Anxiety Toolbox: The Complete Fear-Free Plan. Gloria Thomas

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      – How much do you suffer from obsessions or compulsions?

      – Not at all/a little/sometimes/a lot/all the time

      – Do you have any of the above symptoms or behaviours? On a scale of one to 10, how much do you suffer from these symptoms?

      – On a scale of one to 10 how strongly do you suffer from OCD today?

       (0–1 = none, 2–3 = slightly, 4–6 = moderately, 7–8 = marked, 9–10 = severely)

      CASE STUDY for OCD

       Graham was a 30-year-old graphic designer who worked for a number of large websites. He had been diagnosed with OCD in childhood. At an early age, he developed a fear of contamination and used to clean himself and his surroundings obsessively. His obsession and anxiety was so great that he would take his clothes off to eat his meals because he believed that otherwise his food would be contaminated. The last straw came when he and his family went to friends for dinner and he stripped off and sat in his underpants throughout the entire meal.

       In a regression, we discovered that Graham’s concerns about contamination stemmed from an experience that he had when he was 9 years old. He found a snake and started to play with it. However, an adult screamed at him that the snake was poisonous, took it from him and duly killed it. Graham felt a great sense of responsibility for that snake and developed a belief that in some way he had been poisoned because of it.

       Graham responded well to the TFT algorithm for OCD (see chapter five) and we intervened in his OCD strategy and installed a new way of thinking so that he felt satisfied with his cleaning rituals.

      Body Dysmorphic Disorder

      People’s preoccupations are largely dictated by the society that they live in so it’s hardly surprising, given western society’s preoccupation with appearance, that Body Dysmorphic Disorder (BDD) is becoming more common. This disorder is characterized by a fixation with perceived flaws in physical appearance and the belief that these are in some way repulsive.

      Like all anxiety disorders, individuals can suffer in a mild or chronic way, although to receive a diagnosis the sufferer has to experience a great deal of distress and disruption to their daily life. The disorder is thought to affect around one per cent of the population and both men and women can suffer from it. Although it often starts in the teenage years with hypersensitivity about self-image, it can also begin in midlife when we begin to age.

      We construct our image of ourselves largely from what we see in the mirror. Of course very few of us like everything we see and may worry to a certain extent about the bits we don’t like, but we can usually interpret what we see fairly honestly. However, those with BDD may construct an image of themselves that is hugely distorted. With the more chronic forms of this disorder, the sufferer is preoccupied with their self-image and develops a heightened perception of their ‘deformity’. This can be intensely painful, to the point where their life becomes dominated by self-consciousness.

      Anxieties about the body typically focus on unhappiness at the shape or size of body parts and can include anything from the feet to the stomach, breasts and hands. However, most anxieties apparently concern the face – noses, eyes, eyebrows, mouth, teeth and lips. Bodily hair is another preoccupation, as are birthmarks and other such imperfections.

      It is thought there are a number of causes for this condition. Genetic disposition is one possibility, as this can make an individual more hypersensitive to the disorder – this is likely if another member of the family suffers in a similar way. In more general terms, the roots of a disorder like this lie with the societal expectations that we should all look a certain way. In buying into this and striving to reach those ideals, people often fall short of them and begin to look on themselves with dislike and self-loathing – and this can grow into obsession and preoccupation with the body. The only ones to gain from this are the beauty, health, fitness and dieting industries, which make a fortune out of our anxieties.

      Worries and anxieties about self-image can become irrational to the extent that the person develops behaviours such as mirror checking, excessive grooming or shaving, ritual washing, skin picking and wearing wigs, sunglasses and camouflaged clothing. Undergoing plastic surgery is another aspect of this, as are disordered eating behaviours such as food aversion (which can result in anorexia) or binge eating and vomiting (bulimia nervosa), or simply binge eating that results in obesity.

      Men Suffer Too

      It isn’t just women who are anxious and preoccupied with their appearance. A study in the British Journal of Sports Medicine claimed that, with the increased acceptance of physical exercise as a desirable activity, men are generally only motivated to exercise to improve their physical appearance rather than their health. A common anxiety for men is being puny and this can develop into muscle dysmorphophobia. This dissatisfaction with the body leads to frequent workouts in the gym in order to achieve a more ‘masculine’ size and shape. However, although the individual may become highly muscular, they still see themselves as puny. When they feel that they can no longer develop, steroids are taken to boost physique. Other common male concerns are about penis size and receding hairlines.

      BDD can take over an individual’s life to the extent that they become self-loathing, living in torment that others will notice their ‘flaws’. This makes them more susceptible to developing other disorders, such as OCD, depression and social phobias, and as a result such people can completely isolate themselves in order to avoid anyone seeing their perceived deformity. They believe that true happiness and self-esteem can only be possible if they change their defect. This anxiety disorder is considered delusional, as it is often only the person who is suffering that is aware of the defect – although they are convinced that it is obvious to others too.

      The Symptoms of BDD

      

Refusing to accept compliments about yourself and only backing up comments that feed your concerns

      

Anxiety over perceived flaws

      

Preoccupation with body parts

      

Dissatisfaction with body parts

      

Needing constant reassurance about your appearance

      

Believing that something is wrong no matter what anybody says

      

Frequent mirror checking and body grooming

      

Concealment – using wigs, hats etc.

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