themselves believe that BDD has a neurobiological basis. “My obsession may or may not be related to my childhood experiences, but it mostly feels chemical— out of my control,” Ron said. “It feels like something biological is driving it.” Other people, after searching for a psychological explanation for their symptoms in therapy, are unable to find one. While it could be argued that this therapy outcome reflects unconscious resistance to uncovering a psychological reason for the symptoms, this seems unlikely to be the case for many patients.
A neurobiological basis for body image disturbance actually has a long historical tradition. Early in this century, neurologists explored the neurobiological basis of several types of distorted body image. These included anosognosia (the inability to recognize or acknowledge impaired bodily functioning, such as paralysis) and neglect of one side of the body (e.g., shaving only one side of the face or using only one sleeve of a robe). In 1931, a neurologist reported that some of his patients had interesting reactions toward their left-sided paralyzed limbs, considering them “strange, ugly, disfigured … thickened, shortened, or snake like.”
Such body-image disturbances are related to brain processes and are often caused by brain damage, such as a stroke, in the brain’s parietal region. Injury to the occipital lobes of the brain—the primary visual processing area—can impair visual perception, including perception of facial images. And damage to another area of the brain, the border of the occipital and temporal lobes, can result in an inability to visually identify previously known faces. Some people with damage to this brain area can’t identify their own face in the mirror. An example of the bodily misperception that brain injury can cause is a case published in 1947 in which a man described a dog as a person with “curious hair.”
An unusual case of BDD-like symptoms also points to the involvement of neurobiological factors in the disorder’s development. A 21-year old man who became preoccupied with thoughts that his ears had become smaller, one foot was bigger than the other, and other appearance concerns was eventually discovered to have subacute sclerosing panencephalitis, a rare and diffuse brain disease that was presumably related to the BDD-like concerns. While it’s likely that very few cases of BDD are caused by an identifiable neurological disorder this case illustrates that brain processes gone awry can lead to distorted bodily perception and excessive bodily preoccupation.
*169\204\8*

SAME TIME EVERY MORNING

Understanding the biological clock is important for people who have sleep problems. If we wake up every morning at the same time and sleep at about the same time every night, we are helping to keep the biological clock accurate. If we sometimes read, watch television, or have wild parties late into the night, this irregular life style disturbs the accuracy of the biological clock, so that when we want to sleep we may not feel sleepy. By keeping irregular hours of sleeping and waking, we cause ourselves to experience a mini jet lag all the time. To help the biological clock work in our favour, we should wake up at the same time each day. We know that under free running experimental conditions, without any outside time cue, our natural biological clock is about 25 hours. Were we to let nature take its course, we would sleep about one hour late each day. After a few days, we would be sleeping a few hours later than our normal sleep time. To reset the biological clock to 24 hours, we must ensure that we wake at the same hour each day. Although we think we have little control over sleeping, we do have full control over waking up. Waking up at the same time each morning is now one of the most important disciplines recommended by most sleep experts for treating insomnia.

*49\174\4*

MORE ADVANCED EXERCISES FOR SELF-MANAGEMENT OF ANXIETY: COMBINING THE EXERCISES WITH PHYSICAL ACTIVITY

We naturally think of being quite still while we are relaxing. This is so for the early stages. However, we have now mastered the technique. We are familiar with the relaxed feeling of the mind, and we have learned to induce it quite easily and quickly while sitting down. We have now reached the stage when we can practise the exercises while we are actually doing things.

The first step in this direction is a very simple one. As we relax, we allow our eyes to open a little, and to close again very slowly. We do this in time with our breathing. As we breathe in our eyes open, then they close again as we breathe out. All the time we maintain the deep relaxation of our mind. At first we are content to have our eyes open just a little. As we become more experienced, they can open wider and wider.

The next stage is to do our exercises as we walk slowly down the street. We feel the relaxation of our mind. We are conscious of the ease and rhythm of our body as we move; and all the time we are aware of the relaxation of the muscles of our face and the calm of our mind.

In a similar way the housewife can practise while doing rhythmical domestic tasks such as polishing or using the vacuum cleaner on the floor. By this means the calm and ease of mind induced by the exercises is kept with us in all the tasks of our everyday life.

*75\57\2*