Monthly Archives: April 2014

OCD or Body Dysmorphic Disorder

Anxiety Disorder, Clinical Case Studies, Depression, Obsession & Compulsion

“Why wasn’t I born pretty like some people?”

“What’ve I done in my past life to be born this ugly?”

“How am I going to live with this face?”

“I’m growing older and going to be even uglier. How do I live till then? Can I just kill myself?”

“Why can those people cope with their ugly look and live like nothing happens, but not me?”

This is a defaulted case who now follow up with General Hospital due to financial constraint.

She is in her late 40s, married with two teenage sons, having long standing mood disorder, very preoccupied and worried with her look, thinking about cosmetic surgery. She thinks she’s very, very ugly, and ugly people should kill themselves.

From the outsiders’, she’s actually quite tall and has a reasonably pretty face.

When she walks on the streets and see some women who’re less attractive, she’d be thinking, “how do they live with that look? Why didn’t they just kill themselves?”

She said people teased her. Telling her not to speak to them since she’s so ugly. She can’t bear people’s remarks about her look and appearance.

Her husband and two sons are very supportive, always trying to comfort her. So are her siblings. But she couldn’t get rid of this obsession from her mind. Whether she’s doing something or not, her mind consistently reminds her that she’s ugly. She also tries to do some meditation, but that doesn’t calm her down and release her stress at all.

In a conversation with her for about 30 minutes, she asked over 10 times of “Can ugly people live? Are you sure? Really? They can live till old being so ugly? They don’t have to kill themselves? They must be suffering isn’t it? Why do they bother to live?”

Then few minutes later, she’d be asking all of these questions over again. This suggests some level of OCD, but her obsessional is to do with her look. She also appears to see things very negatively, which may indicate her dysthymic mood, if not depression. In fact when I asked her a few questions, I realized she is almost completely incapable to see things positively, optimistically, and be grateful.

This was when I gave her a task – to write down a list of 30 items “Anything I have that others MAY be jealous with”, I easily gave her over 10 examples (you have healthy limbs; your husband loves you; your sons listen to you; you’re tall; you can see; you get to arrange your time; you can taste food; there’s electricity supply at home; I’m able to pay the bills etc etc).

When she started to ask those “ugly persons should kill themselves” kind of question, I reminded her about the task, and she told me, “there’s nothing anyone will be jealous about me”, couldn’t recall any of the examples I gave her few minutes ago.

So this is a severe obsession with her own definition of “ugly look” and some degree of depression. Before we help her, what  could be the diagnosis?

Is this Morbid Jealousy? – Social Media

Clinical Case Studies, Issues & Debates

We talk a lot about trust in relationships. It’s like the fundamental of any relationships, it’s probably quite easy to lose it with one small action in a few seconds, but to rebuild it can take ages, or forever.

This is a young girl born in 1990s. She knew her current boyfriend of 4-months through an online game then moved on to social media. After meeting each other, they also exchanged phone numbers and start to connect through Whatsapp.

She doesn’t want to be a control freak. But she recently realized that the boyfriend seems to be less caring. Sometimes they don’t talk to each other for whole day. She thought they should still be in the honeymoon phase, how did it end so fast? Sometimes she’d see that her boyfriend was last seen early in the morning on Whatsapp, but he didn’t talk to her, so who did he talk to at such early hours?

So one day when they were out dating, she found a chance to check on his phone, and found this girl’s phone numbers who the boyfriend appeared to be chatting with quite often on Whatsapp.

She wrote down the girl’s numbers, and added it to her phone book. So now the girl’s whatsapp account also appears on her phone. She started to monitor when the boyfriend and this girl are online, whether they are online on the same time, and whether they’re last seen on the same time (one of Whatsapp’s features, it tells you when the contact last online/seen). She’s getting almost obsessed with this checking, especially when she found that they appeared to be online at the same time so often.

At the end she confronted the boyfriend, and ended the relationship, without even finding out that the guy was really cheating. She couldn’t stand it, couldn’t stand the fact that the guy MAY be chatting to somebody else so often, and what’s most, she couldn’t stand her own checking behaviour. She knew when there is no trust in a relationship, the relationship will never work.

Sometimes I’m really not so sure if social medias bring us more benefits or hazards. When people sit in front of each other but do not look at each other, do not talk to each other, but look at the phone and chat with the persons over the phone. Is this still considered as social interaction? Perhaps it isn’t a bad thing when people use it to know more friends and to look for companions, but now people even use it to check on partners, is this still a healthy act?

Is what she does considered morbid jealousy? Can social media now function as a tool to check on partners?

(See more about morbid jealousy and a clinical case study here.)

An Inspiring Patient

Clinical Case Studies

Nobody really likes to talk to her, because she talks non-stop, about herself and her “disorder”.

She mentions the word “disorder” once every few minutes. I’ve always said having insight about your illness is good, and utmost important in your recovery, but when I talked to her, I kept wondering whether this level of insight is good.

She’s divorced with a 10 year-old daughter who lives with her. Her parents are kind of supportive but she thinks it was her mother who pressured her too much and somehow caused her disorder so she refused to live with them, and refused to let them bring their granddaughter. But her relationships with her parents remain close.

She has been through a lot since young. Being the top student but wasn’t allowed by the mother to continue her studies. Working three jobs to cover and support her own family which still fell apart at the end. Having an ex-husband who transmitted HPV to her and left her with the baby daughter to deal with all by herself. Bringing up a baby girl all by herself while coping with her mental illnesses.

She has problems sleeping, and when she doesn’t sleep well, she gets panic attacks. She can also turns aggressive, when she is in that mood, she could punch the wall till she bleed. She sometimes can’t control her emotion, she cries out loud, like a baby.

But she learns about her problems and illness. She goes for jogging, learns yoga and meditation, understands what she should and shouldn’t do in front of her daughter, reads psychology, self-help books, learns about psychiatric pills, and what’s surprising, she teaches the daughter about her illness, so the daughter understands her, loves her, be patient and caring, even when she needs to release her anger and agitation by punching, even when she asks her to stay away from her, the daughter understands that she’s just not well, she still loves her. When she knows she can’t handle it well enough, she seeks professional helps.

She’s often in needs of reassurance. But she’s doing is in fact doing very well.

After a 50 minutes conversation with her today, she was very grateful, and so was I. To learn about someone who’s mentally ill and who’s been through a lot in their lives, but still stay positive, inspirational, motivated, this can’t be achieved just like that by ordinary “normal” people.

Alcohol Related Amnesia / Post-Injury Personality Change

Clinical Case Studies, Unclassified Disorders

He has a history of substance abuse but he overcame the addiction spending 3 years in a rehab centre in Singapore. But during this period of time, he’s become dependent on alcohol.

He was involved in an accident one day when he was taking a cab. His head was injured. Since his recovery he seemed to have become somebody else. He was calm and patient. Now he’s short tempered and very easily agitated. He also doesn’t care about what people think about him anymore, he’d walk around naked in the house, in front of the very young daughter and maid.

What’s worse is his attitudes and behaviour after he gets drunk, he became aggressive and very bad-tempered. He has injured people on several occasions now, on one occasion he even held a chopstick wanting to put it through somebody’s throat, but he was stopped by several friends, whom injured by him.

He had no memories of these incidents the next day when he’s awake.

His wife was very worried. He even beat her up when he was drunk, but the next day he couldn’t recall anything. He was very sorry so the wife forgave him. But she doesn’t what to do as if this continues she and the daughter will be at risk. They don’t know what he’ll do when he’s drunk.

From the wife’s view, he’s very kind and friendly, although he does see quite low of himself, as he’s an adopted child, growing up being teased and laughed by his peers. Till he was involved in the accident his personality has all changed.

What’s the treatment option for such kind of personality change following head injury? How about the alcohol related amnesia – is quitting it the best or the only solution?