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Dr John B
Dr John B, Psychologist
Category: Mental Health
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Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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I have suffered from BDD since I was 15. I am a 42 year old

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I have suffered from BDD since I was 15. I am a 42 year old woman, with a current preoccupation over my hair falling out and wrinkles.I have had a number of cosmetic procedures, all of which help short term and deal with the immediate problem - I never obsess again about the same problem. I paid privately for CBT for a year, but it made me worse, and it got to the stage where I coul;dn't afford more treatment. I took Anafranil at a high dose several years ago for 2 years, but I hated how I felt while I was taking it: disorientated, not myself. It also made me unrealistically positive (I took it to cope with a relationship breakdown and for 2 years I believed the person would come back), and afterwards I had to cope with reality again. I am not prepared to take medication again. My GP told me there are no other options, and it is a chronis illness I will just need to continue to manage.
Is there nothing else I can try?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr John B replied 1 year ago.

Hi,

I'm sorry to hear of the situation. Before I proceed can I just confirm that your are referring to Body Dysmorphic Disorder?

Customer: replied 1 year ago.
Yes
Customer: replied 1 year ago.

Yes

Expert:  Dr John B replied 1 year ago.

Ok, thanks.

By the way it seems that I didn't receive your response straight away so there may be a problem with the system today.

 

It appears that you have (kind of) received the recommended treatment approaches so far in an antidepressant medication and CBT. One thing I notice is that you have been treated with a Tri Cyclic Antidepressant (TCA) rather than a Selective Serotonin Reuptake Inhibittor (SSRI). The recommended medication is a SSRI not a TCA.....I realise that you aren't intersted in medication at this point but I just wanted to let you know about this point in case you ever change your mind on this matter.

Can you tell me a little bit about the CBT your received, what it involved and who delivered it? Also, did it involve something called Exposure and Response Prevention? I realise your experience with CBT was poor and I just want to check exactly what it was you participated in (as there is a huge variety of CBT based approaches).

There are two other psychotherapeutic approaches that are used and while they aren't recommended at this point (due to a lack of reserach evidence) they may be alternatives that work for you. I'll wait for your response to my above questions before I begin discussing these.

Customer: replied 1 year ago.

Thank you for your response. I believe that Anafranil is an SSRI, albeit an old fashioned one. I think it is regarded as the final approach to use, when the more modern SSRIs have failed.


The CBT was delivered by a reputed therapist at my local private hospital, and I know she discussed my case with other colleagues, and I know she was following the NICE guidelines. I did have exposure treatment, too - exposure to mirrors. The way I have got through until now is mirror avoidance, and avoidance of photographs. She also carried out surveys of people - asking for feedback on photos of me to try and prove that there was nothing abnormal about my appearance. The mirror exposure, in particular, caused great anxiety - and precipitated a cosmetic procedure. The reason I didn't get on with CBT was because it was trying to encourage me to be able to tolerate my appearance - in spite of imperfections, and this is where the stumbling block came. I was teased as a teenager, because I had a short jaw, and so goofy teeth, and so I feel I have a deep seated fear, even now, of being unacceptable because of my appearance (I had my jaw broken and reset when I was 21 to correct this - but I still sometimes dream at night that I am still that goofy child). Ultimately my problem is one of self-hate and low self-esteem, even though I am able to list - and even appreciate my positive points. My life is basically happy - I am married, have 2 children and a job. It is just me that I don't like. I had hoped that CBT might help me to overcome these feelings, but as I said, even though delivered sensitively, by a supposed expert in the field, it didn't work. She suggested that my next port of all be to make an appointment to see Dr Veale, who is the expert in BDD, at I think the Priory, but an initial appointment costs £250, just for an assessment, before any treatment is recommended. So I am at a bit of a loss.


Thank you for your time.

Expert:  Dr John B replied 1 year ago.

Anafranil is a trademark name for a Tri Cyclic Antidepressant called Clomipramine and is a different class of medication and yes they are used today if SSRIs are ineffective. Were you previously trialled on an SSRI? Anyway, this is a moot point if you don't wish to use medication.

I was originally going to suggest the possibility of using a mindfulness based therapeutic approach or even Psychodynamic therapy. However I appreciate the obstacle that expensive therapy poses and so perhaps these are no more of a realistic option than an assessment at The Priory. Have you considered therapy that targets low self-esteem rather than the BDD as an option? There are good self help programs designed for low self-esteem that aren't expensive.

Anyway, it sounds like you may wish to end this conversation so I won't proceed further unless you wish to. If I don't hear back then good luck, I wish I could have been of more assistance.

Customer: replied 1 year ago.

Sorry if I sounded curt - I didn't mean to seem as if I wished to end the conversation.


 


The CBT did include mindfulness techniques and I used CDs at home as well as practising the techniques in sessions. I have read many information books about BDD and self esteem already - some recommended by my therapist and some i just found, including The broken Mirror and one by Dr Veale. I also read one by an American about The Highly Sensitive person. However, self help has never worked. I have a lot of insight into my condition, and appreciate that it is chronic, but just I find the thought of living for the next 20 or so years feeling like this every morning, very difficult. I have been doing it for the last 20 years, and it is exhausting. I have tried relaxation techniques: reiki, massage, pilates and hypnotherapy, but all relief seems to be only temporary.


I know that my problem is rooted in aspects of my personality: perfectionism, conscientiousness, sensitivity. But I still hope that there might be a more lasting solution.

Expert:  Dr John B replied 1 year ago.

You certainly do seem to be very knowledgeable about BDD and have a good deal of insight into your situation.

Have you tried a Psychodynamic approach at any stage? It's certainly dropping away as a mainstream therapeutic approach but there are many people in the world have benefited greatly from this form of therapy. Given the lack of success you've had with these other approaches coming at the problem from a completely different angle.

Change is always possible and so I don't believe that you or anyone for that matter need to endure these kinds of problems indefinitely. There are a huge number of people who have battled for years to overcome specific problems with little success only to eventually stumble upon the right therapist, therapy, situation at the right time and achieve success.

I know NHS options are limited but having worked in the NHS I also know that specific funding can be arranged for specialist treatment....wherever that may be. Unfortunately this usually only happens as a result of dogged lobbying by the individual of their local trust. Do you think it would be possible to begin to investigate the possibility of getting the NHS to fund an assessment at The Priory?

Customer: replied 1 year ago.

Thank you - I might try that. I appreciate your help.

Expert:  Dr John B replied 1 year ago.
You are very welcome. If you have further questions or you would like me to expand upon any part of our conversation please let me know. If not.....I wish you the best of luck!
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and other Mental Health Specialists are ready to help you
Expert:  Dr John B replied 1 year ago.
Hi,

I hope you're making some progress with possible options for getting the Priory assessment funded. If I can be of further help, or if you ever have other questions in the future, please don't hesitate to contact me directly. You can do this by simply putting "For Dr John B" at the start of any question you post.

Regards,

John

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