Bored, Lonely, Anxious and LOCKED-DOWN!!

“Guys…Give me a genuine answer: Are you people not at all stepping outside your homes? Like, not at all meeting friends, making any social contact? Last time I stepped out of my house was on Monday, that too to buy bread only! I’m getting tired…I wonder how people survive in isolation and jails?”

I received this text on a WhatsApp group shared with my girls-gang and couldn’t help but wonder about the impact of current Corona Pandemic situation on mental health. While fever, dry cough and tiredness have been reported by the WHO as the common symptoms of COVID-19; we also need to become sensitive towards the by-producing mental health disturbance that has begun to thrive in the world-community whilst being hyper-vigilant to the indicators of this viral infection and restless in the times of lockdown. As can be seen in the quoted text, my friend reported “getting tired”—tiredness of mental nature stemming from being indoors for the last 7+ days and not the pathology of Corona.

The jitteriness and exasperation from being locked-down is evident from the last line that she typed out— ‘How do people survive in isolation and jails?’ Well, here is one of the answers provided in The Lancet Journal by psychologists: Quarantined people often show emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger and emotional exhaustion. In fact, the stressors that precipitated these reactions were identified as longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. So yes, ‘survival in isolation’ is indeed marked by several psychological repercussions!

Unfortunately, mental health outcomes of being under a state-ordered lockdown are now closely mimicking the psychological effects of being selectively quarantined for suspected infection. One reason why I believe this to be happening is due to the “perceived” curtailment of INDIVIDUAL CHOICE common to both quarantine and lock-down situations. For instance, I personally am someone who would stay indoors for a week straight during college examination period. However, the minute I am “expected” to be homebound instead of “deciding” to do so, it makes me restless! Humans are social animals, of course—and in my opinion, we are pretty rebellious ones too! In line with this thought, if I were to tell you right now to NOT THINK OF A PINK ELEPHANT, I am sure you would have first thought of it and then mentally erased the image. Well, I don’t blame you. The human brain is wired as such that it takes more time to comprehend the negatives used in a language. Similarly, since the government has announced, “You’re NOT allowed to leave your homes unless absolutely necessary”, our human brains are going to come to terms with this situation at its own pace. GIVE IT TIME!

Closely associated with the idea of lost personal choice is the Fear of the Unknown. No matter how “chilled” a person you are or how “adventurously” you would like to live your life, the unpredictability of the course of an illness like Corona is unpleasant. In an interview with the American Psychological Association (APA) about the Coronavirus Anxiety, Dr. Fischhoff (an expert in the area) pointed out that more people die of the seasonal flu on an annual basis than those who would die of the COVID-19. However, we panic over the possibility of contracting the Coronavirus because of the novelty involved in its evolution, course and outcome. Since active efforts by the scientists and governments has posed the seasonal flu as being a “common” threat, our minds have translated this into believing it to be a more combatable threat than the corona. Yes, a guaranteed antidote to the COVID-19 is yet to be discovered. However, does this imply that Corona is indefinitely going to leave us helpless? How many of us would confess being guilty of focusing on the rising number of cases in each country as opposed to the number of individuals who have actually been cured of the condition? Again, give it time, STAY HOPEFUL!

‘What do I do to deal with the boredom, loneliness and anxiety?’

Let’s try to establish the scientific significance of some of the tips offered by the University of WhatsApp, national governments, news agencies and b/vloggers by drawing connections with the above discussed literature.

1.  Practice Mindfulness: The discussion on Fear of the Unknown essentially implies that a lot of our anxiety is stemming from our unfruitful thinking about “What will happen next?” Let’s hit the pause button on that thought and all engage in this simple exercise:

Take a few deep breaths and promise to stay committed to this exercise. Instruct yourself: I will direct the focus of my mind. Now, list 5 things present in your environment that you can:

a.  See around yourself at the moment (e.g. books on the table, color of the walls, etc.).

b.  Hear around yourself at the moment (e.g. birds chirping, the rotating fan, etc.).

c. Feel on your body at the moment (e.g. hair on your neck, feet on the floor, etc.).

This simple exercise often forms a part of therapeutic programs targeting anxiety reduction. It will help you to ground yourself firmly in the present which is the need of this time when the future is unclear and worrying about it is not going to aid our mental health.

2.  Set a Routine: As mentioned earlier, curtailment of individual choice is only PERCEIVED. The choice of whether or not we can go outdoors is beyond us right now but the choice of how we handle our schedules irrespective of this one small glitch can help us obtain a sense of control and personal choice.

Some pointers to be kept in mind while setting up a routine are:

  a.    Set short term, measurable goals that can be achieved by the end of the day. Sit back, reflect and appreciate yourself to have achieved these small victories.
b.    We are stimulation-seeking creatures who get easily bored of relaxing and pursuing creative tasks too! The key then is to actively switch amongst the plethora of activities available to us on a timely basis. Draw mandalas for a while, switch to Netflix later, dig up the books you wished to read but never got the chance and of course, catch up on all that sleep you missed!
c.     Remember that ‘normalcy’ is our next door neighbour who is going to strike our doors once the current situation clears. Thus, don’t lose touch with your work, life and friends. Make the most of the technological era we live in to participate in the “WFH Culture”, video-calling the loved ones to satisfy the need for face-to-face interaction and exercising indoors using various Apps or YouTube videos to keep our bodies fresh.
d.    On a personal note, I would suggest to actively incorporate the task of sharing household duties into our daily routines such that our moms who often end up picking up the slack get a Corona induced-break-time too!

3.  Self-work and Professional Help: Consider this to be valuable time that you’ve laid your hands  on to explore and work through a few tough areas that you have been sweeping under the carpet repeatedly.

Some therapeutically valid self-work exercise sheets that are openly available for dealing with one’s disturbing thoughts are:

a.  A worksheet to help you become “un-stuck”: https://thiswayup.org.au/wp-content/uploads/2016/03/Module-3-Thought-challenging.pdf

b. A worksheet to guide you through structured problem solving: https://thiswayup.org.au/wp-content/uploads/2016/03/Module-3-Structured-Problem-Solving.pdf

c. A worksheet to reduce your tendency to worry: https://www.cci.health.wa.gov.au/~/media/CCI/Consumer%20Modules/What%20Me%20Worry/What%20Me%20Worry%20-%2009%20-%20Accepting%20Uncertainty.pdf

Always remember that you are not alone, not even in these times of a lockdown! Many free telephonic counselling services have now opened up in India, especially to provide a pandemic support system. You can check with the websites of Trijog and ListenWorks to gather more information regarding the same. Feel free to also contact on the email-id mentioned on this blog page if you require further assistance in procuring mental health services or self-help material.

 4. Contribute: With several funds being opened up and circulated on the social media for contributing towards the well-being of those in need for a financial aid due to various reasons during this pandemic, a sense of social participation and human touch can be achieved. Many of us may not be in a position to make a monetary contribution and so what I find to be the most valuable contribution is the one that can be made towards the advancement of science and research. Many researchers have stepped forward and started online surveys for collecting data on the psychological, economic and societal impact of the Coronavirus. Such research will readily help professionals to take informed action based on public opinion and experiences in the aftermath of COVID-19. Links to 3 such studies are:

      a.  https://forms.gle/4rHGyDcz56imwUEW7

      b. https://docs.google.com/forms/d/e/1FAIpQLSfdBnvZ5U70Z13ckitZXGYQf66VRTSjnz7rslhImNYgmtggGA/viewform?vc=0&c=0&w=1

      c. https://www.pubgeek.co/clink/survey-covid-19-india/

I would like to end this blog with a few activities of dealing with the boredom, loneliness and anxiety in current times that have been yielded as being personally helpful by me and my close ones. For instance, the observance of Janata Curfew on 22^nd March 2020 and the variety of sounds that reverberated on the streets at 5 p.m. helped me personally feel our solidarity in these lonely times. Similarly, a friend mentioned eating her lunch by the window as being particularly helpful in “feeling fresh and in touch with the world.” Some have called the process of preparing the trending ‘dalgona coffee’ itself as being therapeutic. I invite all the readers to open a string of comments on this post, sharing their cups of happiness in this time of a complete shutdown of the world. WRITE AWAY!

References

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.

Rawat, M. (2020). Coronavirus pandemic and mental health: How we can help people in quarantine. Retrieved 29 March 2020, from https://www.indiatoday.in/world/story/coronavirus-outbreak-covid19-cases-quarantine-mental-health-1652639-2020-03-05

Smith, N., & Barrett, E. (2020). Coping with life in isolation and confinement during the Covid-19 pandemic | The Psychologist. Retrieved 29 March 2020, from https://thepsychologist.bps.org.uk/coping-life-isolation-and-confinement-during-covid-19-pandemic

Speaking of Psychology: Coronavirus Anxiety. (2020). Retrieved 29 March 2020, from https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety

Gaming Disorder: Are those joysticks all that innocent?

Friend 1: Up for a game?

Friend 2: Yeah

Friend 3: Letsss

Friend 4: Football?

Friend 1: Ground or FIFA?

Friend 2, 3 & 4: Of course, FIFA!!

I’m sure that leaving your house for game night or shouting excitedly at the screen while carrying out virtual loots plonked on your home couch might have earned you a dismayed shaking of head from your parents at least once—“Gone are those days when you actually went out to play on field.”

Sure, there is a lot of moral panic surrounding the issue of gaming already and amidst this when the International Classification of Diseases (ICD) declared Gaming Disorder (GD) as a clinical diagnosis in its latest 11^th edition; it raged a controversy amongst professionals and laymen alike. ICD, as published by World Health Organization (WHO), helps in identification, research and report of health trends and statistics globally. It defines the universe of diseases, disorders, injuries and other related health conditions including diagnosis pertaining to mental health. Walking in step with it is the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) which in its 5^th edition has enlisted Internet Gaming Disorder (IGD) as an area requiring further study.

What do these authoritative texts mean by GD/ IGD?

According to ICD, GD is characterized by a pattern of persistent gaming behavior (either continuous or recurrently episodic), which may be online or offline, manifested by:

1. impaired control over gaming
2. increasing priority given to gaming to the extent that it takes precedence over other life interests and daily activities
3. continuation or escalation of gaming despite the occurrence of negative consequences.

This behavior pattern needs to be severe enough to result in impaired functioning in personal, family, social, educational, occupational or other important areas. For diagnosis, symptoms must be evident over a period of at least 12 months, although the required duration may be shortened if all criteria are met and symptoms are severe.

On the other hand, DSM-5 has hinted at complementary yet more detailed symptoms of diagnosis. Under the proposed criteria, IGD would be detected if five or more of these symptoms are present for a year:

      1. Preoccupation with gaming (on internet or any electronic device)

2. Withdrawal symptoms(sadness, anxiety, irritability) when gaming is taken away or not possible
3. Tolerance: the need to spend more time gaming to satisfy the urge
4. Unsuccessful attempts to reduce/ quit gaming
5. Loss of interest in other activities due to gaming
6. Continuing to game despite problems
7. Deceiving family members or others about the amount of time spent on gaming
8. The use of gaming to relieve negative moods, such as guilt or hopelessness
9. Risk: having jeopardized or lost a job or relationship due to gaming

The Controversy

To begin with, there is a debate surrounding the “goodness or badness” of games itself. Although the negative impact of gaming which is so widely reported (for instance: the recent death of a 16 year old in Madhya Pradesh, India after playing PUBG for 6 hours straight) can’t be denied; there is also equally researched but not very well accepted set of data pertaining to the positive contributions of gaming (e.g. increased experience of positive emotions, valuing of cooperation in team games, stress release, sharpening of cognitive abilities and so on). Thus, since the research body dealing with value judgment of the gaming phenomena is not yet conclusive, the move to pathologize gaming behavior has come under crossfire.

A very obvious area that is found under scrutiny is the vagueness of the criteria used for diagnosis. For instance, a scholar has pointed out that the ICD definition doesn’t distinguish between mild, moderate or severe cases; which means that clinicians — many inexperienced with video game addiction and oblivious to the gaming culture — have to decide this for themselves. Also, the DSM criteria requires the individual to exhibit only 5/9 symptoms to be diagnosed with IGD. While few indicators clearly point that something is wrong viz. experiencing withdrawal symptoms, the desire to stop but not being able to and losses on occupational and interpersonal fronts; checking off any 5 symptoms to the exclusion of these 4 important ones for receiving a diagnosis is quite easy. However, the remaining 5 symptoms are questioned for their credibility in indicating abnormality. For instance, any activity that you are extremely passionate about is likely to keep your mind and schedule preoccupied. If being preoccupied with artistic ideas isn’t considered abnormal then why is being preoccupied with gaming till the point of picking it over engagement in other activities considered problematic? Or, one could argue that tolerance applies to almost any hobby because with increased ability one needs to increase the level of challenge to get the same thrill that one got before from that activity. Hence, it is only normal for a gamer to seek increased stimulation from games as his/her level of proficiency increases.

Thus, more research is required to narrow down on what exactly can be considered as signs indicating the presence of problematic gaming behavior. This is cited as one of the reasons for inclusion of this diagnosis in ICD—the presence of such a diagnosis would accelerate more research in the area. However, a concern raised is that the presence of such a diagnostic category might promote confirmatory rather than exploratory research. So, instead of trying to find out what more can be indicative of this condition, clinicians may get caught up in confirming whether or not the prescribed criteria are displayed by the potential cases.

One last area of heated disagreement is where research has time and again pointed out gaming behavior as being accompanied by (comorbid to) other mental health conditions like depression and anxiety. It is often said that excessive gaming is used as a coping mechanism against the disturbing feelings invited by depression and anxiety and so the focus should be on treatment of these underlying conditions thereby rendering the separate notation of GD/IGD diagnosis redundant. However, a parallel that is often used to argue against this position is that of substance abuse disorders. They exist as a separate category despite of being associated with depression and anxiety because they in themselves pose sufficient risk that needs to be addressed first hand. Furthermore, in some cases, substance abuse has been found to lead to the latter conditions and so is GD found to independently exist. Hence, the symptoms presented by GD/IGD deserve to be treated independently of their comorbid conditions.

Will classifying abnormal gaming patterns as a disorder lead to abuse of diagnosis? Will it create a moral panic that was referred to at the beginning of this post? Will it stigmatize the gaming community even more than it is currently? The answer is not quite certain. However, is it a good idea to miss out on a diagnosis based on ICD’s statement that it is backed by a global consensus of scientists? Is it in the best interest of all to leave out this diagnosis because only a small minority of gamers might be suffering from disordered behavior? Will this even help to avoid the supposed moral panic and stigmatization? The answer is again quite uncertain. All one can say is that cautioning the public prematurely about a sensitive topic may involve more harm than gain and so the focus should be on INFORMING than WARNING.

The Deconstruction of OCD

“I am such a weirdo. I have strange OCDs.”

“I am so like Sheldon from The Big Bang Theory.”

“Oh, I can’t keep the TV volume on an odd number. I HAVE AN OCD!”

We come from a generation where the word OCD is thrown around with almost little or no thought put into the context surrounding the reference to this term. Part of why this is so can be attributed to the popular yet grossly misinformed portrayal of this and many other mental disorders in media. In fact, the media portrayal of OCD has almost reduced it to a funny illness that is not to be taken seriously. For instance, when you see Sheldon Cooper knock on Penny’s door 3 times in a row with a monotonous “Penny” following each knock, it first makes you laugh and then (maybe) consider this behavior as problematic. But only when we move beyond laughs will we truly understand this psychological disorder and stop trivializing every other quirk of ours as “a full blown OCD.”

OCD—what does it mean?

Obsessive Compulsive Disorder aka OCD is an anxiety disorder characterized by  time consuming and recurring obsessions and compulsions. An obsession is an unwanted thought, word, phrase or image that due to its repeated and persistent presence in a person’s mind causes unease and distress. These unwanted thoughts feel extremely intrusive to the person experiencing them. They drive individuals to engage in some repetitive acts or thoughts which at the first glance may seem quite purposeful but in fact are compulsions that a person performs in order to reduce or neutralize the anxiety generated from the overwhelming fixation on obsessive thoughts. These compulsions are ritualistic or rule based acts and thoughts which have somehow come to be associated with a particular obsession and exclusively hold the power to help regain control over one’s anxiety ridden mind.

Let’s explain the above highlighted keywords with the help of an example. The most commonly heard OCD is related to the need for cleanliness. A person with this OCD may experience an obsession with the idea of that touching any uninspected surface with bare hands poses a serious health hazard. In order to bury the worry that this thought arouses, s/he may wash hands EVERY time they touch a wall or a stool or a window pane. This can be understood as the compulsion that occurs in response to the overwhelming obsession concerned with hygiene needs. In fact, s/he may persist in their behavior even when their skin becomes all raw due to repeated hand washing. Also, we should note here that the distress caused due to the recurring obsession is so huge that it overshadows the distress coming from the physical pain arising due to the irrational, compulsive act of washing. This can be an indicator that the OCD has reached a clinical level of diagnosis wherein it has started interfering with an individual’s everyday functioning and well being.

OCDs—have your pick of the type

The obsession for cleanliness and hygiene coupled with the compulsion for washing is only one type of the many kinds of OCDs that one may suffer from. The need for order and symmetry is another kind which is often followed by the compulsion of putting things in picture-perfect order. Some individuals are overcome by checking compulsions whereby they often fear that they have committed some error that needs to be checked several times. This kind of OCD may not only involve compulsively checking the stove 5 times before you leave the house but may also involve constantly seeking reassurance from someone else about whether the stove was put off before leaving home.

Also, it is not necessary that a compulsion has to be a physical act. Compulsions can also involve mental rituals like counting up to a certain number or reciting a short prayer each time a threatening thought occurs. Although compulsive picking of skin (excoriation), hair pulling (trichotillomania), hoarding compulsions and preoccupation with perceived bodily defects (Body Dysmorphia) are conditions related to OCD and may in fact show similar patterns of expression; they are often diagnosed as separate disorders.

OCD—how does it sustain?

Individuals with OCD are hyper vigilant to danger detection. At the same time, their nervous system is often slow at recognizing that a threat has passed. When combined, this results in extremely high levels of long-lasting anxiety. Since the automatic danger/safety detection system is malfunctional in individuals with OCD, they try to gain control over their paralyzing fears by manually interfering in the form of compulsions. OCDs sustain due to negative reinforcement of the compulsive acts. In simple terms, negative reinforcement refers to an action that is strengthened as it supposedly removes some form of unpleasant stimuli from the said circumstance. For example, if taking a pain killer calms down your terrible headache then the act of ‘popping the pill when in pain’ is strengthened as it removes the unpleasantness experienced due to the said headache.

Thus, the negative reinforcer of hand-washing is strengthened as it illogically gets paired with the idea that it cleans the germs you contact on touching a wall thereby providing relief. However, over time the act of washing almost becomes an addictive behavior that you are dependent on to get rid of your obsessive thoughts and instead of something that helps you deal with the feelings of threat, it becomes something that makes space for you to experience more obsessive images. Instead of serving as a means to an end, the compulsion then becomes an end in itself.

Dealing with OCD: Exposure Response Prevention Therapy

Although several methods of dealing with OCD exist, the one that has most popular use is the Exposure Response Prevention Therapy. This technique seeks to restructure problematic behaviors and thoughts that drive the OCD. It involves gradual exposure to feared obsessions followed by restrictions on performance of the associated compulsion. A hierarchy of least to most anxiety producing thoughts is created and the person is encouraged to test the waters at a comfortable pace. So, a person excessively concerned about hygiene may start out by purposely touching a glass window and wash hands only after a delay of 10 minutes, then 20 minutes, then 45 minutes then an hour and eventually working up to not washing hands at all in response to such minor anxiety provoking situations. After the touching of this one threatening surface is mastered, one can move on to the next in the hierarchy and so on till a total disconnect is established between the obsession and the compulsion.

This technique and many others are easier said than done. Professional support in diagnosis and treatment is always recommended. OCD is much more than a “funny illness”. It is a very real clinical diagnosis that has the potential to reduce one’s potential drastically. Don’t let the unnecessary obsessions and compulsions take up the mental space that can otherwise be utilized to live a life that is worth it.

From Extra-Large Fries to Extra-Large Size

The “Extra Large” trend can be understood by connecting some dots from the point of view of psychology— apart from obvious biological and genetic reasons, of course. Isn’t it pretty obvious that the lieu of stores offering clothing lines for the “Plus-size” people stems from the availability of “Plus-size” meals at every major fast food joint in the town? The McMaharaja, the Doubly Loaded Pizzas, the Jumbo Pepsi cartons, 50% larger Chips packets and Big Scoop Ice Creams have indeed translated into the need for 3XL sized jeans.

So far, we only looked at how being too thin can be problematic. But at the end of this series on body image, it only seems fair to discuss how being Too Large can be problematic too. When I say ‘Too Large’, I don’t refer to a deviation from what the media has come to portray as the ideal. Too large is a body size where you start experiencing discomfort in your everyday functioning and well-being due to the extra pounds of weight lugging you down.

Did you know: researchers have found that the secret behind thin waist lines of the French is their small portion size? Right in the beginning we drew the connection between serving size and body size and this connection has been indeed upheld by Brian Wansink who found that even nutritionists eat 31% more of ice cream when they are given big instead of small bowls and 14.5% more when they are provided with a large instead of a small scoop. Pretty interesting how your mind fools you into eating more when provided with a larger spoon, eh? Hence, a cool DIY hack to try if you wish to lose some unnecessary body fat is to look around your kitchen and replace all those large serving spoons and plates with smaller ones.

Set point is the weight range in which your body is programmed to function optimally. Biologically, we are bound to return to our set point weight or a number around it because our body is designed as such that when we linger too far away from our set point weight, it either reduces or increases the metabolism rate depending in which direction the weighing scale is tipping. Genes ensure that most of the times you end up having a body shape that your ancestors have had. However, if you believe that hunger happens only in the stomach and not the head, then you’re mistaken. One study conducted with amnesic patients found that if offered 3 meals every 20 minutes after being completely satiated, the amnesic will still eat each with equal appetite. Why? Because they have no memory of having eaten earlier! Thus, your mind has a role to play in weight gain and weight loss too!

Another interesting fact that is widely known is that you eat more when you get more variety. So if you find yourself stuffed and slouched in a corner after hogging on a scrumptious buffet at your BFF’s wedding then you know it is psychology at work! In fact, the phenomenon of social facilitation states that we tend to eat more when we share a meal in other people’s presence. Thus, although savoring meals in isolation doesn’t seem like an appetizing idea, you can try to maybe reduce the number of people who share the table with you at your office canteen to somewhat protect yourself from your brain’s tricks!

Ever reach out for a bar of chocolate when feeling a rush of emotions—good or bad? Ever sit with a box of deep-fried snacks in your lap while you mindlessly watch a chick-flick but reflect on the bad events that happened earlier in the day? Ever use COMFORT FOOD to fight nostalgia, loneliness or anger? Only if these starchy foods ever helped you gain long term relief! All they do is momentarily play with your hormones to give you a “feel-good” factor which fades away soon enough to bring you back to reality with a few extra kilos hugging your waist. So eat when you need, not when you want. Be mindful! One hands-on trick for doing this is to maintain a food journal in which you enter everything that you eat and when. Do keep a record of the self-introspected emotions felt before and after eating to red flag comfort eating. Once the triggering points are recognized, try to consciously replace eating with another, physically involving yet pleasing activity like dancing. This shift will go a long way keeping those love-handles at bay.

Lastly, it is not possible that we talk about food and not mention dieting! Dieting is often considered to be an unpleasant, maybe even fear evoking term for many people. After all it involves putting a check on something that provides an instant mood boost—FOOD! In fact, most of the time people fail to keep up with their diet schedules because of what researchers Herman and Polivy explain to be the “What-The-Hell-Logic”. According to this principle, once you break a small rule of your weight management program, you believe that you don’t have it in you to go through with the rest of it either. This is to say that your thought process in such circumstances goes something like this: “If I am no good at this, what the hell! I might as well chug down that left over cheese pizza with a can of Pepsi and make the most out of my failure.” However, one way in which you can minimize this effect is by harnessing social support and self help. For instance, replace the junk food in your fridge with healthy alternatives. Surround yourself with people who’ll help you achieve this ideal and believe in your efforts. Check whether “out of sight, out of mind!” really works.

 DO YOU RATIONALIZE YOUR UNHEALTHY EATING HABITS TOO? This post may seem like the kind of common sense that existed right in front of your eyes but still somehow managed to skip your attention. But sometimes, aren’t simplest of things most required to take a step towards big changes? So, use this "common sense" knowledge from psychology to keep yourself from inching closer to obesity and develop a healthy body image.

Body Dysmorphia: Bodily Complaints That Never End

Like seen in this gif, all of us have a lot of things to complain about when it comes to our appearance. I wish for a flat stomach every time I want to go out wearing a cute crop top. I wish my thighs wouldn’t get all jelly when I sat down in those shorts. Like Rachel from F.R.I.E.N.D.S., I sometimes have insecurities about my nose too. I wish I wasn’t so tall that I looked like a mother to my BFF when we clicked pictures!

But we can’t have all that we want, can we? And most of us make peace with it (trust me, I try).

However, what happens when slight cribbing about your thinning hair turns into a full blown obsession
with trying out all possible hair treatments in the market? What happens when you start believing in the frantic SMS you type out to your friend—“MY LIFE IS OVER”—when you get a pimple on a date night?

Let me tell you what happens: Body Dysmorphic Disorder (BDD).

Body Dysmorphic Disorder is a diagnosis that is related to Obsessive Compulsive Disorders in which a person becomes unhealthily preoccupied with a real or perceived ‘defect’ in their appearance. An important point to note right away is that even if there is a bodily shortcoming present, it is perceived and reacted to in an out of proportion manner i.e. a small scar, barely noticeable, near your eyebrow may be seen as disfiguring your entire face, thereby inviting that much unnecessary stress in response to it. The perceived flaw may seem invisible and imaginary to people around a BDD suffered but it is a firm reality to that person who unrelentingly believes that there is “something wrong” with how s/he looks. So, no: This disorder is not to be confused with one’s vanity with their appearance. It is a very real and distress- causing mental health condition.

BDD is different from Eating Disorders

Undoubtedly, eating disorders and BDD both circle around body image issues. However, eating disorders are solely concerned with one’s dissatisfaction with their body shape and size. On the other hand, in BDD, dissatisfaction with body weight is just one of the many other body areas that can become a target of constant depreciation. This is to say, BDD sufferers may become preoccupied with scars and hair, facial structure and skin irregularities like moles or even the looks of their genitalia.

A surprising fact? In BDD, people (usually men) can be overcome by the thinness of their body i.e. a lack of muscle and sturdy body build. So, BDD is not all about feeling fat and becoming obsessively
worried about it. Instead, BDD may be concerned with the complete opposite of it too! In fact, the clinical term for this particular type of BDD is Muscle Dysmorphia.

Another differentiating point between BDD and eating disorders is that the latter entail erratic food consumption patterns: you eat too much or too less or purge and exercise till you drop. However, BDD involves fairly normal eating patterns and the individuals may or may not be of the normal weight. Instead, BDD patients may seek cosmetic surgeries as a means of dealing with their insecurities.

Lastly, while eating disorders are more common amongst females, the prevalence of BDD is more or less same for both the sexes. Nevertheless, there may be subtle differences in the body parts that become trouble centers for the two. For instance, females with BDD usually perceive ugliness in their hips and weight while men are more likely to see it in their body build and thinning hair.

Sure, there seems like a considerable overlap between the two disorders and it is even quite possible that an individual may be diagnosed with both at the same time. This may be so when a person shows irregular eating along with distress about a bodily area other than their waist length.

Tell tale signs of BDD

A person with BDD constantly checks himself/ herself in the mirror or their selfie camera for ensuring that they look fine. They groom themselves to an excessive degree as if they are trying to make up for some irreparable short coming. They may also be the ones who constantly elbow you to ask if they look fine. They need a lot of reassurance.

Now you may be thinking, “Hey, I do that too!” But in order to understand what makes these signs a clinical diagnosis try multiplying the intense insecurity with which these actions are undertaken by 10 and estimate the number of times these actions are performed to be almost always. Some say that individuals with BDD spend approximately 1 full hour each day wondering and worrying exclusively about their appearance!

Often, individuals who develop BDD are said to carry a certain amount of biological vulnerability for the same. However, it is only when biology combines with sensitive social experiences of teasing or rejection related to how one looks during adolescence, is when this disorder manifests. Once the idea of having “not up to the mark” appearance takes roots, their thoughts becoming completely biased—almost as if shining an attentional spotlight—on their negative body image. At the same time, they start engaging in checking rituals mentioned above and slowly begin withdrawing from others out of embarrassment. These behaviors at the crux of the moment may seem like “helping” them to reduce their anxiety levels but carry the potential to emerge into full blown Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder or Major Depression. Obviously, this hampers interpersonal relationships of the individual and in 1/3^rd of the cases the BDD patient may become delusional! For example, if they see two people exchanging a laugh while passing by them, they will be ferociously convinced that the topic of amusement was their bodily shortcoming. Social isolation inevitably cuts off their support networks and this when combined with repeated failures on interpersonal, academic and occupational fronts (arising from interference caused by their mental illness) pushes BDD patients towards suicide ideation and attempts 10 to 25% times more than the general population.

Nevertheless, individuals with BDD may have fairly accurate insight about their disordered thinking but may shy away from opening up about their condition to anyone—not even their therapist—for the fear of being misunderstood or absence of knowledge that BDD is treatable. So take out your keen, observant glasses to look out for these signs so that you can help someone who may be in need for professional help to go ahead and seek that help.

BINGE EATING DISORDER: WHAT UNDERLIES ALL THOSE LAYERS OF FAT?

“Let’s binge eat!” my friend squealed.

 “You mean a ‘who-can-eat-pani puri-till-they-drop’ competition? You’re on, buddy!” I replied.

Fill in any favorite food item of yours in the underlined part above—biryani, ice cream, chips, fries—and there you have it, a fun binge eating day with your BFF by your side or a hearty me-time while you catch up on a rerun of your favorite TV show.

I’m sure that all of us are guilty of “binge eating” on some occasion or the other. So much so, that when I introduce Binge Eating as a disorder, many of you will be surprised, maybe worried? However, let’s not jump to conclusions. In order to qualify for a clinical diagnosis of Binge Eating Disorder (BED), one needs to meet the following criteria:

1. When you say that you are going to binge eat, do you mean that you can eat an amount of food so large within such a short period of time (say, 2 hours) that most others may not be able to consume under similar circumstances? If yes, then you’re binge eating.

2. When you are binge eating, do you feel a sense of lack of control—feel as if you can’t stop eating or how much you’re eating? If yes, then you’re binge eating.

3. Binge eating episodes are often associated with eating rapidly as if under the fear of being caught cheating. You hardly taste the food you are so ravenously hogging on! You may eat until you feel uncomfortably full. You may also eat large amounts of food without physically feeling the need to eat. They feel extremely embarrassed about their seemingly uncontrollable eating behavior. And once the sin of overeating is committed, do you feel disgusted with yourself, guilty or depressed about such “rash” eating behavior? If yes, then probably you’re binge eating.

4. Do you feel distress for gobbling down 10 plates of pani puri? Sure, your body might be protesting for an outlet of all that spice. But do you mentally feel troubled for eating and eating and never stopping?

5. How often do you go on binge eating sprees? In order to receive this diagnosis, one must exhibit a compulsive eating episode at least once per week for a span of 3 months.

6. A person has BED if they don’t repeatedly purge all the food that they eat as in bulimia nervosa and only if they are NOT currently suffering from anorexia during which it is possible to have a few episodes of binge eating while still being significantly underweight and meeting all the other requirements for anorexia nervosa.

It may seem somewhat obvious that individuals with binge eating disorder are often overweight. We don’t binge eat fruits and vegetables. We binge eat fats-laced, carbohydrates-rich guilty pleasures. However, making a reverse assumption that all overweight/ obese people are suffering from BED may not be appropriate. Nevertheless, research has repeatedly shown that BED sufferers are over represented in populations that are obese and seeking help for reducing their body weight.

Binge eating disorder is different from anorexia and bulimia wherein the person starts looking abnormally thin and hence receives a lot of attention and sympathy. Instead, BED simply hides under the layers of fat which somewhat seem normal in our trending move towards widening waistlines but at the same time is despised by most. So if a person is fat, you’re fast to assume that he is lazy and undeserving of your help while if a person looks like a moving skeleton, you may raise your brows to form a crease of worry. Although the process of destigmatizing larger body sizes is a long way to go, would it hurt to ask someone you think is struggling and suffering if they need some love and support?  

How to detect if someone is battling against BED?

Since these individuals are very well aware that there is something wrong with them and that acceptance for their enlarged body shape is scarce, they engage in secretive eating. They may eat in normal quantities at the dinner table but if you were to peep into their room or car, you may discover a secret stash of fatty foods or left over wrappers and tins of such foods. They may eat between their meals to be able to eat “normally” in front of others. There have been cases where binge eaters have reported that they have gone “restaurant-hopping” and feasted on foods while driving their way from one restaurant to the other!

A more extreme step would be to actively isolate themselves while eating their daily meals as far as possible because they fear the judgmental looks that will be directed their way if they eat the way they eat.

Mostly though not always, BED is a response that is triggered by depression or anxiety. So if you find a loved one eating erratically and showing simultaneous unruly mood fluctuations then you may want to talk and find out if everything is okay. All of us find comfort in food. When its exam time, I personally find myself eating more amount and eating at more number of times then I do on a normal basis. That’s basically a response to stress. In our brains, when we eat delicious food, it releases the feel-good hormone of dopamine. Dopamine is the same hormone that is also released when we engage in pleasurable activities or even in addictions like smoking. Thus, speaking of the concept of reinforcement again, we can say that binge eating is somewhat maintained as a disordered habit because the release of dopamine in the brain rewards us to continue this behavior.

Low self esteem and exhibition of a “What-The-Hell” logic can also be considered as indicators of BED. These individuals do not believe in their own ability to regulate eating. Thus, even though they may decide to enter a weight loss regime, the moment they slip (which all of us do, with or without the disorder), they may think, “Of course, I am not capable of doing this healthy eating and exercising stuff. Now that I have already broken a diet rule, what the hell, I might as well break all the other rules!”

We all are foodies in our own right. But when are we pushed across the fine line between normality and abnormality because of a threatened body image is something to ponder on. Keep pondering, keep reading, keep following this series on body image!

ANOREXIA AND BULIMIA: WHEN BEAUTY BONES LOSE THEIR BEAUTY

Demi Lovato, our Disney Star, has confessed, “‘Food is still the biggest challenge in my life and it controls — I don’t want to give it the power to say it controls my every thought, but it’s something that I’m constantly thinking about…Body image, what I’m going to eat next, what I wish I could be eating, what I wish I didn’t eat. It’s just constant…” 

Princess Diana revealed in one of her interviews, “The first time I was measured for my wedding dress, I was 29 inches around the waist. The day I got married, I was 23-and-a-half inches. I had shrunk into nothing from February to July.”

Portia de Rossi, an Australian-American model, actress and spouse of Ellen DeGeneres, has stated in her memoir, “Since I was a 12 year old girl taking pictures in my front yard to submit to modeling agencies, I’d never known a day where my weight wasn’t the determining factor for my self esteem. My weight was my mood, and the more effort I put into starving myself to get it to an acceptable level, the more satisfaction I would feel as restriction and the denial built into an incredible sense of accomplishment.”

These women along with many other celebrity figures have suffered from EATING DISORDERS. An eating disorder is a disturbed pattern of daily food intake (either eating too little or too much) along with high levels of unnecessary distress associated with body shape, size and weight. While Demi Lovato and Portia de Rossi suffered from Anorexia Nervosa (AN), Princess Diana was diagnosed with Bulima Nervosa. At the outset, it is important to note that even though the prevalence of eating disorders is higher in females than in males, we have witnessed several male celebrities to the likes of Eminem, Elton John, Russel Brand and others come forward to be open about their struggles with eating. Another common misconception better corrected at this point is that Eating Disorders are not the “disease of the rich”. Yes, it is through the stories of these high-profile celebrities that we have come to know of maladaptive eating behavior patterns. In fact, Princess Diana was one of the first prominent personalities to disclose her body image related issues which reportedly doubled the rate of women seeking treatment for Bulimia in the Great Britain. This came to be dubbed by the media as the “Diana Effect”. It may also be true that the work industry demands of maintaining a particular “body type” may play a major role in these models, actors, singers or royal family members in developing such disorders. Still, this is no reason why someone you know or love may not suffer from a similar condition.

Anorexia Nervosa

An individual is said to be suffering from Anorexia Nervosa (AN) when s/he shows the following three symptoms:

1.      Severely restricted eating which results in the person being 85% of the expected body weight for people their height, sex, age and physical health.

2.      Fat phobia: Intense and irrational fear of putting on weight.

3.      Disturbed self-perception of body shape and weight such that they view themselves as being fat even when in reality they are actually very thin—at times, dangerously thin.

What do I mean when I say “dangerously thin”?

It means that a person with anorexia may lose so much weight that they may actually be at the risk of dying from being underweight. In fact, research has found that out of all mental illnesses, the mortality rate is the highest for those suffering from eating disorders. This might be so because depriving our body of all vital nutrients to such a drastic extent often results in a number of physiological complications such as weakness and brittleness of bones, muscles, hair and nails; low blood pressure, slow breathing and pulse rate; lethargy and fatigue; heart and brain damage and the possibility of multiple organ failure. Although no longer applicable, earlier the criteria for assignment of this clinical diagnosis to women required that the patient stops menstruating completely. Nevertheless, a majority of women with AN don’t menstruate and experience infertility.

There are two major types of Anorexia Nervosa:

In the restricting type of AN, the individual doesn’t engage in binge eating. They simply refuse to eat or engage in excessively strenuous exercise schedules as a means of preventing weight gain.

However, in the binge eating/ purging type, the individual occasionally engages in binge eating of food items followed by means of ridding their bodies of these extra calories by either self-induced vomiting or use of laxatives and extreme exercising. Nevertheless, these individuals continue to remain significantly underweight as they may not necessarily consume a lot of food when they eat, but even such small amounts may make them feel as if they have binged.

An interestingly baffling quality of an individual with AN is that they fail to feel as if there is anything wrong with their eating habits or body image. They show extremely high self control and don’t experience hunger pangs. They often eat the little amount that they do due to force feeding from family and friends. They are less likely to be overweight in the past. Thus, their desire to reduce weight is often driven by an independent and erroneous evaluation of their own “fatness” rather than the need for seeking approval from others.

Bulimia Nervosa

The diagnosis for this disorder is given when an individual meets the following criteria:

1.      Eating excessive amounts of food containing about 3,400 calories within a time period as short as about 2 hours. This might be referred to as binge eating.

2.      Feeling absolute lack of control over eating while engaged in these binge sprees.

3.      Follow up compensatory purging behaviors like self induced vomiting, use of laxatives and diuretics, other medication, fasting or extreme exercising in order to prevent weight gain.

4.      Exhibiting this cycle of binge eating-purging at least once per week for a period of 3 months.

5.      Sole dependence of self esteem on body weight and shape.

6.      Binge eating-purging episodes shouldn’t exclusively occur at the time of meeting all the symptom requirements for anorexia.

An important fact to support the last point is that an individual with bulimia is almost always of the normal weight or slightly overweight which results in failure to make a diagnosis most of the time. In addition, these individuals are very well aware that their eating styles are maladaptive and so their ritualistic binge eating & purging is often kept a secret. Consequently, suicide rates are somewhat higher in this group than those with anorexia as a strong sense of embarrassment is felt by individuals with bulimia. Further, they have a fairly realistic perception of their body shape but are dissatisfied with whatever weight they are at. Their disorder usually is an off-shoot of some critical comments from a significant someone in their life or due to other stressful life situations like marital conflict. For instance, Princess Diana has reported an incident where Prince Charles held her love handles and called her chubby which led her secret journey into the depths of bulimia. Thus, differing from anorexia in important ways, sufferers of bulimia have often been overweight at some point in the past. Also, they are likely to experience strong hunger pangs which when combined with emotional instability may lead them to engage in impulsive eating.

Medical problems undoubtedly follow such erratic feeding patterns. Ipecac syrup used for inducing vomiting have severe toxic effects if taken regularly in large doses. Self induced vomiting also results in dental decay due to the high acidity of thrown up material. This binge-&-purge cycle often causes dehydration which may result in permanent gastrointestinal damage, fluid retention in hands and feet, and heart muscle & valve destruction or collapse.

These disorders compel us to spend a moment of introspection about how body image troubles lead to such severe mental disturbances in something as basic as feeding yourself. Stay tuned for upcoming posts on other related conditions stemming from bodily insecurities.