The Cleaner

JOURNAL ENTRY-SUNDAY, APRIL 15, 2012  (Late night/early Monday morning)
MUST. CLEAN. EVERYTHING. I don't have time to write, there are things to do, things to clean, things to organize. I have dusted every nook and cranny in this room and the adjoining room and cleaned all the mirrors and glass in the house and swept floors and cleaned counters and put dishes away and scrubbed the shower and cleaned the sinks and sanitized the toilet and scrubbed the baseboards and cleaned the ceiling fan and organized a stack of bills and papers on the dresser. All of those things sound really lame, but if you knew how quickly I was getting each task done, you'd be impressed. I've not stopped, except for now, this moment, wherein I'm telling my story. I cleaned everything in the bathroom. I got a laundry basket and loaded it up with various types of cleansers and dust rags and sponges and a broom and dustpan and a Swiffer duster...you get the idea.  I lugged this basket of cleaning supplies around from room to room. I cleaned the kitchen while I was waiting on the coffee to brew. The other K, the one who was here earlier, she drinks tea. Switch Kellie she's called. She wrote a journal entry too.  We are having trouble deciding if we should share all this with the public. Do they really need to know that one of the K's is known as The Cleaner and is OCD about cleanliness and organization?

 
Well, there you have it. I'm always cleaning when I am in charge.  I have an actual fear of dirt. I wear rubber gloves up to my elbows (they're actually lime green with a Pucci-style print on the cuffs; they're called "Glam Gloves") I'm terrified of the cobwebs which I sometimes find in the corner of a spare room. If I get in the shower, the tiles over my head seem to try and swallow me up and drip germs on me and I look around and I'm just surrounded by dirt, dirty tiles, mildew, black gook, rust stains, red streaks where hair dye got on the shower wall, stained grout that is no longer white...oooooh Shivers just ran up my spine! I can't think about the dirt anymore.  It's freaking me out. Besides, I cleaned all that stuff, so there's no dirt now, and obviously I was exaggerating about how dirty the shower was to begin with. Everything has been cleaned and sanitized.  In pretty much every room, except for Husband's rooms of course.  I'm afraid to dust in there; what if I accidentally broke something?  So I've cleaned the kitchen, the bedroom, 2 bathrooms, the den, the dining room, the living room, the laundry room...I organized drawers and shelves...I thought about alphabetizing all the CD's, but that seemed like a task larger than I felt I had time to accomplish.  Some day, I will do that task.  I promise you.  So I, The Cleaner, for a while have been sharing co-consciousness with a different K.  The Good Daughter appeared occasionally when we went into our mother's room, but for most of the weekend, Switch Kellie was here.  She made the big list of things to do, and cleaning was on the list.  And so I came and took over and saw to it that everything got cleaned properly.  I can't vacuum because Mom is asleep, but I'll do it later. Also, still need to mop the kitchen. And I wonder if the windows need washing...What else can I clean? I don't see any point in going to bed now. Might as well keep cleaning. Let's get serious-I'm thinking about polishing silver... And have I ever mentioned that I wash the bar of soap  in the soap dish? It's true. Is that weird? I mean, it's soap. It should be self-cleaning.

Magical Thinking Outside the Box

I fall into the category of a patient who holds the erroneous belief that ones thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. Magical thinking is defined as believing that one event happens as a result of another without a plausible link of causation.  In clinical psychology, magical thinking is a condition that causes the patient to experience irrational fear of performing certain acts or having certain thoughts because they assume a correlation with their acts and threatening calamities.

 In other words, you believe that by doing a certain thing, or by thinking certain thoughts, that you can cause bad things to happen.  The outcome can also be a good one. I have had these sorts of thoughts since my childhood, and indeed magical thinking seems to be a normal part of childhood development. (Except I never outgrew it)   I think that if I focus on one thought, one idea, one sentence even, and if I repeat it over and over again, many many times, then I can cause a particular event or outcome.  I also believe in performing rituals, such as turning off the lights a certain way or counting the number of times I lock the door.  Locking the door in and of itself is a ritual, for after it's been locked, I must unlock the door, open it, unlock the screen door, open that then slam it shut, lock it, then close the wooden door and lock first the deadbolt and then the door lock. I will repeat this process 3 times.  Later that evening, I will have to check the door locks (repeatedly, as it's one of my compulsions), and to check the main entrance, I must repeat the ritual of unlocking everything, opening both the wooden as well as the screen door, and start over again with the shutting and locking of the doors, again 3 times.  I believe that if I don't do these things each and every time I walk past the door, something bad will happen.  I'm not sure what, but something along the lines of the boogey man getting inside the house and hurting me and my family.  I have to protect my family, so I perform the locking of the doors ritual every single night.  As far as magical thoughts go, I can give you an example from just the other day.  I had to take my mother to the hospital for pneumonia, and I believed that if I said a certain phrase over and over again, that it would cure her.  Since she wasn't cured immediately, I believed that I'd not said the phrase a sufficient number of times, so I tried harder.  I repeated my magic phrase over and over as I walked through the hospital doors, walked up the hallway, and got on the elevator.  When someone got on the elevator with me, I quit saying my phrase out loud, but continued repeating it to myself in my head.  When that lady stepped off the elevator, I resumed my oral recitation.  When I got to my mother's room and found her to still be sick, I blamed it on my period of silence while riding in the elevator.  I change my magic words to suit each situation, and while I don't know how the rituals get started, I do know that I feel tremendously ill at ease if I don't perform them.  Most of the rituals which I do are far too personal and embarrassing to admit here in the blog.  I will tell you that I have rituals for driving my car, which are designed to keep me safe on the road and accident-free, and I have rituals for when I am sick which involve lighting specific candles, candles whose flames I believe will shorten my illness and make me well again.  Some of the rituals I perform are quite simple, such as writing a phrase on a sheet of paper over and over again.  I believe that the more often I write the phrase, the more likely it is to work.  I do believe these rituals and magic words will work if I can only do them properly.  When they don't work, I assume I must've screwed up the ritual or said the wrong words or said them an unlucky number of times.  I have a conviction that thinking equates with doing.  Magical thinking is characterized by lack of realistic relationship between cause and effect.  Intellectually, I know that I can't alter reality using only my thoughts...yet I believe that I can. Different parts of me hold different beliefs, and sometimes the various K's contradict one another.  In other words, not all of the me's perform the rituals.  The turning off of the lights.  The counting. 

Everything revolves around the number three, and I must perform each ritual a minimum of three times, or a number divisible by three.  This does not apply to the TV-yes, I have rituals associated with watching television-whose volume must be turned to a certain number on the control, rather than based on the actual noise level.  Also, I tune in to specific channels based upon their numbers rather than the programming,  Some numbers are good-3, 6, 9, 13, 23, 27, 30, 33...I can go on and on.  I just instinctively know which numbers are good and which ones are bad.  My belief that the number 3 holds special powers is a strong one, so strong in fact that as an artist, I feel it is my responsibility to hide the number 3 within each of my paintings or pieces of art.  I also have the number 3 represented in all of my tattoos, the ones I have and the ones I hope to get.  Three is my own personal magic number. I suppose it's common for people to believe they have a lucky number; well, I take it to the extreme.  I do everything 3 times. If I enter a public restroom, I always enter the third stall.  I always take the third item off the shelf at the grocery store.  In every aspect of my life, the number three plays a role.  I remember the first time one of my doctors brought up the subject of magical thinking.  I got really paranoid, and assumed she was trying to trick me into giving up the secrets of my power. Years later, I understand that this is something that ALL of my doctors believe I engage in, but I still can't wrap my brain around the fact that it's considered a symptom of my mental illness. It's not a symptom, it's a philosophy. It's a lifestyle choice.  I push the elevator button 3 times, I count the stairs as I walk up them, I avoid stepping on sidewalk cracks.  Do these things make me more mentally ill?  I think not.  I consider all the little rituals I do to be a part of what makes me ME.  It is just who I am, these are my personality traits, or quirks if you must.

 I can't explain it rationally, I just know that in my mind, I completely believe that by burning a light blue candle, I will cure my cold.  That by flicking the light switch on and off 3 times, I will keep the negative energies from entering the room.  Keeping bad spirits away is a huge part of my magical thinking, and many of my rituals are designed to keep negative energies away from me and my world.  I'm not sure if this counts as magical thinking or if I'm just being superstitious, but I believe that spirits who exist on an alternate plane of reality come into our world and affect our lives, touch our souls.  Whether these spirits are positive or negative depends upon what rituals I've performed that day, what mantras I've repeated, what thoughts I've had, even what colors I'm wearing.  I guess that does sound irrational...but to me it's completely rational. To me this is truth.

The Evolution of My Self-Mutilation, Part II

(This is going to be a very difficult post to write; I've never confessed these things to anyone. I'm completely humiliated and ashamed and embarrassed to death to admit these things out loud, but I feel it's important to speak out. Perhaps I can help someone else.)

In the first half of this post (The Evolution of My Self-Mutilation: Part I), I described how I began cutting at the age of 13.  I was always very careful with my routine, never daring to nick an artery or something that could cause a trip to the hospital, as that would reveal my secret.  I was a cutter throughout my teens and into my 20's, but then I took a break for several years and didn't cut. I turned to tattoos and body piercings as a substitute.  I told myself I was better, that I'd outgrown such behavior. That was a lie. I started cutting again on my 30th birthday.  But this post isn't about cutting, it's about self-injury, which comes in many forms.  I didn't need a razor blade to harm myself.  In fact, the self-injury actually began many years before I picked up a knife and made my first cuts.  This post is about my main form of self-mutilation.

I've suffered in silence since the age of 9 from a disorder whose name I never knew until two months ago.  This particular disorder is actually visible to others, in a tangible, physical way, or at least its symptoms are; it's much harder to hide than say Bipolar Disorder.  It's something I've misunderstood and been ashamed of and hidden from family and friends, and my doctors as well, all these years, for almost my entire life. Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often ending in bloody wounds and causing tissue damage severe enough to leave scars.  The urge to pick-or scratch, bite, tweeze, or squeeze- is similar to an obsessive compulsive disorder, but for some people the condition is more akin to substance abuse; I haven't yet figured out which one of those two groups I am in.  The activity causes great anticipation in me before I engage in the behavior (as with substance abuse), and while I'm doing it I feel a tremendous sense of anxiety relief (as with OCD).  Plus, 79% of patients, including myself,  report feeling a pleasurable sensation while picking.

My first memories of picking at my skin were in 4th grade, and it was on my face of all places.  There was no way to hide it. I can remember staring into the mirror and seeing all these flaws on my face, all sorts of imperfections.  Well, we, the K's, cannot tolerate imperfections, especially when we can alter the appearance of the flaw and hopefully remove it altogether. (This thinking stems from my Body Dysmorphic Disorder) So I began to squeeze any little bump I thought I saw on my face.  Then I mashed some pores on my nose that seemed dirty.  This led to my scratching at a mole on the side of my cheek. And so on and so forth...worse and worse every day. One day I was feeling sick at school and the teacher sent me to the nurse, and she looked at my face and decided I had chicken pox and so I got to go home that day.  I was too embarrassed to tell her that I'd created those angry red spots myself.  To this day,I find the subject completely humiliating and I hesitate to write about these things here, but when I started this blog, I said I was going to be honest, and so here we go.

How did my parents not notice?  Well, they did notice, but I pretended that it was just acne.  Puberty came early for me and so it wasn't hard for them to believe the lie.  As the years went on, I honed my skills and began using implements, not just my fingernails, to pick.  Tweezers were, and still are, my "weapon of choice", but at different times I have used scissors, nail files, needles, safety pins, and nail clippers, plus weird little things here and there, such as a paper clip or a thumb tack.  Anything I can use to remove the perceived imperfection, which apparently only I could see.  That's the thing which kills me, the fact that no one else can see all those blackheads on my face, or all those pimples, enlarged pores, scars, or ingrown hairs.  That was what I saw when I looked in the mirror.  I saw something flawed, something ugly.  I started wearing my hair in my face, but then in junior high I discovered that I could have just as much fun-yes, FUN-picking at the skin on my arms as I could my face, and no one would be able to see it.  That was a real turning point for me, when I moved from my face down to my body.  It was easy to wear long-sleeves and keep my skin covered, and since I quit picking at my face, my skin cleared up and I actually had a very nice complexion.  It's ironic, that everybody in 4th grade thought I had acne and teased me, but once I was in high school and everybody else had acne, I had smooth skin. (We never teased anyone with acne-one of the K's wants me to tell you that.) I'm not sure if my skin-picking was a precursor for my cutting. I just know that my cutting and my skin-picking coincided beginning in 7th grade and lasting until I was in my 20's.  I'd cut and cut, then take great pleasure in picking at the scabs from the cutting. I loved seeing how many times I could make the same wound bleed.  We'd go through phases of terrible picking, and then we'd stop for awhile, and let our skin heal.  Often we'd just move to a different part of our body to pick while the first area healed; the cutting was random and could occur anywhere on us. Try to imagine how horrible this looked-my body covered in rows of razor blade cuts on my thighs and upper arms, and then surrounding the cuts were open wounds, all shapes and sizes, all over my body from the chest down.  The only part of my body that didn't get cut or picked at was my hands, but even they were subject to abuse-I bit my fingernails down to the quick, I tore at my cuticles, and I chewed the skin all around my nails, resulting in horribly ugly hands which I mostly kept in my pockets.  It wasn't until my mid-20's that I was able to control chewing on my hands, and my nails finally grew out and I kept them manicured and no one would ever guess that I'd been a nail-biter for so long.  That was the same time I gave up my cutting and skin-picking for several years, and I actually had nice skin with no bloody wounds or scabs. I was modeling then, so it was important to keep my compulsions in check, but God it was hard to do.  I was only able to maintain this smooth, clear skin for those few years in my mid-20's; I was cutting and picking again by the time I turned 30.  And this time, I had a new favorite area to pick at-my lips.  Yes, I'd bite and tug at and peel the skin from my lips until they were raw and bloody. To this day, I cannot keep my fingers away from my bottom lip. It's a compulsion which my husband tries to help me control; if he sees me chewing on my lips he'll tell me to stop.  He also polices me when I shave my legs or pluck my eyebrows, as he knows how these activities can easily trigger me and lead to my either cutting or picking.

                                          
I have these episodes in which I lose time and stop thinking about anything other than the imperfections on my skin.  I can go into the bathroom, and won't emerge for hours, literally.  Some days, I have shorter picking sessions scattered throughout the day and night, but a lot of times I go into my bathroom, lock the door, and get lost in the mirror.  I have lost entire days like this (when I lived alone of course) and I always feel the same way when it's over=baffled.  I usually don't remember what I was doing, and I can't believe I was in the bathroom for such a long period of time.  I will look down at my body and be shocked to find bleeding, open wounds scattered all over my arms, shoulders, legs, chest, and sometimes even my breasts.  God this is embarrassing.  But I want you to understand that this compulsion is something that certain people deal with. This is a real disorder.

Approximately 2% of the population has this disorder.  It's considered a similar condition to and is often comorbid with Trichotillomania, where persons pull out their hair, and is as difficult to treat. Thank God I don't pull out my hair.  Treatment for Dermatillomania include Cognitive Behavioral Therapy and prescriptions for SSRI's.  I do take medication which helps me, but I've never sought therapy for my disorder because I'm just too ashamed and embarrassed to admit to my psych doctor that I have this problem.  She knows I self-harm, she just doesn't know to what extent.  Dermatillomania causes intense feelings of guilt, shame, and embarrassment, and this increases the likelihood of self-injury. Suicide attempts occur in approximately 12% of patients with this condition.

 And I have to interject this now--The Kellie is really very angry that we are divulging this information to anyone, let alone The Public. The Kellie has a diva's reputation to uphold.  The Kellie is NOT a compulsive picker.  She has soft, smooth porcelain skin which she works hard to maintain.  She can't look at us when we're covered in sores and scabs; she is disgusted by us.  I'm fairly certain that anyone would find us disgusting.  I mean, this is a really gross habit.  No, not habit, compulsion.  I am powerless to stop this behavior.  In fact, I usually don't even realize I'm doing the picking.  I lose time, a lot of it, and I become absorbed in the activity, and it's as though someone else is driving the car, so to speak, and I don't have true awareness of this...not really.  I see the aftermath.  I see the bleeding, gaping holes in my flesh, the peeling skin, the nasty scabs, and of course the scars.

Recently, as in two weeks ago, I had to go see a medical doctor because the self-harm had gotten so out of hand that my wounded legs would NOT heal, and I feared I was getting infected.  I was totally humiliated to show him the dozen or so large (3 inch x 2 inch) sores on my calves.  They were all bloody and scabby and it was obvious I'd been picking at them as early as that very morning.  He was very understanding and did not embarrass me.  He gave me a steroid cream and said it should clear up my skin in 3 weeks.  So far, I've got the same large wounds, only now they're all dry and cracked and peeling.  It is my belief that the scars from these particular self-inflicted wounds will be the worst ones I've ever acquired, and will probably result in me never again being able to wear shorts or dresses. Sigh. (Last Summer I wore short dresses and told everyone the sores on my legs were just mosquito bites, but that excuse won't cut it this year)

I don't want to make myself ugly, really I don't.  But this is my fate.  I've gotten much better about the cutting, and only do it in times of extreme stress, but the picking is harder to control. I can stick my hand in my sleeve and pick at my arm right in front of someone and they'd never know. And I do.  Thankfully it's Winter now, so it doesn't seem odd that I'm all covered up.  But I worry about Spring and Summer...I have a whole new group of friends now that I've gotten married, and I do NOT want any of them to find out about this.  My big fear is being invited to a pool party. I can stop picking long enough to heal for special events (I wore a sleeveless wedding dress) but I can't stop altogether and it's impossible to predict when some skin might be visible.  I worry constantly about my secret being exposed.  Sometimes, I'm still asked to model, and whether or not I take the job has to do with which areas of my body will be seen.  I had to turn down 2 jobs in the past few months because my arms were too scabby.  I don't know if this condition will ever be under control. I fear that I'll have to deal with this for the rest of my life.  Man, that's a hell of a lot of scars.

The Evolution of My Self-Mutilation, Part I

I don't know what the trigger was, or what initially drew me to it. All I can remember is that sometime around the age of 13, I began cutting.  It was my secret.  I wasn't doing it because I was suicidal-I didn't want to die (well, sometimes I did, but that's a whole different story)-I just wanted to feel the pain and see the blood. Cutting is totally different than suicidal actions.  I certainly wasn't doing it for attention, as I've actually heard some therapists say about the practice of self-injury. (OOH that makes us mad!) I didn't want attention, I wanted everyone to just leave me the hell alone. I was careful to cut in places that other people wouldn't be able to see, like my thighs and my upper arms.  Sometimes I used a knife, sometimes a razor blade, sometimes scissors, once or twice even a piece of broken glass.  It didn't matter to me.  What mattered was the physical act of hurting myself, of disfiguring myself, of punishing myself.  I had different reasons for the cutting at different times, but the compulsion was always the same: to draw blood.  Cutting was a release of all the pent-up anger and anxiety that I was suffering through not only as a hormone-driven teenager, but also as an unmedicated psych patient who was majorly depressed as well as manic and at times even psychotic. I was a wreck. I took everything out on my body. I chewed my fingernails down to bloody stubs when I was in school and couldn't hurt myself as I'd have liked. I stole a scalpel from the Biology lab and it became a favorite cutting utensil. By the time I was 15 I was carving words into my forearms.  I was terribly depressed as a teenager and the cutting was a way to relieve some of the agony of living.  The pain on the inside was so great, that the only way I could handle it was by experiencing pain on the outside.  So I cut, my arms and my thighs, inside my arms and calves.  Perfect rows of cuts, spaced evenly, all the same length. I'm even OCD when I'm in self-injure mode. The cuts had to be PERFECT, and I'd spend exorbitant amounts of time making each cut perfectly align with the ones beside it.  Sometimes, I'd use a needle or nail scissors and draw swirly patterns on my arms and I loved watching as the blood ran down my arms, mixing with each other, the patterns and blood resembling roses on my arm.  I felt better about the pain in my head and heart when I could feel the pain on my body.

 And speaking of that, I should explain that better.  When I'm doing any type of self-harming behavior, I get so caught up in what I'm doing that I am in a whole other world.  I guess what I'm talking about is dissociation, but I'm not sure it happens every time.  Sometimes, I can't feel the pain as I'm not in my body. Sometimes I'm a K who either is strong enough to endure the pain, or else I actually get psyched about it and enjoy it. (One or two of the K's is into BDSM). And of course, many times I don't remember the self-injury at all, I just find the bloody mess left behind. That, and the scars.

  So many scars.  I lie about how they came to be on my skin.  I have told the same story for many years, about how I was in a terrible car accident (true) and how all those little scars on my arms came from a broken windshield and pieces of metal showering down on me. (Truth? Some of them are cigarette burns, others are from needles/sharp objects)  Or I'll explain the round scars by saying that I had horrible acne in my teens.  Or I will just act like my skin has always been that way, and that those aren't scars, they're birthmarks.  Or something like that.  (sigh)  So many lies. At least I'm very pale-skinned, so the scars show less than they would on someone with darker skin.  After so many years though, it became impossible to come up with a sufficient lie and so we just started wearing long-sleeves at all times. And long pants or dresses.  We avoided the beach or pools-no way in hell could I bare that much skin-and I'm sad to say that I missed out on a lot of good times throughout my life because of my embarrassment and shame due to the results of cutting.  At other times we'd let all our wounds heal, and it was during those times, in our early 20's, when our skin was pale and smooth, that we did artists' modeling.  Since K is an artist and was an art major, she had lots of friends who approached her to model for photography class or sculpture.  For several years K modeled for art classes.  Now during this period in my life, I gave up the self-injury altogether. Naturally I couldn't cut while I was posing, sometimes nude, for artists, so I began getting pierced. For those of you reading this who cut, please do not be offended by my likening body piercing with cutting; I understand there's a huge difference, I'm just saying that for me the two interchanged nicely.  I found body piercing to be a natural replacement for cutting.  I mean, I still got to experience the pain, which I longed for and even needed, plus I was tearing into my flesh, stabbing sharp metal needles into my skin, causing bleeding and wounds and a pain which would linger until it had healed up.  Now some of my piercings, in addition to my compulsive need to scar my body, were also decorative (such as my navel or nose); other piercings I got strictly for the pain.  For those, I'd leave the jewelry in for a couple of days and then take it out and let the piercing heal. (Example=both sides of my labia) It should come as no surprise then that I have a number of tattoos as well; again, it just seemed to me to be another form of self-mutilation, only I was paying someone else to hurt me.  I insisted on designing all my own tattoos, and each one has a special symbolism behind it.  I get tattooed when something life-altering happens; I get pierced when I'm in extreme emotional pain. I have six tattoos, including a large black piece which covers my stomach and wraps around my navel.  I've been pierced 34 times, including a corset piercing which was 12 piercings done all in one sitting, up my back (then I was laced up with satin ribbon; it was for a photo shoot)  The most painful piercing, by far, was my urethra, and I had it done twice. Is this too much information?  I'm just talking about my wounds, wasn't that the point of this blog post?  Forgive me for rambling on about my body modifications.  But it was my psychiatrist who told me that tattoos and piercings are the "grown-up" version of my cutting and self-harm.  One other thing I found to be especially fulfilling and painful was getting branded with blessed cone incense, three at once in an inverted triangle on my lower back.  A Buddhist performed the ritual and placed the incense cones on my back and then just let them burn all the way down until they went out by themselves. Yes, it hurt.  And I'd love to do it again, on top of the same scars. So I guess the only question left to ask now is, Do I ever still cut, like with a razor blade? The answer, unfortunately, is yes, but it's not nearly as bad as it once was. The stress would have to be over the top and unbearable to make me cut with razors again.  I'm well-medicated and have a husband who keeps an eye (he times my bathroom visits) on me and besides, I can always just go get inked or pierced.  And I always have that special scar on my left wrist as a reminder of darker days.

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.
        

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.