Category Archives: Unclassified Disorders

Online Dating Addiction

He said at first he was just going on online dating sites as he was feeling a bit lonely (though he didn’t use the word “lonely”, that’s just how I interpreted it). He is in his 30s, works in bank, bought a house last year and living on his own. He has rather limited social life as his work occupies almost all his time (13-14 hours a day, sometimes more, weekend too!) 

He went on multiple dating sites to increase the chance of meeting “the one”, some popular sites and some not so, but he’d make sure there’re at least some [female] users in the country (well, it’s still not so common a thing in Malaysia). He said some dating sites had literally no female users in his area.

Over the months he chatted with so many girls. At any one time he could be chatting with 3-4 girls on 2-3 different dating sites. “As long as they responded. But I do filter – religions, ethnicity mainly. The rest, it doesn’t matter, but I do check their pictures. I don’t talk to those without pictures. Who knows you may be talking to an old man or…”

But to my surprise, when I asked how many he had met in person. “None. We’d always mention about meeting in the future, or doing something together. But I never do it. Initially I thought it was due to my work. Well, at least that was the excuse I gave myself and them girls. But slowly I realized I had no intention to meet any of them.” ??!!

“I only enjoy talking to them, flirting with them, perhaps imagining how things would go with this particular girl in the future (then with another girl in “another future”). They fill my time, which isn’t much, anyway, due to my commitment to work and house loan”

“I feel good. I laughed genuinely, and I’m sure I made them happy, and they’re also laughing, giggling in front of the phone. It uses up my leisure time and I constantly feel accompanied, day or night. This one stops writing back? Fine, there’ll always be next and next, next one. So my problems of being alone and not having much social life are solved. Why still bothered to meet up? Especially it probably would often lead to disappointments anyway.”

“I know I’m not the only one being this way. Some people met up and found someone that they’d regularly see, but they continued to surf the dating sites and flirt with others. Why stayed committed when you have so many more constantly waiting for you [in your phone]? They said this more often happen in guys, but I think the girls are doing it, too, but perhaps in a more discrete way.”

I didn’t bring up the word “addiction”. I’m not even sure whether this is ordinary or unhealthy or… At the time of writing he’s still on dating sites, happily. Hopefully I get to come back to update this post as of what happens to him in the future…

Here are some of the interesting experiments done on online dating sites:

Pretty woman with ‘worst dating profile ever’ still got dates

Cruel Intentions: How I Hacked Tinder And Got 2015 Matches In Under 17 hours

OKCupid: We Experiment on Human Beings!  (The site did various experiments on its users!)

Paranoia? Anorexia? Body Dysmorphic Disorder?

It was first suspected that she has Othello Syndrome (morbid jealousy, case study here). When she came, she just split from her boyfriend and was having suicidal thoughts. The mother said she was constantly checking on the boyfriend, his phones, his whereabouts, his friends etc (similar to the case here). She was also hearing voices, very bad-tempered, having very unstable mood and insomnia.

Few days after she started taking anti-depressant and anti-psychotic medicine, she called up and asked if she could take weight loss pill “L*** B***”, she said it helps to lose body fat only, will not lead to diarrhea. So she was told ok to take this weight loss pill along with her medicine.

Few weeks later, the mother called and questioned us, why we allowed patient to take weight loss pills. Mother said patient has been taking the pills, along with laxative pills (for constipation) excessively, she could take over 20 tablets a day, and purging herself (to vomit). She’s in fact only 43 kgs when she first came to see us, she doesn’t need to lose any weight. But our position is to tell patient that the weight loss pill is safe to be taken with our medicine, but that’s obviously based on the fact that patient is taking it accordingly. It’s not our position to advice patient regarding her weight (we can do so, but we can’t stop her). It also important to note here that if the pill will cause diarrhea or vomit then it won’t be suitable to take with medicine.

So mentally she’s got much worse, as she wasn’t regular with the medication, plus all those means that she’s using to lose weight, her body probably couldn’t take in any of those medicine. She got more sensitive and paranoid, always thinks that people are talking about her, especially when she is out. At one point they had to admit her into hospital for drips as she was taking too much of those pills. After the discharge she finally realized what harms those pills are doing to her body and brain.

So she stopped purging and trying to lose weight. She’s given up on the idea of losing weight. But few days ago she came back for review, now she’s considering rhinoplasty (plastic surgery on the nose)! Almost obsessed about going for it…

Paranoia, anorexia nervosa and body dysmorphic disorder are undeniably inter-related and co-morbid, but does one move from one to another?

Body Integrity Identity Disorder (BIID)

If you were a surgeon and someone came to you asking you to amputate his leg, for how much he is suffering deeply due to this leg and for no physical health reason, what would you do?

The thing is if you don’t do it, they may DIY. One practiced first, he got rid of part of his finger as a prelude to amputating his leg. Another one laid on the train track and let the train run over his limbs. One more shot his legs off with a gun, etc.

Just like Gender Identity Disorder (GID), “body integrity identity disorder hypothesises that a normal function, which is your comfort in how your body fits together, has gone wrong.” When they envision themselves, the image is without the limb, the limb makes them feel “incomplete”.

Do they all desire an amputation due to BIID or a sexual fetish? An obsession with amputees and amputations?

Here was a perfectly healthy man with a perfectly healthy leg. Yet he went under the knife voluntarily, in a foreign country. He trusted a surgical team that worked under a cloak of deception. How much must a man suffer to come to this: lying by himself on an operating table, attended only by strangers, in a small, obscure hospital thousands of miles from his home in America?

Is amputation the only way out? Is it ethical?

Look at some case studies and the history of BIID here (a long read): This is what it is like to be at war with your body – the compulsion to be free of a limb is no imagery illness

Related study: Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial

Alcohol Related Amnesia / Post-Injury Personality Change

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?

Underlying Perfectionism?

The mother made an appointment being not so sure about what her daughter’s problem is. She said the daughter is lacking confidence, or something is wrong with her, but the mother isn’t sure what it is.

This patient was doing A-Level at College A. She later said the course wasn’t so good and so she wanted to transfer to College B. So the parents went through a lot and completed the application and helped her to do the transfer. Everything went well for the following months. Till about one month ago, the patient told her mother that she wants to transfer back to College A again. The mother wasn’t happy about it but still she asked for the reason. The patient said she isn’t making any friends in College B, all her friends are in College A, she wants to go back there. The parents think it’s not a good decision so they continued to persuade her to stay on, and encouraged her to take part in some societies/organisations in order to make new friends.

The patient then stopped attending classes, when her request wasn’t fulfilled. She stayed home all the time, keeping to herself, not responding to mother when the latter speak to her. She isn’t even answering her friends’ phone calls (well, we thought she wanted more friends?). It does appear that she’s rebelling. But other than that she’s also losing the ability to make decision, to be assertive about what she wants and doesn’t want. When the mother asked whether she wanted to go back to College B, as the college has been calling the mother, she just stayed quiet.

This was continued with another two weeks till the mother came to us. The mother doesn’t know what to do. The mother consulted doctor on behalf and brought the medicine back to the daughter. She was very eager for the daughter to get better, to return to college and sit for her exam in two weeks.

So the mother gave us a call every two days, asking us what to do with her daughter, asking why her daughter still couldn’t make any decision, keep to herself, not going back to college, asking when she would get better…… She tried to push the daughter further and further, and of course, in such short period, she gets no results, but probably have made things worse.

What do you this girl’s problem is? Perhaps some underlying psychological worries? Depression? Social phobia? Agoraphobia? Laziness?! Avoidance, avoiding what? Some obsessions, obsessed with what she wants? Or is she a perfectionist? Someone who tolerates no imperfection? So when a bit of problem shows up she just avoids it?

What do you think?