Human Rights Campaign – Internet site

New Study Reveal shocking rates of attempted suicide among trans-adolescents.

30% of transgender adolescents have attempted suicide at some time. 51% suffer from depression and many engage in self harm.

https://www.hrc.org/news/new-study-reveals-shocking-rates-of-attempted-suicide-among-trans-adolescen

New treatments are being used. However; at what cost?

What Are Puberty Blockers?

Recent conservative legislation has targeted a class of drugs used to treat transgender adolescents. But what do these drugs actually do?

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By Lena Wilson – The New York Times

May 11, 2021

Lately, puberty blockers have become a subject of debate in state legislatures, as lawmakers across the country introduce bills to limit health care options for transgender youth. Legislators in Arkansas already passed such a law, although Gov. Asa Hutchinson vetoed it last month. Arkansas conservatives argued that “the risks of gender transition procedures far outweigh any benefit at this stage of clinical study on these procedures.” But medical experts say that’s not the case.

Among the significant benefits of puberty blockers are a reduction in suicidal tendencies, which are often high in transgender adolescents, and a reduced need for expensive gender-affirming operations as adults. But while puberty blockers are commonly referred to as “fully reversible,” more research is needed to fully understand the impact they may have on certain patients’ fertility. There is also little known about the drugs’ lasting effects on brain development and bone mineral density.

Transgender youth have been the focus of new laws in states including Mississippi and Idaho, and pending in many others, designed to restrict their participation in sports — but this debate is largely separate from the discussion of puberty blockers.

Because the use of puberty blockers in transgender kids is still relatively new, the information is developing.

Here is a roundup of what experts know so far.

What are puberty blockers?

Puberty blockers are medications that suppress puberty by halting the production of estrogen or testosterone. They can stop transgender kids from experiencing the effects of puberty that may not align with their gender identities. Medically, the class of medications are called gonadotropin-releasing hormone agonists, or GnRH agonists. They are approved by the Food and Drug Administration to treat precocious puberty — puberty occurring at an unusually early age — so when they are prescribed to treat transgender youth, it’s considered an off-label use.

“Off-label,” the American Academy of Pediatrics noted in a 2014 statement, “does not imply an improper, illegal, contraindicated or investigational use” — it merely refers to the process of F.D.A. approval.

The medications may be given as shots in a doctor’s office every one, three or six months, or as an implant which lasts for about a year. Dr. Jessica Kremen, a pediatric endocrinologist for Boston Children’s Hospital’s Gender Multispecialty Service, noted that patients and families may prefer the convenience of the implants or six-month shots.

“It depends a lot on what is obtainable through a patient’s insurance,” Dr. Kremen said. Insurance companies are reluctant to cover off-label drug treatments, and implants can run up to approximately $45,000 per implant out of pocket, while shots cost can cost thousands of dollars per dose.

“That often determines which form we ended up using,” Dr. Kremen said. “But they all work well, as long as you administer them on time.”

How do they work?

Typically, in puberty, gonadotropin-releasing hormone helps to produce follicle-stimulating hormone (FSH) and luteinizing hormone (L.H.). In people assigned female at birth, these hormones prompt the ovaries to make estrogen, which promotes processes like breast growth and menstruation. In people assigned male at birth, they prompt the testes to make testosterone, which promotes processes like facial hair growth and a deepening of the voice.

Puberty blockers disrupt the production of FSH and L.H., therefore blocking the production of estrogen or testosterone. As a result, transgender adolescents do not continue to develop unwanted secondary sexual characteristics — transgender boys do not develop breasts and transgender girls do not develop facial hair, for example.

Puberty blockers do not stop an early stage in sexual maturation called adrenarche, which can cause acne, the growth of underarm and pubic hair and body odor.

Who can get puberty blockers?

Although parents might think they should start puberty blockers very young, so that a child never has to experience any physical changes associated with the unwanted gender, experts say it’s better to wait at least until the early stages of puberty have started. Dr. Stephen Rosenthal, medical director of the child and adolescent gender center for U.C.S.F. Benioff Children’s Hospitals, was a co-author of the Endocrine Society’s 2017 guidelines for transgender health care. He recommended starting puberty blockers when breast budding or the enlargement of the testes has begun, at the earliest.

That’s because Dr. Rosenthal does not recommend puberty blockers for prolonged use outside of the normal window of puberty. They restrict the functioning of the gonads, which may lead to adverse health effects. The longer blockers are used past the typical start of puberty — generally age 14, at the latest — the greater the possible risk.

When blockers are initiated in the early stages of puberty, Dr. Rosenthal typically suggests that his patients stop using them by age 14. At that point, patients, with their families and their doctors, can determine whether to introduce hormones that help them develop according to their gender identity or resume puberty in the gender assigned at birth.

Dr. Rosenthal further recommended that before starting blockers, children be evaluated by a mental health professional and determined to have gender dysphoria. He said families should also undergo a thorough process of informed consent, during which they are educated about the potential effects of blocking puberty — including adverse ones.

The World Professional Association for Transgender Health’s guidelines for medical care suggest that “before any physical interventions are considered for adolescents, extensive exploration of psychological, family and social issues should be undertaken.” Professionals emphasized mental health care as an integral part of the process.

What are the benefits?

Treatment with puberty blockers may improve the mental health of transgender adolescents, who are at high risk for suicide. A 2020 study found lower odds of lifetime suicidal ideation in transgender adults who wanted to take puberty blockers and were able to access this treatment. Another recent study showed similarly positive effects: transgender adolescents receiving puberty blockers had less “emotional and behavioral problems” than transgender adolescents recently referred to care, and also reported rates of self-harm and suicidality similar to those of their non-transgender peers. A 2020 study of 50 transgender adolescents indicated that puberty blockers and gender-affirming hormone treatments, or both, could positively impact quality of life and decrease depression and suicidal ideation. A 2014 study found that 55 young transgender adults who used puberty blockers, took gender-affirming hormones and had gender confirmation surgeries were able to “resolve” their gender dysphoria and showed overall well-being “in many respects comparable to peers.”

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Because puberty blockers halt the development of secondary sexual characteristics, transgender adolescents who take them before gender-affirming hormones may also be able to avoid future gender-affirming procedures. For instance, transgender men who don’t develop breasts wouldn’t have reason to have mastectomies, while transgender women who don’t develop masculine facial features might no longer choose to have facial feminization surgery.

The Push to Restrict Rights for Young Transgender People

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A growing trend. Measures that could transform the lives of young transgender people are at the center of heated political debate across America. Here is how some states are approaching the subject:

Texas. In October, Texas became the most populous state to bar transgender girls from participating in girls’ sports at public schools. Gov. Greg Abbott also issued an order to conduct child abuse investigations against those providing certain medical treatments to transgender children. A court ruling later stopped the order from being applied.

Arkansas. Last April, Arkansas enacted a law, the first of its kind in the nation, barring physicians from administering hormones or puberty blockers to transgender people younger than 18. It is now on pause because of a legal challenge from the American Civil Liberties Union.

Indiana. Gov. Eric Holcomb, a Republican, vetoed a bill that would have banned transgender girls from competing in school-sanctioned girls’ sports. The governor said the bill, known as H.E.A. 1041, would likely have been challenged in court.

Utah. A day after the decision in Indiana, Gov. Spencer Cox, also a Republican, vetoed a similar bill that would have barred young transgender athletes from participating in girls’ sports. Republican legislators subsequently voted to override the veto and enacted the legislation.

Kentucky. Gov. Andy Beshear, a Democrat, vetoed a bill that would prevent transgender female athletes from playing on girls’ sports teams in middle school and high school. The State Legislature, which is dominated by Republicans, is expected to override the veto.

Alabama. Gov. Kay Ivey signed a law banning medical care for transgender youth who are transitioning. She also approved legislation requiring students to use restrooms and locker rooms in line with the sex listed on their original birth certificates and restricting discussions on gender and sexuality in kindergarten through fifth grade.

Other states. Since 2019, lawmakers have introduced bills seeking to bar transgender youths from joining school sports teams consistent with their gender identities. They have become law in Alabama, Arkansas, Florida, Idaho, Iowa, Mississippi, Montana, South Dakota, Tennessee, Texas and West Virginia.

What are the risks?

Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.

The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.

A handful of studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines.

The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning (cognitive processes including self-control and working memory), while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory. (Of course, rams are not humans.)

The effects of puberty blockers are often referred to as “fully reversible,” including in both the Endocrine Society and WPATH guidelines, because of evidence showing that girls treated for precocious puberty were still able to undergo normal puberty and have children later in life.

Halting puberty at its onset and then later starting gender-affirming hormones — a typical course for some transgender adolescents — may affect the ability to have children, she said. The Endocrine Society advises clinicians to counsel patients on “options for fertility preservation prior to initiating puberty suppression in adolescents.”

It is also worth noting that Lupron, one of the drugs widely used as a puberty blocker, has been reported to have long-term adverse effects in women who used it to treat precocious puberty. Women have reported issues including depression, bone thinning and chronic pain.

Puberty blockers may also impact future gender-affirming surgeries for transgender women. A recent study showed that transgender women who began puberty blockers at the start of puberty were 84 times more likely to require abdominal surgery if they wanted to pursue gender-affirming surgery. Because tissue from the penis and testes is used to construct a neovagina, and puberty blockers prevent the growth of those organs, material from the colon or omentum may need to be used.

An in-depth conversation detailing puberty blocker treatment and all its potential effects is an essential part of any transgender adolescent’s care. Specialists are eager for more research, but for now, they say the apparent benefits outweigh the hypothetical risks.

“Medications are rarely without side effects,” Dr. Kremen said. “That is usually not enough of a reason to allow a child, who is telling you that they’re extremely distressed by the pubertal changes that they’re seeing, to continue going through puberty.”

 “Knowing what we do know, these medications have enormous benefits for the population that we care for,” she added.

Lena Wilson is a project manager at The New York Times and a freelance writer covering film, TV, technology and lesbian culture. @lenalwilson

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https://www.npr.org/sections/health-shots/2018/07/26/630619038/bill-of-the-month-a-plan-for-affordable-gender-confirmation-surgery-goes-awry

Transgender surgeries can easily cost the patient $100,000 or more. And, those are just the medical costs.

So, the debates continue to rage. We can’t really fault the doctors who, treating young patients who inflict self-harm on themselves and/or attempt suicide, help the patients out of their distress and into a happier life.

Yet, there is any amount of scientific evidence to support conditions such as Kallman syndrome, where the individual does not go through a normal puberty due to insufficient hormonal growth. Individual born with this condition frequently suffer from osteoporosis and are infertile.

Development of the large bones and the reproductive tract occur during this time in a person’s life. To chemically avoid this period of mental and physical growth may have consequences that are far reaching for the individual. Consequences that few, if any, teenagers are capable of grasping.

What did transgender people do 50 to 100 years ago? 200 years ago? Did they all commit suicide? Is there any research on this? If lawmakers have long concluded that 21 years is the legal age to drink alcohol; why is 13 or 14 years a proper time to make lifetime decisions not only about one’s sexuality but modifications of one’s entire body? Does this make sense?

It is easy to say I don’t understand because I don’t have a transgender child. True, but I have a child who was a teenager and I have been a teenager. Also, I have taught teenagers. These can be tough years. Uncomfortable years. Are we promoting serious body modifications in order to avoid discomfort? What is wrong with having the individual wait until they are 18? So they can avoid a mastectomy? Removal of breast tissue is the least complicated of surgeries the individual will go through if they want to become fully male. How about lifetimes on hormone therapies? How many studies have been done that tell menopausal women to get off hormone replacement therapy? That the pills cause cancer?

The human brain is not adult size until about age 14. True adult judgement comes along very gradually a long time after that.

University of Rochester Medical Center

The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so.

In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=3051#:~:text=The%20rational%20part%20of%20a,cortex%2C%20the%

Once these extreme body modifications are done, it is unlikely they can be undone. It’s not like getting a tattoo or dying your hair pink.

Not the same, not at all.

The end.

          TRACKER

Buzz, buzz.

Denise stirred. Buzz, buzz, the sound continued. A soft, vibrating movement on her side.

She rolled back and forth a couple of times and finally opened her eyes. The buzzing sound continued. She focused for a moment then hit the little tracker resting in her pajama pocket and sat up. Denise wiped the sleep out of her eyes and pulled the tracker out of her pocket. 7 hours and 42 minutes it read.

Hum, she thought to herself. “Well, it is not exactly eight hours of sleep but it’s probably okay,” she mused. After using the bathroom she stepped on the scales; 146 pounds. She frowned. Damn vacation! She was up two pounds. Damn it and she had been working so hard too.

Stepping off the scale she sighed, “Guess that’s the price for fun, huh?” she thought to herself. Going over to her desk, she pulled out the sugar monitor and pricking her finger, put in a little sample of blood. After several seconds it read ‘94’. She smiled. Her blood sugar was doing great! And the new diet plan emphasized low sugar levels to get the weight off. She felt like she was working toward her goal nicely.

In the kitchen, Denise hit the button to start the coffee maker. Regular black, no ‘special’ coffees with sugar additives.  She opened a new box of Special K cereal and retrieved the low-fat milk from the frig and added ½ of a green banana to the cereal and started to eat.

Back at her desk she opened her mail and started to check her bank balances. Hum, the one checking had a $5,000 balance and the other one was really low at $1,000. That vacation again. Whew! Just wiped her out! Her savings had a nice $25,000 balance and her 401k was rocking along very smoothly. Denise felt very proud of herself. As the daughter of an almost welfare mother and humble beginnings, she was doing pretty well for herself.

She had had to fight and fight with the travel agent to get her to take a cash payment for the vacation. 

“But, everyone pays by card,” the woman had said, almost pleading.

Denise had had to ‘counsel’ the woman and coax her into taking the cash and telling her it would be okay. That she was just very uncomfortable using ‘cards’ and this was how she did business. The woman shook her head, mumbling and very reluctantly took the cash over to her boss’s desk and handed it off to him. There was some soft mumbling that went on. The travel agency manager was a chubby little guy, who didn’t do much, as far as Denise could tell, except eat and play computer games all day.

She had been to this same agency before. They had gone through the same song and dance last time. The little fat guy stole a glance her way. She smiled beatifically back at him. She knew what was coming. He heaved himself up from his desk, reluctantly and cautiously approached her.

He smiled first. She smiled back. “Miss Smith,” he ventured, looking down at the agency document in his hand.  She nodded helpfully. “Miss Smith,” he repeated, “we don’t usually work with cash transactions. They can be…….” he searched manfully for the proper words. “they can be difficult to….trace.” He smiled again hoping to hell that she would understand without causing some fuss.

Denise was ready, they had in fact had the same conversation over a year ago; maybe he didn’t remember. She explained, slowly and very carefully how much she understood his position but that she didn’t ‘like’ to use credit cards because of all the interest and banking fees. She understood very well that was how most people did it, but couldn’t they make an exception this time? Besides, they had sold her another ticket just this way over a year ago.

The little fat man looked surprised. “He’s probably surprised he let a woman get the drop on him once before,” she though with a smirk. The man stared at her almost a full minute then shook his head and waved for the girl to continue the transaction and took the wad of cash back to his desk. With a look of almost disgust, he pulled out what looked to be a metal box and stuck the cash in there. This was no doubt going to necessitate an extra trip to the bank. He wasn’t pleased. 

Denise, smiling, completed her trip arrangements to Belize with the girl and got her confirmation paper. She left the agency smiling. She was always happy when she got people to see things her way. She had learned long ago that the banks were the biggest rip off artists in the business with their interest rates and fees on top of fees. “Better in my pocket than in theirs,” she thought to herself.

She got into her little economy car and started the engine. The car was a very uninspiring grey green color that she hated; but what the heck, she had gotten a super discount deal through her brother, the used car salesman, so there were no complaints.

Continued Part II

This day was particularly long and dusty. I had to drive from Redondo Beach back to the San Fernando Valley and was bushed.

Carmen, the Hispanic housekeeper, was responsible for picking up the princess from school each day and driving her home. Thereafter, hopefully, getting her started on homework. How much homework ever happened versus how much TV watching was being done, was the question.

This particular summer day, Carmen was in the process of starting dinner. The princess was looking like she was looking at her homework. I decided a nice long hot bath would be just the ticket.

I stripped down and got into my big tan tub with the Jacuzzi jets in the ‘bamboo’ bathroom. The previous owners must have been trying for some sort of Asian theme as the gold and rust wallpaper was a bamboo print and the curtain, a rolled up ‘bamboo’ affair. Once you got the jets going in the bath, it was Calgon take me away.

It just so happened that I was doing a lazy scrub of my armpits when I discovered a lump in one armpit. I instantly panicked and the huge ‘C’ word loomed large in my mind. I was devastated. I began to plan my own funeral and then get very weepy that Scooter was going to lose her mother so young.

It was while contemplating my own death, that over the sound of the bathroom fan, I could make out a faint ‘wop, wop, wop’ noise. The nosie continued.

With a “What the hell?” I got myself out of the big tub, did a half-dry and put on my bathrobe.

Like a cop at a crime scene, I ventured carefully into the family room and followed the sound. At first, given the confusion, I couldn’t tell what I was looking at.

Scooter was screaming and jumping around, Paws was leaping repeatedly into the air. There was something grey and white fluttering around and around the dining room table. Carmen had the broom out, was waving it up and down and whacking the floor. This was creating the ‘wop’ sound I had been hearing.

My benumbed brain finally kicked into gear. Paws had captured yet another bird from the backyard and had brought his prize into the house to show off. As luck would have it, the unfortunate creature was still alive, trying desperately to get away from the cat who was trying equally hard to recapture him.  

Carmen was ineffectually trying to ‘shoo’ them both out of the house and Scooter was helping by screaming and jumping up and down. I clamped my teeth together, yanked open the slider door, grabbed the broom and with one mighty ‘whack’ sent Paws out into the yard.

“Scooter, stop screaming!” I yelled. She gulped and shut up. I found the dust pan. Carmen and I managed to capture the almost dead bird and take him to the garbage can on the side of the house where he could rest in peace.

That done, I finally made it back to the bathroom, where the water was now lukewarm. I had forgotten all about my cancer when suddenly a thought popped into my head. I lifted my arm in front of the bathroom mirror and examined my lump. It was a very large, subcutaneous pimple, the kind I always got at a certain time of the month. I got some mud masque and plastered my armpit with it and put on some clothes so Carmen could go home.

Forty-five minutes later, dinner was done and on the table when the Master of the house had returned.

“So,” he queried, “anything interesting go on today?” He was looking down, slicing his chicken.

Scooter opened her mouth  to tell the cat and bird story. I shot her a freezing look and cast a meaningful glance at Paws, lying casually on the rug, licking his fur.

 Scooter stared back at me, then looked over at Paws. A momentary look of panic flashed across her face as she began shoveling down mashed potatoes.

“Na,” I said, “just another day, how ‘bout you?’

The end

Read more of Courtney’s writing in:
https://sites.google.com/view/webbywritercom/page-5?authuser=0

and Amazon/Kindle.

                                             

The alarm clock went off in that annoying way it had, every single morning at 6am. Why was it always 6 am?

I stumbled out of bed to turn it off. I had long since learned that I could not trust myself to have it next to the bed. I careened back to the bed and fell in a lump on my pillow. The drool woke me up again and I faced the inevitable and ambled into the bathroom, then the kitchen. Mercifully, the master of the house had at last figured out the automatic coffee maker. If I could just keep it together long enough in the evening to pour in the water, measure out the beans, grind them and dump; not forgetting to hit the ‘on’ button, I was assured of lifesaving caffeine in the am.

I clutched the first cup to my chest like a new baby and opened the door to the back yard. It was summer and the yard was still cool and invitingly green. The lawn chairs beckoned to me. Chubby, the dog, had gotten up with a big yawn and was taking his morning pee in the bushes. The cats were prowling around looking for big game. Paws, the big cat, sniffed the dog’s pee like it might be interesting. Early summer, the intense Southern California heat had not yet begun so we still had a few coolish days left. The birds were flitting about. All seemed right with the world.

Taking another sip, I wandered back to refill my cup and start my rounds of waking and reawaking the Master and child of the good ship suburbland.

The Master was pretty good, once his feet were actually on the floor. It was but a few moments before the big red bathrobe I got him one Christmas was tied around his skinny waist and he was slouching into the shower.  I could hear hot water pelting down. By the time he was out of the shower and on his second cup of coffee, he was almost speaking.

Getting the princess up and moving out of lavender kingdom was another matter. It could easily take five trips to wake and then reawake her highness and position her into an upright state. She had to be tempted with food to actually get moving. It might have been a Coco Puffs morning or perhaps a cinnamon oatmeal day; these things run together.

Whichever, I had learned to do breakfast first and dressing second so that we didn’t have to dress two times in one morning on account of spills.

The Master and commander was showered and dressed and sitting down to eat and shooting an impatient look at the princess.

“If I have to drive her to school, why can’t she get her clothes on first?”

Actually, a logical question.

“Lee, I think we have discussed this before,” I said in my smiley voice, “too many spills cause us to have to dress all over again. Remember?”

The princess was busy intently studying the back of the cereal box, trying to figure out how to get the prize, not paying too much attention to us.

“Mommy, I don’t see how you can get the parrot from this game.  Do they just send you the parrot in a box by mail? How do they breath?” The princess wanted to know

“Darling, I am not sure that it is a real parrot.  Maybe a toy one is what you win.”

“Oh, that’s no good,” Princess Scooter answered, “I only want it if it’s a real one”

“Ah,” I answered sagely.

“It could keep Chubby company,” she told me brightly.

“I think Chubby has lots of company with the two cats,” I replied.

“Yeah, but cats can’t fly,” she told me wisely.

The Master muttered something about how he could certainly make a cat fly and would too if that cat brought one more GD bird into this house.

“Ok,” I said hurriedly, “it’s about time to go Scooter, let’s go get your clothes on.”

Of course, ‘getting your clothes on’ was a process much easier said than done.

The teachers at Scooter’s school told me to have her pick out the maximum of three outfits the night before to reduce the morning fashion crisis.

This worked, sort of, if I locked and bolted the closet door so that she couldn’t get ‘one more thing’ out of there that had to be added to the ensemble. My current ploy was to quickly make her bed and plop the outfits in a row, blocking eye contact to the closet.

Making a choice between the three could sometimes be a grinding chore and some days easy. Usually those days were the ones were she wore the same outfit over and over again. Not so great for total cleanliness, but it did cut down the decision making time.

Years later I worked with a guy who, I realized with some surprise, wore exactly the same pair of pants and the same shirt to work every day. The next week, he changed the shirt and pants, wore those all week, then repeated the process the next week.  At first I was prompted to say something to him and stopped myself. “He has a system,” I told myself and in fact he had.

Anyway, garments on the body, books in the backpack; lunch in the lunch pail, wagon train ho! The Master and princess were off to another full-filled day. I was left to run around like a crazy person, stuffing dishes into the dishwasher and getting my clothes on.

Since most attorney offices didn’t get going until 10 am, I usually had enough time to pull it together with some reasonable organization and hit the freeway crawl with all the other commuters. I worked for Universal Insurance Company. My job was to meet and greet the clients in the flashy, expensive offices of their flashy, expensive attorneys who all had perfectly tailored suits and perfect orthodontia work.

The work was not super hard but with the Los Angeles freeway grind, a girl could get pretty tired at the end of the day. You can swear at just so many people behind the wheel of the car before it stops being fun.  

This day was particularly long and dusty and I had to drive from Redondo Beach back to the San Fernando Valley and was bushed.

Continued in Part II

Famous People with BDD

These celebrities have shared their struggles with appearance anxiety and Body Dysmorphic Disorder (BDD)

What is BDD? Find out more >

Billie Eilish

The Singer Billie Eilish has opened up about her Body Dysmorphia “I’ve never felt comfortable in really tiny clothes,” she said, “I was always worried about my appearance. That was the peak of my body dysmorphia. I couldn’t look in the mirror at all.”

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Reid Ewing

Reid Ewing the actor from Modern Family has been open about having suffered from BDD for years. He has undergone many cosmetic surgeries but has never been satisfied with the results. When he first moved to LA, he admitted that all he wanted to do was sit in his apartment and take photos of himself from every angle. His first surgery was at age 19 for a cheek implantation that he describes as leaving his cheeks “as hollow as a corpse’s.” He then had multiple surgeries to fix the problems that he believed the initially surgery had caused. He now believes the surgeries were unethical and ineffective. He said, “I genuinely believed if I had one operation I would suddenly look like Brad Pitt”. 

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Robert Pattinson

Robert Pattinson, an actor who rose to fame through the Twilight movies has revealed his experiences of BDD:

‘Body dysmorphia, overall tremendous anxiety. I suppose it’s because of these tremendous insecurities that I never found a way to become egotistical. I don’t have a six-pack and I hate going to the gym. I’ve been like that my whole life. I never want to take my shirt off.”

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Shirley Manson

Shirley Manson, the lead singer in the pop group Garbage, states in a magazine interview that she had a history of BDD:

“I always turned up five hours late because I’d be fussing about my hair and make-up. I would change into a million different outfits, and make them change the lighting a million times, I would spend two hours crying in the toilet – and whatever the result, I always thought I looked disgusting. I would look in the mirror every morning and be upset. I would get dressed and look in the mirror again, and be upset. It could be anything; I could be too fat, too thin, too flat chested. My hands were not long enough, my neck was too long. My tummy stuck out, my bum was too big… It was driving me crazy and I was wasting energy – precious energy – that I should have been putting into my music or my family or friends”.

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Michael Jackson

Michael Jackson (1958-2009) probably had BDD (as well as many other emotional problems). He is famously known for his extra-ordinary amount of cosmetic surgery (and indeed denial of having had cosmetic surgery.)

He had had an abusive childhood from his father who repeatedly called him ugly and he suffered from acute acne as a teenager. In latter years, he led an isolated life and repeatedly covered his face using a surgical mask when out in public.

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Andy Warhol

Andy Warhol (1928-1987) may have had BDD. The pop artist, who put Campbell soup cans and coloured photographs of Marilyn Monroe in museums, was very self-conscious and preoccupied by “redness” on his nose.

In his autobiography (Warhol, 1975) he reveals, “I believe in low lights and trick mirrors. A person is entitled to the lighting they need.” (p.51).  “At one time, the way my nose looked really bothered me – it’s always red – and I decided that I wanted to have it sanded… I went to see the doctor and I think he thought he’d humour me, so he sanded it and when I walked out of St Luke’s Hospital, I was the same underneath but had a bandage on” (p.63). “If I didn’t want to look so bad, I would want to look plain. That would be my next choice” (p.69).

Carl Withers, who became his lover in 1952, confirmed in an interview “he was incredibly self-conscious and had such a low opinion of his looks; it was a serious psychological block with him.” His concern with his nose is reflected in one of his early works “Before and After”, which is an advertisement for a rhinoplasty and can be seen in the Metropolitan Museum of Art in New York.

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Currently, controversy is raging in the state of Florida about a bill which restricts underage minors from having permanent sex-change operations even with the consent of an adult. In these days of ‘everything is new’ including transgender issues, research into the annals of psychiatry show that body dysmorphia was studied as far back as Freud and is frequently associated with deep seated depressive issues. Before we start agreeing to slice and dice, some insight into research that has already been done would be very useful.

Indian J Psychiatry. 2006 Oct-Dec; 48(4): 260–262.

doi: 10.4103/0019-5545.31561

PMCID: PMC2915600

PMID: 20703349

Body dysmorphic disorder, dysmorphophobia or delusional disorder—somatic subtype?

V.K. Aravind^* and V.D. Krishnaram^**

Author information Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

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Abstract

Excessive concern about the appearance of one’s body is the hallmark of body dysmorphic disorder (BDD). A case with recurrent intrusive preoccupation and concern about the appearance of the face, ritualistic behaviours associated with this preoccupation, resulting in social and interpersonal difficulties is presented. The difficulty to draw a discrete boundary between BDD and a delusional disorder of somatic type is highlighted.

Keywords: Body dysmorphic disorder, change of face appearance, delusional disorder, somatic type

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INTRODUCTION

Body dysmorphic disorder (BDD) previously known as ‘dysmorphophobia’ is defined as a preoccupation with an imagined defect in one’s physical appearance. The preoccupation is associated with many time-consuming rituals such as mirror gazing or constant comparing.¹ One of Freud’s patients who was subsequently analysed by Brunswick was known as the ‘Wolfman’ and he was preoccupied with imagined defects on his nose.²

In 1886, Morselli described dysmorphophobia. Dysmorphophobia by proxy was reported by R. Laugharne in 1997—the patient was preoccupied not with her own appearance but how her potential offspring might look.³

There is frequent comorbidity in BDD, especially in depression, social phobia, and obsessive–compulsive disorder (OCD) and delusional disorder.⁴ Beliefs about defects in appearance usually carry strong personal meanings and implications. A belief that his nose was too big caused one patient to feel that he would end up alone, unloved and that he might look like a crook. Also, such patients are likely to display delusions of reference, believing that people around them notice their defect and evaluate them negatively or humiliate them as a consequence of their ugliness.⁵

A further aspect of BDD is time-consuming behaviours adopted by sufferers to examine the defect repeatedly or to disguise or improve it. Examples include gazing into the mirror to compare particular features with those of others; and some other features such as excessive grooming, which can be quite deleterious especially where the skin is concerned, camouflaging the defect with clothes or make-up, dieting and pursing dermatological treatment or cosmetic surgery.

Delusional disorder comprises a heterogeneous group of disorders of unknown aetiology whose hallmark and chief features are the presence of a single delusional system. Major modes of presentation of somatic delusional disorder, ‘mono-symptomatic hypochondrical psychosis’ are those of infestations by insects, worms and foreign bodies, emitting a foul odour (halitosis) or of being ugly.⁶

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915600/#:~:text=INTRODUCTION,mirror%20gazing%20or%20constant%20comparing.

         

She is old and every inch of her

is covered up against the

freezing cold.

I can see her here from upstairs

on my Stairmaster as I start at 1.5 and

start to work my way up.

She has an old metal cart with big wheels and

she patiently places one piece of cardboard

after another into the cart.

I hit the button up to 2.5 and think about

how I need to get more

distribution on my books. She puts another

bit of cardboard in the cart.

I am on Face Book and Twitter and should get

stuff on Pinterest and Tumblr and Share.

More cardboard goes in.

Also; Kindle, Biz Sugar and Aviary Capture and what the hell is that

anyway?

I push the number up to 3.5 and the disco music

next door is just blaring in the dancercise class. I can hear the thump, thump of the women bouncing, clapping and shouting.

She disappears and comes back with more cardboard.

The problem is  the stock market and

then the interest on these damn credit cards.

She places more cardboard in the cart.

I am thinking about having my eyes done.

I need more Botox, Jesus, what’s that guy going to charge me this time?  Hair color; need another box of hair color.

She places more cardboard in and I punch the numbers up to 5.0 and

I am moving now. The pounding next door seems louder and I increase the speed to 6.0. 

“You know,” he tells me, smiling, “you would be pretty if you just weren’t so old!”

Got to get these pounds off, they really show up on my chin and age me so much. Faster on the treadmill.

“Mom, I need some money. I can’t make my rent.”

“I don’t have it darling. I have to buy plane tickets. I’m sorry.”

‘Ok, I understand,” she says dully.

Slowly, she puts more cardboard in the cart. “When the hell is she going to be done?” I think.

“You know, it is really too bad you have to work in a place like that,” my friend says. “If you would get a job in a good place, I would come visit you.”

I am really starting to work up a sweat.

 “That school you work for isn’t very high level,” the teacher tells me.

“It’s my first University job.”

“It just isn’t a very good school.”

I am flying on the treadmill now.

“I have published several books.”

“But who reads them?” asks my coworker.

“I have readership.”

“Yeah.”

I get off the treadmill to go join all the other middle-aged ladies bouncing and screaming in the gym.

I feel sorry for the old lady gathering her cardboard; it must be tough working out on the street on a day like this.

Read more of Courtney’s writing in:
https://sites.google.com/view/webbywritercom/page-5?authuser=0

and Amazon/Kindle.

Winter unwove into spring and the end of school approached with the end of year activities; dances, dinners and the like. Key Club decided to have a big end of the year dinner at a fancy restaurant in town. My mother dutifully created another ‘hand-made’ dress for me. I hinted around at one of the other guys in the group that I needed a date and he obligingly asked me to go. Jeff was a nice enough kid, cute and pretty smart without being movie-star good looking or brilliant. He wasn’t Peter, but as a member of the Key Club, he was still in the ‘inner circle,’ and I was still holding out hope.

The big day arrived and I got into my new dress, my hair looked presentable and I spent an hour on my makeup. Jeff was scheduled to pick me up and as I was getting ready to go a thought struck me; my dad. My dad was always about half in the bag by dinner and by the time Jeff and I got back; he would certainly be way gone and around the bend liquor wise. I had a hurried and feverish conversation with my mother and she promised to ‘get him out of the house.’ I said to her “Can’t he just go to the Club for a few hours? He’s there all the time anyway.” She made promises to make it happen and my ride picked me up without a hitch.

We got to the restaurant and immediately saw Linda and Peter by themselves in a booth. Peter summoned us over and we ‘got’ to sit with them. My dress at the time was a yellow, polka-dot affair that my mother thought was ‘really cute.’ I thought it looked really dumb but, what choice did I have? Linda was sitting, regally, by Peter’s side in a low-cut black cocktail dress, no doubt purchased for the occasion. My eyes bugged out a second while I took this in and for a moment considered covering myself with table napkins. However, this passed and we got to soup when I realized Linda was wearing a new necklace. Was that a diamond heart setting? I couldn’t bear to ask. The last remnants of hope were drifting out the window with the beef vapors.

Two painful hours later, Jeff brought me home and we sat down in the living room to chit-chat a bit with my mom. Things seemed to be going well and Jeff was starting to look better to me. Suddenly, the front door opened and in walked my dad.

Walked in is too generous a phrase; stumbled in is a better way to put it. He stumbled in with a shot glass in his hand. “‘ello, everybody,” he slurred. “Woos’ ‘is,” he continued, pointing at my date.

I got a grip on myself and carefully said, “Jeff, this is my dad. Dad, Jeff.”

“Glad ‘met ‘ya young man. Want a drink?”

“Dad, Jeff is sixteen years old, I don’t think he is old enough to drink,” I responded tersely.

“Oh, no,” Dad continued, “Never too young to have a drink. Man’s drink,” he lurched a bit toward the increasingly nervous Jeff. “Scotch?” he queried hopefully.

Jeff was starting to look wildly around the room, trying to find the escape hatch. My mom was twisting a paper towel in her hands and I had, by this time, stood up.

“He doesn’t need a drink, Dad; he’s fine,” I spat out.

“Oh, no,” Dad responded, “‘ittle drink. Be right back.” He veered off course toward the kitchen.

The moment he was out of the room; Jeff leapt up and started to stammer, “Well, nice meeting you Mrs. Caufield, nice, nice house. Ah, thanks Cissy, I, I’ve got to go. So, see you at school, right?” And without completely running, he got himself to the door and out like a flash. I didn’t even bother walking out to his car.

My dad came back in carrying two glasses with brown liquid. “Where’d ‘e go?” He sagged down on the Barcalounger, his favorite chair.

“The young man left, Dan,” was my mother’s plaintiff reply.

“Oh,” my dad started to sip his drink again. “More ‘fer me.”

I could feel a curtain of rage sweep over my body. I tore out of the room and ran toward the garage.

My mother yelled, “Cissy, Cissy where are you going?”

I knew where I was going; I was going to the locked trunk. I found the key, wrenched the lid open and found the revolver; loaded as per usual. Running back into the living room, aiming with both hands, I pulled the trigger and shot my dad. Boy, was that sound loud. My mother shrieked.

I almost fell backwards from the recoil. A second later, my dad was touching a little red streak on the top of his head and there was a hole in the Barcalounger.

“You shot me,” he said blankly.

Let my digress just a little; I never really meant to kill my dad, more like just make a point, if you know what I mean. I had taken riflery and small arms at summer camp at his insistence.

“Any daughter of mine,” he had said pompously, “should know how to shoot like a man, defend yourself.” So, I did learn how to shoot like a man and was pretty good at it too. This was just a little statement shot so to speak.

My mom was open-mouthed. I threw the gun down and ran to my room, slamming the door behind me as hard as I could. Throwing myself on my bed, I burst into tears.

The next day; our house was pretty quiet. Dad and Mom were at the kitchen table when I came down for breakfast. My dad’s head was hanging and he had that special kind of green look I knew so well. On purpose I banged down my cereal bowl. He jumped a little and winced, but didn’t look up.

My mother was fiddling nervously with a fork when I sat down. I didn’t say anything. She chirped brightly. “Cissy, your dad and I have had a long talk. Didn’t we Dan?”

My dad moved his head a little.

“And, well, we have decided he is going to go get some help with his, his…..problem. That’s right, Dan, right?” Little head movement from my dad.

“Oh, and about those guns in the garage,” my mother continued, “we have decided we are going to get rid of those too. Might be better for all of us,” she finished brightly sounding a bit like we were planning a trip to Florida. I nodded glumly and finished my cereal in silence.

Actually, my mom was right about the guns. It probably would be better for all of us; next time I might not miss.

The End

Read more of Courtney’s writing in:
https://sites.google.com/view/webbywritercom/page-5?authuser=0

and Amazon/Kindle.

You can’t always get ahead but you sometimes can get even.

My next door neighbor had everything. She lived in one of the best houses on the block, she had bleached blond hair at age thirteen, and she always wore it up high and ‘teased’ with a ton of hairspray. She wore real black eyeliner, cut-off jeans and big white men’s shirts over that. She was cool. Her mother didn’t work and spent time making cookies and pies so that when the ‘girls’ came over to Linda’s house, there were always cookies and lemonade.

Her real name was Belinda; but she shortened it to Linda. She was one year older than I and had one brother who always played football. Not only was her house nicer, her parents drove bigger, newer cars and her mom had time to take her shopping for all the latest clothes. When Linda moved in next door; she blew the socks off everyone in the neighborhood and she became an instant hit. Everyone always wanted to hang out at Linda’s.

I, on the other hand, had non-descript brown hair, not bleached and not ratted (what’s that?) I don’t think I owned a can of hairspray. My hair is mostly stick straight except for one little spot that likes to pop up into a weird curl all the time. My mom worked five days a week and when she wasn’t doing that, she was shopping for fabric to make us all ‘hand-made’ clothes. Most of my clothes were either ‘hand-made’ or hand-me-down until I was almost twenty.

I lived next to Linda with my mom, dad and two obnoxious brothers. It didn’t seem fair that Linda got so much attention from everyone; I lived there first! Anyway, like I said, my mother was usually either gone at work, playing bridge or hidden away in the sewing room. She could be counted on for saying things like, “That’s nice,” or “If you don’t like them Cissy, why don’t you stop playing with them?” That’s my name, Cissy Caufield, named after one of my mother’s friends. Who names a kid something like Cissy? Dumb.

Oh, and my dad. My dad was a big guy, very handsome at one time, lots of black hair and shiny white teeth. He was a WWII veteran and loved nothing better than to tell a ton of stories about the war. He would ramble on about some story or other about the war or the military, have a sip of scotch, and continue. He was proud of the fact that he still had three service revolvers in the garage. There were always loaded, ‘just in case.’ He kept them locked in a steamer trunk, but I knew where the key was.

Did I mention the scotch? Yes scotch, and lots of it. My dad was a drunk. In addition to telling stories, he loved to get drunk. Yes drunk, not tipsy; but smashed, blotto, wacked, bombed, stewed to the gills, pie-eyed, blind drunk, stumbling drunk, very, very drunk.

My mother would spend time, when I got into one of my fits about Dad, to use her best calming voice to talk me down and tell me how we needed to be understanding of Dad; he’s got problems, he needs our support, etcetera, etcetera, blah, blah and blah. She would get that pensive, screwed up look to her face and look a little bit like a suffering puppy and I would finally snap out of it and she would go back to her nice-nice face. Gag!

Time marched on and before long I, my brothers and Linda were all at the same high school. Linda still had the bleached blond hair, and I still had the weird hair but these days she was on a ‘diet’ specially constructed by her mother. She was trying out for the flag twirling team and had to ‘slim down’. I never had to go on many diets as I had a stick figure already. I too tried out for a cheer-leader position and worked at it very, very hard. However, Linda got picked for flag and I didn’t get cheer. So now, in addition to seeing her next door all the time; I also got to see her kicking up her heels and showing off her satin rump while twirling a flag at half-time. Lucky me.

Eventually, being the good-girl type, I joined the Key club and we all ran around doing service work. There was also a boy section to this service thing and the girls and guys would occasionally get together for projects. It was on one of these projects that I saw him. One year older than me, slim with a little muscle, black hair, blue eyes and very, very nice. Peter. Peter was the president of the boy’s side of the Key club and he was gorgeous. Wow.  He would start talking and I would hang on every word like a dog waiting for a biscuit. He walked by and I almost drooled.

I am not sure if I ever really talked to Peter; other than in my head of course, but I was certainly working up to it. In addition to that, I had plans; many, many plans for me and Peter.

It was with thoughts such as these dancing in my head that I drove home from school one night to a big surprise. As I pulled round the cul-de-sac; my headlights hit a car that was parked in front of Linda’s house. Suddenly, two heads popped up from the back seat. I drove by and parked and the heads disappeared. As I was walking inside it hit me as to who they were; it was Linda and Peter! I was shocked, stunned and disbelieving. Oh no; that, that…..how could she! I saw him first!

Later days proved the grim and disappointing truth; Linda and Peter had become an ‘item’ on campus. My soul was dark and filled with dread whenever I had to drive by her house, afraid of what I might see again. Good God, this couldn’t be happening. But, oh yes, it was.

Continued part II