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Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with a real or imagined defect in one's own physical appearance. People with BDD have a distorted or exaggerated view of how they look and are obsessed with actual physical characteristics or perceived flaws, such as a certain facial feature or imperfections of the skin. They often think of themselves as ugly or disfigured. People with the disorder often have problems controlling negative thoughts about their appearance, even when reassured by others that they look fine and that the minor or perceived flaws aren't noticeable or excessive.

Body dysmorphic disorder causes people excessive anxiety and distress, often impairing their social life and performance at school or work. People with BDD may find it difficult to meet new people or make friends because of intense fear that their appearance might be judged in a negative way. In severe cases of BDD, a person may severely limit contact with other people in an attempt to avoid having others see the perceived physical flaw.

The signs and symptoms of body dysmorphic disorder include:

· Frequently comparing the flaw in appearance with that of others

· Repeatedly checking the appearance of the specific body part in mirrors or other reflective surfaces

· Refusing to have pictures taken

· Wearing excessive clothing, makeup and hats to camouflage the perceived flaw

· Using hands or posture to hide the imagined defect

· Frequently touching the perceived flaw

· Picking at one's skin

· Frequently measuring the imagined or exaggerated defect

· Elaborate grooming rituals

· Excessively researching about the perceived defective body part

· Seeking surgery or other medical treatment despite personal opinions of others and recommendations of doctors that the flaw is minimal or doesn't exist or that treatment is unnecessary

· Seeking reassurance about the perceived defect or trying to convince others that it's abnormal or excessive

· Avoiding social situations in which the perceived flaw might be noticed

· Feeling anxious and self-conscious around others (social phobia) because of the imagined defect

People with severe BDD may drop out of school, quit their jobs or avoid leaving their homes. In the most severe cases, people with BDD may consider or attempt suicide.

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i think if we based psychological diagnoses on generic lists like these we'd all be schizophrenic, suicidal, bmd freaks?

what im getting at is that I hate how the instiutions label nearly everything as abnormal. As freud said, we are all neurotic, its part of being normal

lots people with a low self esteem might have al lthose characteristics, even if they don't have acne

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yes thats a little odd, but rubbing grease into your face isn't bdd, thats desperation.

i think we all exaggerate how bad our situation is, but not to the extent where they have bdd.

Many anorexics are diagnosed with bdd. They might be like a skeleton but in their mind they think they are fat as a whale.

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the whole population tends to exaggerate their weigth problems, nose, spots, breast problems etc. i doubt half the population have bdd

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i don't really have flaws...i just want to be more beautiful...is that BDD?

just kidding lol. i'm concerned about my appearance, but no more so than the average person.

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Lauryn, have you been diagnosed professionally or is that a self-diagosis? I think I have been verging on it myself over the years, more excessive picking and making my face so much worse than it needed to be. In fact I actually got diagnosed by one derm as having Acne Exorcee, which is a similar thing to BDD, but where you pick at your skin so much that you actually induce the problem that you hate so much in the first place. However, like all the derms I have seen he did nothing other than prescribe some topicals - probably what I really needed was some cognitive behaviour therapy (psyche stuff!) and a good psychiartist to get to the bottom of why I felt the need to do it in the first place - there is usually life trauma at the bottom of this sort of thing. It is annoying to think that if i had'nt messed with my face so much as a teenager when the whole skin thing started to become an issue, I would'nt be in the boat that i am now , but I just could'nt help myself - it has always been a really compulsive thing for me. I can lose hours in front of the mirror and just feel completely hateful about myself afterwards, then i do'nt go out for days because my skin is so bad and needs time to heal - its a viscious circle of pickin, then healing, then pickin again,and it completely takes over oyur life. If it was'nt for my little boy and the fact that I have to be functional to some degree, I think I would have lost myself to the whole thing a long time ago.

Thankfully, I am starting to get on top of it through a combination of willpower, some miraculous products and this website which has been an invaluable resource and support -jus knowing that there are so many people out there who are in the same situation, feeling shit about their skin and wanting to make things better for themselves, takes the sting out of the whole bad skin experience - we WILL overcome!!

If you need to talk Lauryn, please PM me. Your post did'nt say much, which makes me think you are testing the water to see if anyone will repond. BDD and OCD are very difficult things to live and deal with on your own, and as you can tell from the previous posts, not that many people understand the extent of the problem.

Take care hon.

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Lauryn, have you been diagnosed professionally or is that a self-diagosis? I think I have been verging on it myself over the years, more excessive picking and making my face so much worse than it needed to be. In fact I actually got diagnosed by one derm as having Acne Exorcee, which is a similar thing to BDD, but where you pick at your skin so much that you actually induce the problem that you hate so much in the first place. However, like all the derms I have seen he did nothing other than prescribe some topicals - probably what I really needed was some cognitive behaviour therapy (psyche stuff!) and a good psychiartist to get to the bottom of why I felt the need to do it in the first place - there is usually life trauma at the bottom of this sort of thing. It is annoying to think that if i had'nt messed with my face so much as a teenager when the whole skin thing started to become an issue, I would'nt be in the boat that i am now , but I just could'nt help myself - it has always been a really compulsive thing for me. I can lose hours in front of the mirror and just feel completely hateful about myself afterwards, then i do'nt go out for days because my skin is so bad and needs time to heal - its a viscious circle of pickin, then healing, then pickin again,and it completely takes over oyur life. If it was'nt for my little boy and the fact that I have to be functional to some degree, I think I would have lost myself to the whole thing a long time ago.

Thankfully, I am starting to get on top of it through a combination of willpower, some miraculous products and this website which has been an invaluable resource and support -jus knowing that there are so many people out there who are in the same situation, feeling shit about their skin and wanting to make things better for themselves, takes the sting out of the whole bad skin experience - we WILL overcome!!

If you need to talk Lauryn, please PM me. Your post did'nt say much, which makes me think you are testing the water to see if anyone will repond. BDD and OCD are very difficult things to live and deal with on your own, and as you can tell from the previous posts, not that many people understand the extent of the problem.

Take care hon.

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Hi bexi and lauryn, I suffer from BDD. Now I feel much much better, but 3 months ago I had the worst moments in my life. I started going to therapy and to a psychiatrist (who prescribed prozac) and about one month and a half ago I started feeling like myself again, without these stupid obsessive voice going on dayt and night in my head, saying you're ugly, go look at the mirror, your skin is terrible, etc. I'm sure you know the feeling. Anyway, please ask for help. A really good book that gave me ideas on how to overcome this is The Broken Mirror, very good, check it out. wink.gif

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Lauryn - wow, i never would have found those sites on my own! Thanks for that! Looks like you got all the support you need there - what an amazing group of people! Spent some time reading posts on facepick.tripod and it really struck me how intelligent,funny,creative, caring and truly supportive they all were. Its funny how we seem to be predominently women is'nt it? Something definately going on there....

I really did'nt realise there was there was so much support out there - I am definately going to register - see ya there sometime! eusa_dance.gif

aliciany, who is the author of that book? I would really like to check it out.

Um, prozac - not really my cuppa tea really as I try to avoid all prescription stuff as a general rule -glad its workin for you though! I am sure that such drugs do have there place though, its just that I'm a big wiener when it comes to anything remotely pharmecutical cos I've had such bad experiences in the past (steroids sent me nuts!), plus I'm a bit of a health freak!! Any thoughts to how you'll be when you come off them, or is that not even an issue to you right now? I think that the biggest and hardest thing is to just break the habit, and if prozac is helpin you do that, then wicked. biggrin.gif

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Hi bexi and lauryn, I suffer from BDD. Now I feel much much better, but 3 months ago I had the worst moments in my life. I started going to therapy and to a psychiatrist (who prescribed prozac) and about one month and a half ago I started feeling like myself again, without these stupid obsessive voice going on dayt and night in my head, saying you're ugly, go look at the mirror, your skin is terrible, etc. I'm sure you know the feeling. Anyway, please ask for help. A really good book that gave me ideas on how to overcome this is The Broken Mirror, very good, check it out.  wink.gif

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Lauryn - wow, i never would have found those sites on my own! Thanks for that! Looks like you got all the support you need there - what an amazing group of people! Spent some time reading posts on facepick.tripod and it really struck me how intelligent,funny,creative, caring and truly supportive they all were. Its funny how we seem to be predominently women is'nt it? Something definately going on there....

I really did'nt realise there was there was so much support out there - I am definately going to register - see ya there sometime!  eusa_dance.gif

aliciany, who is the author of that book? I would really like to check it out.

Um, prozac - not really my cuppa tea really as I try to avoid all prescription stuff as a general rule -glad its workin for you though! I am sure that such drugs do have there place though, its just that I'm a big wiener when it comes to anything remotely pharmecutical cos I've had such bad experiences in the past (steroids sent me nuts!), plus I'm a bit of a health freak!! Any thoughts to how you'll be when you come off them, or is that not even an issue to you right now? I think that the biggest and hardest thing is to just break the habit, and if prozac is helpin you do that, then wicked.  biggrin.gif

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SKIN PICKING AND NAIL BITING: RELATED HABITS

By Fred Penzel, Ph.D.

Although this newsletter has always been limited to discussing matters related to trichotillomania, I would like to introduce a slightly different but related topic. It may come as no surprise that there are other types of problem behaviors quite similar to trich in a number of ways. I am referring specifically to compulsive skin picking and nail biting (also known as onychophagia). These may not sound serious, but neither does hair pulling to some people. Since I have met quite a number of people who have one of these problems in addition to trich, I now routinely screen for them.

What I am referring to is not the kind of little bits of rough nail or cuticle that everyone picks at or bites from time to time, nor is it the occasional blemish that people might squeeze or pick. These nail-biters continually bite their nails past the nail bed and their cuticles until they bleed and are constantly walking around with red, sore, and sometimes infected fingers. Those who pick their skin compulsively have their faces and bodies covered, at times, with red sores and scabs known as acne excoria, a self-inflicted skin disorder that resembles acne. The smallest pimple or blemish must be opened and picked at or squeezed, either with the fingers or another implement such as tweezers, needles, pins, toothpicks, etc. Numerous scars are often the result.

Just as those with trich wear hats, scarves, wigs and makeup, nail-biters keep their hands behind their backs or in their pockets, and skin pickers wear makeup, put on clothing that covers bad areas, apply Band-Aids or just stay indoors when looking their worst. They feel the same shame and social embarrassment and experience that out-of-control feelings at times. They, too, wonder why they can't stop and they also question whether or not they are crazy.

Another similarity between these problems and trichotillomania is that they seem to happen when people are in one of two modes. Some do it in an automatic way, as if they are in a trance and not really thinking about what they are doing. Usually, they are involved in some other activity at the same time such as reading, talking on the phone, working at the computer, watching TV, etc. For others, the deliberate picking or biting is their main activity at the time, and they will frequently interrupt other activities to engage in it.

There is also a strong commonality seen in the various purposes behind these three problems. At the most basic level, they satisfy an urge. Many report an almost uncontrollable feeling of needing to do them. Pulling, picking or biting also seem to deliver a pleasurable or relaxed sensation. When sufferers feel stressed, doing these things has a kind of soothing effect on their nervous systems, and reduces levels of stimulation. On the other hand, when they are bored or inactive, they seems to provide a needed level of stimulation to the nervous system. This probably accounts for why so many people who dislike doing them find it so hard to stop. It simply "feels good" at the time, no matter what the consequences. These behaviors may really be all about self-regulation in certain individuals whose nervous system may not be doing a very good job of regulating itself (see the article "A Sensory Regulation Theory of Trichotillomania," on this website).

Another factor also seems to be at work for a subgroup of people. This involves a kind of compulsive perfectionism. Some hair-pullers must pull "special" hairs that feel "different" or as if they don't belong due to their look or feel. In the same way, nail-biters will often try to bite off rough-feeling or broken bits of cuticle or nail sticking out in order to make their nails feel smooth and look "perfect" or regular. Skin-pickers will stand for hours in front of mirrors closely examining their faces or other body areas for the tiniest bump, irregularity or enlarged pore and then try to eliminate it, or drain it, in hopes of achieving a 'perfectly' clear complexion. Paradoxically, all of those who pursue such goals always end up looking much worse in spite of their efforts, as a result of the damage that they do to themselves.

What all these similarities seem to point to is that these three behaviors are probably all different aspects of the same problem.Some have theorized that theret may be that the same out-of-control grooming mechanism in the brain underlies them all. My own theory is that there may be some type of dysfunction of a brain mechanism that regulates levels of stimulation within the central nervous system, and that these behaviors represent an attempt to control these internal stimulation levels externally. People seem to pull, pick, or bite when thery are either overstimulated (dus to stress or excitement) or understimulated (due to boredom or inactivity). Many similar behaviors can be observed in animals who are kept in confined or unstimulating environments, or who live in stressful conditions.

There are many that now believe that compulsive hair pulling, skin picking, and nail biting form a subgroup of what is becoming known as the Obsessive- Compulsive Disorder Spectrum. OCD has been previously been regarded as only a single disorder. It may in fact represent a range of related disorders, including classic OCD, Body Dysmorphic Disorder, Anorexia Nervosa, Bulimia, Trichotillomania, Onychophagia, Compulsive Skin Picking, Compulsive Nail Biting, and Tourette's Syndrome. Recently, a new term has been coined for these problems - Body-focused Repetitive Behaviors (BFRBs). As with trichotillomania, skin picking and nail biting are considered to originate within the chemistry of the brain, and may well have an underlying genetic cause.

In my own practice, I have seen quite a few hair pullers who also bite their nails and/or pick at their skin. While it has never been surveyed systematically, there may be many out there with multiple symptoms. Interestingly, quite a number of people don't realize that their several problems may be connected until it is pointed out.

As with trich, these other two disorders appear to respond best to medication and behavioral therapy. Medication should never be considered an end in itself, but a tool to help you do the therapy. Drugs which remedy these problems do not work instantly- It may take several weeks before you see any results. They also may not work perfectly. Usually, 60-70% improvement from a medication is considered a good result. The medications mainly used to treat picking or biting problems are the same group as those used for Trich and OCD. This group is made up of the latest and most potent antidepressants, and includes Anafranil, Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Serzone and Effexor. Sometimes, these drugs may also be augmented with other medications, most often small amounts of the same medications used to treat schizophrenia. These would include Risperdal, Zyprexa, Seroquel, Geodon, and Abilify. Please note that this does not imply that people with BFRBs are in any way psychotic. Keep in mind that no one drug is best, since there is no drug works for everyone. You have to work your way through them in a trial-and-error way, until you find the one that is most effective for you. One further caution on medications is that they do not necessarily work for everyone.

One other option might be to try the B-vitamin inositol. I have seen this work in a number of cases. It seems to reduce the urge to pull or pick. It is broken down by the body into two secondary neurotransmitter chemicals that enhance the activity of serotonin in the brain. Serotonin, is a brain transmitter that may be implicated in OCD and related disorders. Inositol is usually taken in large quantities, but will not build up to toxic levels in your system, as it is a water soluble vitamin. Side effects can include gas and diarrhea, but usually, they will either quickly pass, or not occur at all. The vitamin is taken in powered form, and is built up to a maximum dosage of 18 grams over a six week period. Some people require the maximum, but some can get by with less. (You can get more detailed information about this in another article listed on this website. The title is "Inositol and Trichotillomania.") Inositol can also be safely used to augment antidepressant medication. The only exception is that it cannot be taken together with Lithium. Children generally take smaller doses than adults.

Therapy for these disorders consists of two parts. The first, is Habit Reversal Training (HRT), a four-step process which teaches you awareness of your habits, how to relax, how to breathe and center yourself, and to perform a competing and opposing muscle response. (I have described this technique in a previous issue of TLC's IN TOUCH, in an article on cognitive/behavioral therapy for trich, which I'm sure you can get copies of.) It can be extremely useful if practiced daily and stubbornly, as it must become as automatic as the habit you are aiming to eliminate. These are stubborn problems for two reasons. First, you have probably rehearsed the unwanted behaviors hundreds or even thousands of times. It is important to accept that they will not simply be overcome in a few days or weeks. Second, you are fighting the fact that they feel good to do, and provide much short range satisfaction and either stimulation or soothing. It takes time and a good deal of effort to master, but I believe it is worth it. Research shows it to be an effective technique.

The second part is known as Stimulus Control (SC). Skin picking and nail biting are a complex behaviors, with many different inputs. SC is a behavioral treatment that seeks to help sufferers first identify, and then eliminate, avoid, or change the particular activities, environmental factors, mood states, or circumstances that have become associated with, and that trigger picking or pulling. The goal here, is to consciously control these triggers that lead to the undesirable behaviors, and to create new learned connections between the urges new non-destructive behaviors. A much more in-depth description of these treatments can be found in my two books - "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well," and "The Hair Pulling Problem: A Complete Guide to Trichotillomania." Both are published by the Oxford University Press, and you can find out more about them at www.ocdbook.com and www.trichbook.com ..

Even if you have more than one of these problems, don't despair. They can be overcome if you have the motivation. More important is learning to "de-stigmatize" yourself. You are not crazy, helpless, morally weak or totally out of control, even though you may feel like some or all of these things at times. Once you get down to realizing that you are just a person who simply happens to have a problem, you can start to make some serious progress. Skin picking and nail biting are chronic problems, so there currently isn't a 'cure', but you can find a recovery if you are willing to work at it.

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Inositol sounds interesting - seretonin levels have always been a bit of an issue for me.The idea that it might be related to a physiological process is something I have'nt heard of before - makes me feel less of a freak thinkin that it could be my nervous system malfunctioning rather than being obsessively vain and psychologically challenged...have only just recenty got out of this mode of thinking and accepted that what I've had going on for so many years is not something to feel guilty about and its as normal as any other disorder.

Thanx for all that Lauryn - really informative, eye-opening stuff for both me and those who have never even heard of this problem before...knowledge is power, and understanding is everything.

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Inositol sounds interesting - seretonin levels have always been a bit of an issue for me.The idea that it might be related to a physiological process is something I have'nt heard of before - makes me feel less of a freak thinkin that it could be my nervous system malfunctioning rather than being obsessively vain and psychologically challenged...have only just recenty got out of this mode of thinking and accepted that what I've had going on for so many years is not something to feel guilty about and its as normal as any other disorder.

Thanx for all that Lauryn - really informative, eye-opening stuff for both me and those who have never even heard of this problem before...knowledge is power, and understanding is everything.

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I use a combination of things depending on the damage I've caused and the nature of what I've picked. At the mo I am concentrating on taking such good care of my skin both externally and internally so that there is v little to pick in the first place, although lack of spots does'nt always stop me - I am a bugger of examining every single pore and blackhead and squeezing the life out of em!!

For open wounds and infected spots that are really sore I find that hot/warm salt water works really well to sterilise the area and promote healing. Aloe vera gel taken straight from the plant (I have one in my bathroom,whcih is incidentally slowly gettin killed cos one of my kittens keeps sittin in it!) is ace for taking away redness when you have gone overboard on the squeezing. I also use antibiotic ceam when an infection looks like it is going to get out of hand. For scabs, I guess I jus try to keep em clean and moisturised.

Overall, my topical skin car regime is this: Morning 1) wash with either plain water or bicarb if I want to do a gentle scrub - don't like soap or cleansers as they don't seem to suit my skin

2)tone with diluted apple cider vinegar which is good for scarring and stops you getting so many blackheads - leaves your skin silky smooth as well.

3)apply exfol serum (skin biology) which contains sacylic acid

4)apply a small amount of jojoba oil which is great for moisturisation and slows down blackhead production too

Night time 1) wash as above

2)ACV again, but this time I leave it on for about half an hour then wash it off, as I am I think it may interfere with the other topicals I apply

3) after second wash, I apply emu oil with copper peptide serum and let it sink in for 20 mins or so

4)apply a generous amount of retin-a

thats about it really. I also take a load of supplements - MSM, alpha-lipoic acid, agnus castus,red clover, evening primrose,vit c, milk thistle and a multi vit when I can stand taking it - its one of those huge horrid tasting ones that gets stuck in your throat when you swallow it! Oh, and am taking ACV internally in water about 3 times a day as it has health promoting properties and I am hoping it is going to help with candida.

How about you?

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in the morning i was with neutrogena original face wash with my bath gloves

then a tea tree oil exfoliant from body shop and i leave it on for 2-5 min

then my glycolic acid lotion

at night a shower wash face with neutrogena again

then SA lotion

if im really scarred up i put bag balm or buh bye on theem to keep from picking.

i do steaming at least once a day

and i take VITAMEDICA supplements everday and night

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