13 Jul 11 HOW BDD AFFECTS LIVES – SUICIDE

It isn’t known how many people with BDD kill themselves, but some do. A study of dermatology patients reported the very sobering finding that of those patients known to have committed suicide over 20 years, most had acne or BDD. The psychiatric literature also contains descriptions of people with BDD who committed suicide because they were so distraught and despairing over their perceived ugliness. And I know of numerous people with BDD who committed suicide. Several were beautiful young women with skin concerns who picked their skin. Another was a young man who had been obsessed with his “misshapen” forehead, and another a young man who hated his hair. Yet another was a man in his 50s who hated his beard and whose life had been devastated by BDD.Bill told me that there were some people with BDD I’d never be able to interview. When I asked why, he answered, “Because they’re dead—they’ve killed themselves.” He should know, because he had attempted suicide 15 times because of the pores on his nose. He could no longer cope with the torment of his perceived ugliness. Another man said something nearly identical: “I think many people have committed suicide because of BDD. I know, because it’s so painful. I made two suicide attempts at the time my symptoms were severe. I felt very isolated, and I lost hope.”I have no doubt that in many cases successful psychiatric treatment (SRIs and/or CBT) prevents suicide. In my fluoxetine (Prozac) study, suicidal thinking decreased significantly more with fluoxetine than with placebo (sugar pill) treatment. Juanita had a good response to fluoxetine. She called me years later to say that she’d gotten married and had a great job. She was no longer suicidal over how she looked. Luke also had an excellent response to the same medication plus cognitive-behavioral therapy. After treatment, his appearance no longer tormented him. He went on to a successful career in television, and gave up thoughts of suicide. “It’s the furthest thing from my mind now,” he told me. “I have a great life. Thank God I got treatment. I owe my life to it.”*146\204\8*

10 Dec 10 ALCOHOLISM RECOVERY PROCESS: PRELIMINARY OR INTRODUCTORY PHASE

The preliminary or introductory phase begins when the problem of alcoholism comes to the foreground. This happens when the alcoholic lets those nagging suspicions surface that there is something wrong with the drinking. On personal initiative, he might make some initial inquiries, which may be directed to friends and associates.
“You know, Jane was really mad at me for getting a bit tipsy when we went out last Friday night. You were there. I don’t see anything wrong with letting go after a long hard week, do you? She’s always on my back about something these days.”
Often others may not recognize these queries as a disguised or tentative “cry for help.”
Ideally the friend, coworker, or colleague who is the recipient of these initial queries listens carefully and avoids the trap of offering false reassurance or reinforcing denial with a comment like “Oh, you’re just imagining it.” Ideally they will share the information that people can get in trouble with alcohol, that alcohol use can be a significant health problem; they will then urge the seeking of a professional opinion, and do whatever they can to see that the person gets there. The first overture may instead be made to the alcoholic by a member of the clergy, family member, friend, or perceptive physician—someone who is sufficiently concerned to speak up and take the risk of being accused of meddling. Suspecting an alcohol problem, any one of them might request that the alcoholic seek an alcohol expert to explore the possibility. On the other hand, a court may “sentence” an individual convicted of DWI to alcohol treatment. Increasingly common also is that the spouse of the alcoholic may seek counseling as a result of the chaos of living with an alcoholic; or the employer may notice developing problems and attempt to intervene.
At this point the alcoholic is a fish nibbling at the bait. He moves close and backs off. He wants to know, but he doesn’t. Of course his drinking causes him problems, but he doesn’t want (is scared) to stop. What he really wants to learn is how to drink well. He wants to drink without the accompanying problems. In getting in touch with a counselor, the chances are pretty good he wants the counselor to teach him how. (This represents an impossible request, so the counselor must avoid getting sucked into trying.)
What can the counselor do? First, the counselor must make a careful evaluation of the problem in order to assess its nature and severity. Following that, a tentative treatment plan will be devised, possibly using outside expert opinions. These treatment recommendations will then be discussed with the client. This discussion will explain the recommendations, including any possible “risks” of treatment contrasted with the dangers of not initiating treatment.
The assessment process for an alcohol problem or alcoholism, just like any other evaluation process, is intended initially to collect data. The counselor in a very general way will be endeavoring simply to get a clear picture of what is going on in the client’s life.
In terms of the specifics, keep in mind that it is of the utmost importance to avoid getting into a defensive position. You need not be defensive as to the reason you can’t be helpful in teaching the alcoholic how to drink successfully. That is guaranteed to push the alcoholic’s seesaw and drive him away. There is, however, a mutual goal “to have things be okay.” The counselor can buy into this without accepting the client’s means of achieving it. The task of the therapy will be to assist the alcoholic to see his behavior and its consequences accurately. As this occurs, the client will be confronted with the impossible nature of his request. The counselor will be most successful by being open, honest, patient. The counseling is doomed if you are seduced into playing the “patsy,” or if you try to seduce the client by being the “good guy, rescuer.” Having a coworker with whom to discuss cases and their frustrations can help keep the objectives in sight.
Alcoholism is a disease that requires the client to make a “self-diagnosis” for successful treatment to occur. Treatment, full steam ahead, cannot begin until the alcoholic, inside himself, attaches that label to cover all that is going on with him. A head, or intellectual, understanding does not suffice. It must come from the heart. In fact, the whole thing can be confusing. He certainly doesn’t have to be happy. He simply needs to know it’s true. Then without hope of his own, he borrows the counselor’s belief that things can change.
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