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HOW BDD AFFECTS LIVES:  ANGER AND VIOLENCESometimes anger and violence are directed toward the surgeon or dermatologist who provided unsatisfying treatment. I’m aware of a man who severely assaulted his plastic surgeon because he was so upset over the outcome of his surgery. Another tried to murder his dermatologist after the treatment didn’t work. And there are a number of published reports of people with apparent BDD who threatened, stalked, attempted to kill, or actually killed their dermatologist or plastic surgeon. In a 2001 survey of 265 members of the American Society for Aesthetic Plastic Surgery, 2% said they had been threatened physically, and 10% had been threatened both legally and physically, by a patient with BDD.BDD can spawn illegal behavior. As I discussed above, BDD can lead to illegal drug use. Ian broke into houses across the country so he could get to California to get a tan. Todd shoplifted from drug stores. “I don’t like to do it,” he said, “but I have to get stuff for my skin, and I don’t have any money.” Over several months, he’d stolen nearly $1000 worth of items. “I’m afraid I’ll get caught,” Todd said, “and I feel guilty doing it. But I can’t resist. My acne is destroying my life. I have to make my skin look better!”Another man had done many illegal things—such as assaulting people and breaking and entering—in the hope that he’d go to jail. He explained, “That way, no one would see me except the other inmates. And it’s too hard for me to keep a job because I look so bad, and I wouldn’t have to worry about it in jail. Jail would be better than this hell I live in every day.”   *142\204\8*

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Exercises for the physical fitness of the body are quite the fashion. But to many people the idea of exercises for the relaxation of the mind seems rather queer, and it is only just acceptable. And now we come to pain; and we find the idea of exercises with pain is so strange to most people that they can hardly accept it at all. But it is not simply because the idea of exercises with pain is unusual to people that they are reluctant to accept it. There is something more involved.

As in matters of sex, there is a kind of taboo about pain. And as with sex, there is a reason for the taboo. In discussing the masochistic embellishment of pain, I said something of the nature and origin of sadism and masochism. The idea of the experience of sexual pleasure in the giving or receiving of pain is horrible, and shocks us. It would seem that the taboo against any voluntary experience of pain is in fact a protective mechanism against the activation of the sadomasochistic traits that lie buried within us. Because of the unconscious operation of the taboo, people are loath to experiment with pain, and if they do, they are often faced with misunderstanding by their professional colleagues in much the same way as those who first started to write about sex.

In addition to the problem of the taboo, there are considerable practical difficulties. Experiments with pain involve us in the sensation of pain, which we do not like because it hurts us. Then there is the further difficulty of getting a suitable painful stimulus which does not cause too much bodily injury. Electric shocks are now widely used for this purpose as there is no injury to the tissue. However, this is a biologically unnatural stimulus, as in our evolutionary development we have had no experience of this kind of pain. I have therefore preferred to keep to the simpler and more natural modes of painful stimulus.

*140\57\2*

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We have already discussed the devastating effect that stress may have on sex in the way of causing impotence, premature ejaculation and frigidity. I now wish to discuss with you the relationship of sex and stress from a completely different point of view.

There is some major problem or adverse happening in our life that is causing our stress. It is easy to feel that if we could only get our mind off this problem for a little while it would do something towards freeing us from our anxiety and nervous tension. This is a common enough feeling.

Many people try to divert their mind from the problem by reading a thriller.

But there is another path to the same end. Instead of reading a thriller, we can act out a thriller in the reality of our present-day life. The practical circumstances of our ordinary life limit our choice for such an adventure. What could be better than an affair?

The person who reads a thriller before going to bed usually does not do so for the specific reason of escaping from the symptoms of stress. More commonly, the real motive remains unconscious, and he just drifts into the habit of thriller reading because it seems to suit him. It is the same with those who act out a thriller with an affair. It is not a consciously premeditated act to avoid stress. Rather the situation is experienced as a pressing need to do something.

So he has an affair. The short-term effects are good. He does, in fact, feel less tense. The affair has taken some of the stimuli arising from his problem from pressing so intensely on his brain cells.

Of course, the relief is only transitory, and the long-term effect is disaster, which adds another problem increasing his basic stress.

Sex and stress may come together in yet another quite different way. It is a sex romp to reduce stress.

It works like this. Stress results from the over-stimulation and over-alertness of brain cells. This leads to the uncomfortable restlessness of body and mind which is a prominent symptom of stress. In sexual intercourse there is first a build up of tension. Then orgasm comes, and in both man and woman there is relief of tension followed by quiet relaxation. Some people, either consciously or unconsciously, sense a similarity between the tension of stress and the tension that arises before orgasm. There is the background feeling, ‘If orgasm relieves one form of tension, may it not relieve this other form?’ And of course it does. A man or woman may be tense from stress, then after a sexual experience there is a feeling of quiet relaxation. Of course, the tension builds up again. So the tendency is to repeat the sexual experience simply for the relief of tension that follows it. And a pattern develops not dissimilar from that of taking drugs, reliance on alcohol, reading a thriller or the overuse of prescribed medication.

In a similar way, masturbation may become a regular pattern of behaviour, in either men or women, for relieving stress. People come to masturbate from quite different reasons. For some it is the simple physiological urge for sexual outlet. With others it is basically a part of erotic fantasy. For some lonely introvert persons it combines with fantasy to relieve their loneliness. But for others it becomes simply a stress-relieving mechanism.

Many young men have spoken to me along these lines. «It seems crazy. It’s not really sex at all. I get so tense. So terribly tense about my work. Awful. Then just go and do it. The tension goes. But then feel I should not have done it. Guilty, I suppose. »

*73/98/5*

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Incidental problems

We have seen how the major problem operates on a background of continuing minor problems, and how the major problem produces associated problems, all of which combine to produce stress. However, the matter is often complicated by the advent of an incidental problem. This is something not associated with our general background, nor is it the result of the major problem. It is really a matter of two unrelated problems coming upon an individual at the same time.

A woman may have just learned of her husband’s unfaithfulness. She is shocked, but just manages to cope. Then two days later her son is knocked off his bicycle and seriously injured. She breaks down with severe symptoms of stress.

In clinical psychiatry this type of story is common. It goes to show that our brain can often integrate the impulses from a major problem, but some other incidental problem will prove the last straw that breaks the camel’s back.

There is a serious financial problem at work. He is just coping. A few days later his trusted assistant, on whom he relies, is suddenly struck with some illness that will keep him away for several weeks.

These are incidental problems, and in their pure form are quite unrelated to the major problem. But there is often a grey area in which it is hard to see whether they are related or not. There is a major financial problem, and the trusted assistant gives notice of going to a better job. Had he been thinking of this for some time, or did the sudden problem at work prompt him to make a move?

This same principle applies to many matters in ordinary life, when it is hard to be sure of the relationship of one event to another. A woman has decided to leave her husband who is a very dependent man. He does not feel well. A blood test shows a slight abnormality. It just could be suggestive of leukemia, and her decision to leave is thwarted.

Unrelated problems

«Just not coping. Feel it is the end. Mother died a month ago. Should be getting right again by now, but I’m not. Widowed six or seven years. Mother again seemed to fill the gap in my life. Of course she depended on me. But I did not realize that I still depended on her. Now she’s gone.

The children, both of them, have just left home. One married, the other just living with her boyfriend. That’s life. They have their lives to lead. But me? It’s just a question mark. »

We can see how the major problem, the loss of the emotional relationship with her mother, is significant in producing stress only through augmentation by the incidental problem of the emptiness of her life resulting from the children leaving home.

*35/98/5*

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