I may have some slight OC symptoms (definitely doesn’t suffice to be diagnosed as an OCD), but still struggle quite a bit to look at those pictures.
How do you feel? Can people with OCD look at them? (Don’t take it too seriously, it’s definitely not serving as a tool to diagnose OCD)
Pictures extracted from here.
“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?
Came across this article and think it’s really worth sharing, also a very good case study reflecting the growing up environment of infants/toddlers nowadays:
Some food for thought: How do we help the younger generations to develop healthy relationship with those advanced gadgets? How do we balance while using them as educational or entertaining tools (not iNanny!) but not overusing leading to obsession and/or addiction?
(To the educational psychologists and child experts: is this going to be a newly added and researched Developmental Disorder?!)
At first glance, you probably don’t quite find any obvious relationship between Anorexia (irrational fear of gaining weight, food restriction, distorted body perception) and Psychosis (“loss of contact with reality”) in my title, but with some explanation in the brackets I hope it does make it a bit obvious…
This young boy came with his parents that day. He seems a bit underweight when we were told that he’s already 13 years old. The mother said he was above 60 kgs, much bigger size than most of his peers, but now he has lost almost half of his size, and is still losing.
He was the target of bully, his schoolmates made jokes about his size and weight. He made no friends and had very low self-esteem and confidence. Then he started to avoid taking meals. The parents have to persuade, convince, force him with all kind of methods. Still, he continues to lose weight.
He’s also obsessed with cleanliness (yet another OCD case), very fear of contamination and infection. Though one very different thing from the other obsessors, is that he can’t take off his shoes, as he thinks if his feet have any contact with the floor, the dirt and dust will be “transmitted” into his body, causing him fat! causing him fat! causing him fat! (Something’s wrong with my writing style, I think I’m also obsessed with repeating when I talk about OCD cases).
Although we can’t really be sure chicken or egg which came first, here it seems likely that he first became anorexic, then only led to obsessions with cleanliness. But being highly fear about things on the floor causing him gaining weight, he is so close to delusional and psychotic. Guess what’s happening right now? He thinks the medicine will make him fat and so is refusing the medicine…
It seems that anorexia is also a kind of obsessions and compulsions, but it can also be so serious and appear like psychosis. Just like how they see themselves in the mirror, completely distorted, different from how we see them, isn’t that “losing contact with reality”?
I remember this young man very well. I got phone calls from his mother about one hour before we close for 3-4 days continuously. The mother said she was bringing him back for review, but they didn’t turn up at the end.
Till that afternoon they showed up just before we closed. The psychiatrist was still seeing a patient so they had to wait for a bit. This young man went into the toilet, and spent at least 20 minutes in there, till the nurse was calling his name several times, looking for him in the waiting area and outside, still hadn’t found him. The mother said he was in the washroom. When the door was opened, he went back into the basin and continue with washing, washing his face and hands. We tried to stop him, telling him that doctor wanted to see him right now. It took another 5 to 10 minutes till he was literally dragged out from the washroom and into the consultant room.
Before he left, he stood there and wave to us as we said goodbye to him. He was there waving for like 10 minutes. The mother seemed to have given up, just stood by the clinic door to wait till he’d done.
This is the one and only time I see this young man with obsessive compulsive disorder, doing massive washing and arranging rituals.
Till recently, about two months later from when I first saw him, I met another very similar case and recalled this young man, wondering why he hadn’t come back for review, I decided to make a call to him, just to know how he has been recently.
He picked up the call, and when I asked “Good afternoon, are you Mr Chan?”, he answered, “I’m Mr Chan Ah Meng” (pseudonym). I stated where I’m calling from, and that I merely wanted to know how he’s been doing, why I haven’t seen him for such a long time. He said he has stopped schooling, now helping his father, he’s seeing another psychiatrist now, still repeating, so disabling that he had to stop schooling. When he said he was still repeating, he repeated it a few times. Other than that he’s been doing ok. I informed him if there’s of anything we can help him, he can call us back, then I hung up the phone.
Later I was busy with other work, my colleague told me that he called me back. So I rang him back, again he had to identify himself as Mr Chan Ah Meng. He said “nothing important now, nothing important now, nothing important now…” So he thanked me for calling and I said you’re welcome, I hung up again. Within few minutes he rang again, “what did you last say just now?” I said I couldn’t really remember, then he answered, “you said ‘you’re welome’, you said ‘you’re welcome'”… Then he thanked me again and I hung up.
And I hung up.
And I hung up.
She has an over 11 years history of depression with obsessional ruminations, and insomnia, and has maintained relatively well on medication, after a course of 6 ECTs.
She is the 7th of 8 siblings, with no family history of mental illness. Her parents divorced when she was still a child, she lived with her mother who doesn’t really care about her. At young age she was unfortunately raped repeatedly by a relative and his friends. She never really mentions it to others, most of the time she can pretend like it never happened to her before.
She is a hairstylist who works from home. So sometimes when there’s no customer she’s spending a lot of time alone at home. One of her elder brothers sometimes helps her financially, knowing that it costs her a lot to take psychiatric medicine long-term. She has once tried to follow up in the general hospital, but after taken one dosage of the medicine prescribed by the hospital doctor, she spent the whole night trembling and crying, feeling the head spinning. Since then she’s never thought to go to the general hospital (N.B. here I’m not saying that psychiatrists from GH isn’t good, but most of them aren’t Chinese, so there’s a language barrier there, which can cause problems in diagnosis and prescription).
She’s always complaining of head and neck pulling sensation. It’s worst when she can’t sleep well. She spends most of the time being worried about this pulling sensation, although nothing wrong was found physically when she went for check-up.
Sometimes she can be very obsessive, being worried about the same thing continuously, asking similar questions repeatedly, needing a lo of reassurance. She’s currently much better with medication, and with a lot of counselling she can slowly accept occasional poor sleep and insomnia (What to do if I can’t sleep well?).
Adverse childhood experience is always a risk factor for many mental illnesses, but also a perpetuating factor.