Friday, February 3, 2012

Our Today

We went to the post office today, to mail some packages for Husband.  I was watching my body walk down the sidewalk when we encountered an elderly man with white hair.  He smiled and greeted us pleasantly.  I don't know who said it, but someone spoke up and said "Hello! How are you?" and I could see a teeth-baring (but fake nonetheless) smile on our face.  It was so surreal, hearing the words come out of our mouth, knowing that I wasn't speaking at all.  Everything snapped back to "normal" (whatever the hell that means) when I went inside the building and saw a friend of Husband's; the proper K took over then.  Next thing I remember is the dog barking.  We are in the bedroom., and the dogs are both barking.  It's loud.  I wish they'd be quiet.  I have some time to myself now... but who am I?  There is evidence that I've eaten lunch, and if I think really hard I can kindof see me eating sometime...was that today?  It's more like it happened in a dream.  Husband will be home in 45 minutes; is that long enough to figure out who we are supposed to be?  We called our doctor to make an appointment, but the lady on the phone said she was out sick.  She told us that she would call K next week and let her know when to come in.  I'm really glad that we are going to see the doctor again; I have lots of questions for her.

Don't Look At Me!

K was diagnosed with Body Dysmorphic Disorder about 10 years ago, but she's had it much longer than that, I'd guess since she was a pre-teen.  Body Dysmorphic Disorder is a mental illness characterized by distorted body image and obsessions about perceived physical shortcomings.  A person with BDD is extremely concerned with their appearance, and this manifests as a preoccupation with a perceived defect of their physical features.  Simply put, K's obsessed with how she looks, because of her (self-declared) flaws.  This causes psychological distress that impairs occupational and/or social functioning.  The person complains of a defect in either one or several features of their body, or vaguely complains about their general appearance. (K complains both generally AND specifically.)   The disorder is generally diagnosed in persons who are overly critical of their mirror image, physique or self-image, even though there may be no noticeable disfigurement or defect.  In other words,  K sees an ugly (read=imperfect) reflection upon looking in a mirror, even though no one else sees anything wrong with her appearance.

BDD is often misunderstood as a vanity-driven obsession, whereas it is quite the opposite; people with BDD do not believe themselves to be better looking than others, but instead feel that their recognized "defect" is unforgivably ugly or not good enough. People with BDD may compulsively look at themselves, or do the opposite-cover up and/or avoid mirrors. They typically think about their appearance for at least one hour a day  (usually more) and, in severe cases, may drop all social contact and responsibilities as they become a recluse.  K positively must look at herself in any mirror she comes across, and spends hours making herself "presentable" before she will leave her house.  We haven't dropped social contact altogether, but do go through periods in which I'll avoid people for days or weeks at a time.

Common symptoms of BDD include:
  • Obsessive thoughts about a sensed defect(s)
  • Delusional thoughts and beliefs related to sensed appearance defect(s)
  • Chronic low self-esteem
  • Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface
  • Major depressive disorder symptoms
  • Suicidal ideation 
  • Strong feelings of shame
  • Social withdrawal, isolation or social phobia
  • Perfectionism 
  • Alcohol & drug abuse
  • Feeling self-conscious in social situations; thinking that others notice/mock their perceived defect(s)
  • Repetitive behavior (such as constantly applying makeup or checking reflection in mirror)
  • Compulsive/repetitive body modification (such as multiple plastic surgeries)
I exhibit all of these symptoms.  I must point out that K has never had plastic surgery however.  Instead, my body modification rituals include tattoos, multiple body piercings, cutting, and branding.  One therapist told me that my tattoos and piercings were another form of self-injury, and that my methods had evolved from cutting with razor blades to piercing with needles.  I guess I could believe either explanation.  I am trying to permanently alter my appearance to distract from our flaws (BDD), but K very much enjoys the pain and gets pierced to help her deal with reality or emotional distress (SH).

A person with BDD may exhibit obsessive and compulsive behaviors related to perceived appearance defect(s). (K does all of these things.) Some of these include:
  • Compulsive mirror checking OR avoidance of mirrors-- I can't walk past a window or a reflective surface without looking at myself;  I'm not vain, I'm checking my flaws.  On the opposite end of the spectrum, there is a K who hates to see herself in a mirror and tries to avoid it (she also doesn't like to get her picture taken)
  • Attempts to camouflage perceived defect (such as wearing lots of makeup, hats, or baggy clothing)--A couple of the K's wear little to no makeup, but most of us use a good deal of concealer and liquid foundation, and a bright red lipstick to draw the eye away from our flaws. (The Kellie loves to be dramatic and wears heavy eye makeup as well.)  All of the K's wear hats (K collects hats) and most of us wear baggy clothing to hide our body.  However, The Kellie will wear fitted clothing, and she loves to wear corsets. Note that corsets also alter the appearance of the body.
  • Use of distraction techniques (such as wearing extravagant clothing or excessive jewelry)--Each of the K's has a different style, but almost all of them stand out in a crowd and are over the top with accessories-hats and scarves and tons of jewelry.
  • Excessive grooming behaviors (hair-combing, eyebrow plucking, skin picking)-- Throughout the day, most everyday, K smooths or touches her hair, plucks her eyebrows and also picks at her skin. I'm not sure if this counts, but she also paints and repaints her nails and toenails.
  • Seeking reassurance from loved ones-- I seek constant reassurance from my husband, friends, and family about how I look.  "Do I look OK?" comes out of K's mouth dozens of times a day.
  • Comparing appearance to that of others--Not only do I compare myself to every female over the age of 16, but I almost always feel that every other girl I see is more attractive than I am.
  • Compulsive skin touching (to feel the perceived defect)--I catch myself constantly touching the areas of our face and body which I feel are unacceptable; I don't know why...maybe to see if the flaw is still there or has grown larger?
  • Self harm--My first memory of self-harm is from 4th grade, and it's gotten worse over the years.  I intend to do a blog post soon about my experiences with self-injury.
  • Obsession with plastic surgery--As I said earlier,  I've never had plastic surgery,  but I do constantly think about which procedures I'd  have done if I could afford it. (breasts reduced and lifted, tummy tuck, forehead lift, butt lift, facelift, all-over liposuction...) In extreme cases, patients have attempted to perform plastic surgery on themselves, including liposuction and various implants with disastrous results.  I have to admit that I have done some minor work with a scalpel, but certainly nothing drastic. 
The three most common areas of which those suffering from BDD are critical are the hair, the skin, and the nose.  For K, the obsession focuses on her skin, especially that of her face, and she's particularly critical of her chin/jawline/profile.  She's been obsessed with her teeth for as long as she's been seeing a dentist.  She's also obsessed with her overall body, mainly the legs;  to a lesser degree she obsesses about her nose and hair.

In most cases, BDD is under-diagnosed.  It is often associated with shame and secrecy; therefore, patients often fail to reveal their concerns about their appearance for fear of seeming vain or superficial.  BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia.  K, like most people diagnosed with Body Dysmorphic Disorder, is shy, introverted, and neurotic. Certain personality traits make people more susceptible to BDD.  Others include perfectionism, sensitivity to rejection or criticism, unassertiveness, and social phobia.  K is bothered by all of these things.  Treatment for Body Dysmorphic Disorder includes both cognitive behavior therapy and medication, namely SSRI's.  K is currently being treated with both of these.  Writing about it now, and seeing everything in black and white, the diagnosis seems so simple and easy-to-see.  If only it had really been that easy for our doctors! Perhaps then K would be living a different life now, with more confidence and fewer mirror checks.

Thursday, February 2, 2012

A Complaint To Myself

Someone inside my head is really wanting to write....  but she's being held back by the others.  I can't hear what she's trying to tell me, so I can't write it down.  I can't hear her clearly because there are too many other voices in my head, all trying to talk over one another.  Damn!  This is so frustrating.

(I wish that we could easily separate each voice inside our mind, so that I might be able to actually understand what everybody's saying at all times...)

Wednesday, February 1, 2012

The Care and Feeding of Us- Part II

We've talked about K's bizarre food preferences (The Care & Feeding of Us-Part I); now I'm going to tell you how her mental illness affects the physical way she eats.  In Part I, I think I demonstrated  that she's OCD when she eats (in that no foods on her plate can touch, and no food in her mouth can mix), but I'll go even further.  I'll tell you just how OCD K really is. It takes her a long time to get ready to eat.  She has to prepare her plate, by separating her food into categories.  There are different categories for different types of food; some foods are separated by color, others by texture or shape.  Let me give you an example:  K loves Lucky Charms cereal, but she must eat it in a certain way.  First, she eats all of the crunchy oat pieces out of the bowl.  Next, she eats each marshmallow one color and shape at a time, and in a specific order (In this case, yellow is first, blue is always last).  K "saves the best for last", so if there's a bite she's especially interested in, say the crunchiest, blackest part of her well-done hamburger, she'll eat that bite last, after the rest of the burger has been eaten.  Also, she always eats symmetrically. Take one bite from the left side, take one bite from the right side.  One bite from the meat/entree, and one bite from each side item, in a counter-clockwise direction.  Yes, this is time-consuming, but she's compelled to do it. 

 Food is often cut or separated into small pieces before she begins to eat, and this serves two purposes: it allows her to equally distribute a sauce or gravy onto bites of food, and it also gives her the ability to easily count the number of bites she eats.  I'm not going to go into great detail here, let me just say that K does a kind of numerology, and the number of bites eaten has to be what K considers to be a "good" number (3 is the best number).  During this process, K is also "editing" her meal, meaning she's picking out everything green as well as anything unwanted, such as peppers or onions,  plus she scrapes off any unwanted sauce.  At home, of course, she has to do less of this; her husband does the cooking and tries to accommodate her tastes.  Some things can't be made to K's liking and she has to pick out a lot of ingredients (example=chili).  Needless to say, K is a slow eater, and she can be terribly self-conscious about all of these rituals, so she prefers to eat in private.  (Not all of the K's are like this; some of us are less uptight and enjoy dining out very much.)  It's so complicated just to get a bite to eat!

Of course, the K(s) with an eating disorder tries to avoid eating altogether, and will take diet pills and appetite suppressants and guzzle energy drinks instead of consuming food.  I am trying to get K to be more health-conscious, but I'm outnumbered by the other K's.  Before the ARDS incident (When Do People Sleep Around Here?), our breakfast/lunch consisted of two pots of coffee and however many cigarettes we could chain smoke during the consumption of that coffee.  Now, we don't smoke (well, I think The Kellie does), but we still drink our two pots of coffee in the morning.  And then we can, and often do, drink additional cups or a pot at night.  K is a coffee fiend.  Probably not the best thing, considering how poor her diet is... and the worst part of all is that she doesn't even take vitamins.  Her doctor put her on some prescription strength vitamins once, but she threw them up (perhaps her body didn't know what to do with nutrients!), so now we don't take any sort of supplements.  I know we should, and every January I make a New Year's resolution to take vitamins everyday, but our memory is so bad we always forget... On many occasions I've found bottles of vitamins, some expensive, and the bottle is always nearly full but has expired, so it appears that I try to get K to take vitamins at times, I just can't stick around long enough to see that she actually takes them.

I wish that I, and Switch Kellie (aka Smart Kellie), could join forces and take control of K's body and mind and see to it that she develops some healthy habits.  I've been trying to get Switch Kellie to come back out-I can feel her just under the surface of our consciousness; she's always with us, listening, since this last "episode"-but so far she just speaks to me, not through me.  Hopefully, one day soon, Switch Kellie will come forward again and take over and whip us back into shape; I'm good at controlling K's cravings and monitoring her food intake, but I need Switch Kellie to motivate us to work out.  All of this sounds absolutely nuts, and I suppose it IS, but this is the reality that we, the K's, are currently existing in.   ...and wouldn't you know it?  My stomach is growling, but we can't agree on whether or not we're hungry.

Sunday, January 29, 2012

The Care and Feeding of Us-Part I

K is hungry.  That's not unusual for her.  You can often hear her stomach rumbling from lack of food.  She's trained herself to ignore the hunger.  We have to feed her, for survival's sake, but I don't like to.  I don't like to eat.  In fact, I hate it.  I wish there were some sort of pill we could take instead of having to eat; I would give up food altogether.  K has very eccentric eating habits.  She's been a weird eater pretty much since she started eating solid food.  For example, she won't eat anything that touches another food on her plate.  Nothing can touch.  She'd love to have those sectioned cafeteria trays to eat from.  Another weird thing is that she can only have one type of food in her mouth at a time, and she won't even take a drink until she's swallowed that bite of food.  Nothing can mix.  Her mother always says, "It all goes to the same place!" but this does not change K's attitude toward her food.  If you think that's weird, it gets even weirder.

K says she "doesn't eat plants", meaning she doesn't like fruits or vegetables.  There are some exceptions: potatoes and corn.  Also, she'll eat beans two ways: baked beans, or refried beans.  The weird fruit habits are these: she loves (some) fruit flavored foods, like blueberry flavored anything, but she won't actually eat the real fruit.  She'll eat cherry pie, but she'll pick out all the cherries.  She likes orange juice only if it's mixed with champagne or vodka.  She's never actually eaten an orange or a banana or a strawberry, and she only has an idea of what fruits taste like if they have a jelly bean flavor for her to sample.  One more thing, anything with seeds is definitely off limits.  OH yes, and Rule Number 1: No green foods.  It's interesting to note that K loves blue foods however.

Since she's the ANTI-vegetarian, you might think that K eats a lot of meat, but that's not true either.  She will only eat certain cuts of meat.  She will NOT eat anything from a chicken or turkey except the breast, and she won't eat any meat that's still on the bone (it reminds her that it's a dead animal).  If she eats beef, it must be extra well-done; if there is any trace of pink in her steak, she will not eat it.  It must be gray, through and through, and it's even better if the steak is actually black and crunchy on the outside.  She always buys the leanest ground beef and is very careful to get rid of as much grease as possible before she consumes it.  She dries her food off with paper towels.  She will not eat veal or rabbit or venison or duck, because those animals are too cute.  She refused to eat any pork until just a few years ago, because she owned a pet pig and thinks they're far too intelligent an animal to eat.  Bacon is the exception, but she must have it extra crispy, preferably burnt.  She positively will not eat anything that still resembles a dead animal, such as ribs. K would secretly love to be a vegetarian, because the truth is that it grosses her out to eat meat, but since she eats no produce, she'd probably starve to death.

Other foods?  K does love pasta, but only certain shapes and certain sizes, and the sauce should be white. (The little girl in us still likes SpaghettiO's however.)  Seafood is can't still be "in animal form", so crab legs are off limits, but K loves shrimp if it's been peeled and cleaned thoroughly.  We, the K's, disagree on fish; some of us like it and some of us don't.  Pizza is a favorite, but only plain cheese.  What K really loves are breads and cheeses.  When she spent a few weeks in Paris, she dined only on cheese, a crusty baguette, and wine every day, and that was fine with us. 

K's bizarre eating habits are famous around here.  If she goes to a restaurant, she orders like Meg Ryan in that movie "When Harry Met Sally", meaning everything has to be special-ordered.  No butter, hold the lettuce, sauce on the side, substitute baked potato for fries.  She never orders anything as-is from a menu.  Another peculiar habit is her taking packets of Taco Bell hot sauce in her purse whenever they go out for Mexican (the waiters get a laugh out of finding those empty packets on her table).  She doesn't eat at McDonald's anymore, but when she did, they hated her there, for she'd come in and order a Big Mac without the produce, and they'd have to make her one fresh.   The sub shops love her-just throw the meat and cheese on the bread and you're done.  K does not use condiments, but there are exceptions to this rule, such as mustard on a hot dog (which should be turkey, not pork or beef).  No ketchup, no mayo, no guacamole, no salsa.  Hot sauce should be as hot as possible, but K hates the flavor of Tobasco sauce.

So.  I guess I've proven my point, that K is an eccentric eater.  I haven't even gotten to the part about her eating disorder yet-  I only let her eat one meal a day, and if I get my way, it's even less than that.  We don't eat breakfast or lunch.  We try to consume as close to 500 calories a day as possible, and that's just so we don't faint.  K eats around 6:00 at night, and after she eats, she usually goes into the bathroom and throws up.  No big deal, it's been going on for so many years that it pretty much comes naturally to her.  She can practically throw up on command.  I'm forever buying fat-free, sugar-free, and diet foods, and I'm obsessed with K's caloric intake.  Because of our doctor's orders, we're not allowed to have a scale in our bathroom; apparently I used to weigh in too often and punish myself for any weight gain.  I can't even put into words how horrified I am that K's current medications have caused substantial weight gain.  However, according to our medical doctor, our body is currently in "starvation mode" and so my metabolism has nearly shut down.

I remember the specific day that I realized (or at least, thought to myself, as it wasn't true) that I was fat:  I was in 3rd grade.  It  was spring, and I was wearing shorts.  I noticed how my thighs, when pressed flat onto the desk chair, looked really wide.  I was appalled, and decided right then and there that I HAD to lose some weight; I went home from school, walked to the store, and bought a Tab (it was the only diet soda available at that time).  K hated the taste, but we forced her to drink them from then on and she eventually grew used to the bitter flavor of the saccharin-sweetened drink.  We've been drinking diet drinks ever since, and K now lives on Diet Coke.  Allow me to wrap this up.  We have a bizarre love/hate relationship with food, we are beyond finicky, and K was diagnosed with an eating disorder but refuses to believe it's true because she's not currently skinny.  In Part II, I'll tell you how our OCD affects the way we eat (Would you believe K spends over 10 minutes eating a Snickers candy bar one layer at a time?).