Monthly Archives: July 2014

Paranoia? Anorexia? Body Dysmorphic Disorder?

Clinical Case Studies, Obsession & Compulsion, Schizophrenia & Psychotic Disorder, Unclassified Disorders

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)

Clinical Case Studies, Issues & Debates, Obsession & Compulsion, Unclassified Disorders

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

When you get old…

Anxiety Disorder, Clinical Case Studies, Depression

She usually calls me a few times a week, especially when she first came to see us.

This is a woman in her late 70s. She has 3 daughter, 2 married, one lives in Singapore and another in the UK. She lives with her youngest daughter who is still single. Although she does her best for her mother, her work is usually very busy and occupies most of her time during the week.

This woman has problems getting into sleep, so she used to take alcohol to aid sleeping. Then she had problems with her heart arteries and had to go for coronary angioplasty twice. Since the discharge her physical health deteriorated. She can no longer move around freely like she used to be, take alcohol the way she wanted it, do her daily chores like going to the market, cooking, visiting friends, walking around etc.

She spends most of the time alone in the house, not doing much. She can’t do much work as she feel her limbs have no strength (to even take up a pot filled with water). She isn’t interested in watching TV or reading papers. The elder daughter bought her an iPad and tried to teach her playing games and using Skype to connect with her grandchildren overseas, but she gave up learning half way. What’s worse, now that she isn’t allowed to take alcohol, she couldn’t sleep at all, could only sleep for few hours taking sleeping pills.

She sees no purpose of her life, and thinks very negatively. She can’t see hopes and meaning of her life. Whatever suggestions and advice made to her, she finds excuses to dispute them (symptoms of depression). When I told her how negatively she has been thinking, and all this negativity comes from her illness, not from herself; and when she’s well, she wouldn’t behave, think and feel this way at all, she doesn’t believe it – she sees no “negativity”, she thinks all these feelings and thinking are completely normal, anyone in her shoes would experience the same cognition and emotions.

In some countries the suicidal rates in the elderly are very high, I don’t have the statistics in Malaysia, but I’m sure there’re quite a number of them suffering in silence. Asian cultures place enormous value on filial piety which includes caring for the elderly (especially parents) when they can no longer look after themselves, but still, this is not always possible, so it’s important to have a plan in mind, whether it’s to have a partner with you (not necessary a spouse) and look after each other, to live in the old folks house with the others, or get a private carer.

But while you’re still young, look after your physical and mental health, be prepared for it before you get there, and take good care of your body now so that it’s fit for you to go a long way!